EM vs IM

[Surgery2Do]

I am going to try to scramble this March and wanted some opinions of EM vs IM.

I am a 37 y.o. female divorced with a child in the sixth grade.

As a EM doc can you work as a hospitalist? I am still considering surgery but I like the idea of set hours in the EM.

Previously before medical school I worked as an RN in the OR.

Any advice on why EM vs IM is welcomed.

Thanks

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[Sheerstress]

No, you cannot work as a hospitalist (i.e. an in-house internist) if you are trained in emergency medicine, and vice versa.

I would say that you should go after whatever you really enjoy doing. You will admittedly have a much more flexible schedule and much more free time as an emergency physician than you would as an internist, and especially a surgeon.

 

[ckent]

I'm pretty certain that EM physicians cannot work as hospitalist. Some programs don't even have required inpatient general medicine months during their program. Anyways, you are going to have a difficult time irrespective of what field you go into as a divorced mother. EM's hours may be more manageable and predictable then IM and I wish that I could say don't make that your primary deciding factor, but I know that for many people there are things more important then their careers in medicine (such as their family). You should also look into programs that have part-time residency positions, some will allow two residents to split up one residency spot. It will take you that much more time to complete residency, but it may become more manageable that way. Also, you should also consider just waiting a year and applying next year when you can look for spots that meet your program criteria. Good luck.

 

[NinerNiner999]

If you have already completed step III, couldn't you get your license and moonlight in ED's until next year's match? That would give you some cash for your child and might give you a better idea of whether you like the field and whether you want to go back for residency.

 

[Surgery2Do]

Actually I am just trying to decide on a speciality. I am fortunate that I have plenty of money and can even hire a nanny to help take care of my child. It is not so hard to look after a 12 year old and surely someone would take the job.

I love the OR and doing procedures. My concern with EM is that after a few years I will get burned out and I do not know what other things a ER doctor can do ........ besides the ER.

After residency I am sure that EM offers a better lifestyle than other specialities and many of my friends state that FP & IM doctors can also work in the ER.

 

[iwakuni_doc]

Originally posted by Surgery2Do
.....many of my friends state that FP & IM doctors can also work in the ER.

Ohhh....tread lightly on that view...that's a rather insulting statement to throw into an Emergency Medicine forum.

As a comparison:
Some ENT, derm, & FP's do cosmetic surgery as well - doesn't mean they should or that it's in the patients best interest not to see a properly trained plastic surgeon, as opposed to someone who thinks they can do the job.

Likewise, I think you'd be hard pressed to find anyone on this forum who'd advocate that FP & IM docs should be staffing ED's - no more so than we should be serving as hospitalists. It's not what you're trained to do...

 

[Eidolon6]

EM trained docs don't do inpatient, hospitalist care. Now IM trained docs can do ER care at select institutions. Some VAs employ IM docs part time to run their Triage/ERs. EM as a specialty is relatively young and not until the 80's did you see it blossom as an independent entity. Prior to this, most EM docs were in fact IM or generalist trained. You do find a fair number of docs who grandfathered into emergency medicine from other specialties as well. For a while, the governing body for emergency medicine granted certification to docs who could prove a certain percentage of their practice was done in the emergency room. There is a shortage of ER docs in rural hospitals especially. They are more apt to employ non-residency trained folks.

As for lifestyle....its what you make it. ER docs have it good...no pager...little obligation to the patient once you've left the building. The burnout....is probably overblown....You do get a variety of patients, but the more interesting cases are handed over to the surgeons, internists or subspecialists who often do the bulk of the diagnostics and treatment of the patient. You also see, in high volume, the spectrum of social disease ranging from garden variety ignorance to galactic stupidity.

IM/subspecialties is the harder route. Hospitalists are definitely in demand but there are a lot of crummy offers out there and generally, its not a simple as ER shift work (thnk of being an intern....forever). Plus you are entrenched with the social dynamics of moving patient in and out of the hospital....arguably the most frustrating aspect of internal medicine. Chronic disease management can wear you down too...
Cards, Pulm, GI have lots of procedures, a specialized knowledge base and can include inpatient medicine component. Plus, you maintain an IM boarded status...so you can continue to do general medicine, hospitalist type work if you so choose. I know some GI and Pulm guys who also work as subspecialty hospitalists....not a bad gig if you are willing to work.

 

[DrQuinn]

Originally posted by Surgery2Do
After residency I am sure that EM offers a better lifestyle than other specialities and many of my friends state that FP & IM doctors can also work in the ER.

Don't put all your eggs in that basket. ACEP is pushing hard (and correctly) to the government, as wel as hospital administration, that EM-residency trained physicians be running the EDs (not to say the WHOLE EDs, you may see PA/ARNP/FP/IM in the fast-track), as not only are we more cost effective, but efficient and likely less prone to lawsuits (not 100% sure of that last statement).

Q, DO

 

[tjmDO]

I recently joined the ACEP and they sent me a manual called Emergency Medicine a Medical Students Guide and If I remember correct it did say that EM trained physicians are working as hospitalists. I think this manual may also be accessed online at their web site.

 

[roja]

Originally posted by Eidolon6
EM trained docs don't do inpatient, hospitalist care. Now IM trained docs can do ER care at select institutions. Some VAs employ IM docs part time to run their Triage/ERs. EM as a specialty is relatively young and not until the 80's did you see it blossom as an independent entity. Prior to this, most EM docs were in fact IM or generalist trained. You do find a fair number of docs who grandfathered into emergency medicine from other specialties as well. For a while, the governing body for emergency medicine granted certification to docs who could prove a certain percentage of their practice was done in the emergency room. There is a shortage of ER docs in rural hospitals especially. They are more apt to employ non-residency trained folks.

As for lifestyle....its what you make it. ER docs have it good...no pager...little obligation to the patient once you've left the building. The burnout....is probably overblown....You do get a variety of patients, but the more interesting cases are handed over to the surgeons, internists or subspecialists who often do the bulk of the diagnostics and treatment of the patient. You also see, in high volume, the spectrum of social disease ranging from garden variety ignorance to galactic stupidity.

IM/subspecialties is the harder route. Hospitalists are definitely in demand but there are a lot of crummy offers out there and generally, its not a simple as ER shift work (thnk of being an intern....forever). Plus you are entrenched with the social dynamics of moving patient in and out of the hospital....arguably the most frustrating aspect of internal medicine. Chronic disease management can wear you down too...
Cards, Pulm, GI have lots of procedures, a specialized knowledge base and can include inpatient medicine component. Plus, you maintain an IM boarded status...so you can continue to do general medicine, hospitalist type work if you so choose. I know some GI and Pulm guys who also work as subspecialty hospitalists....not a bad gig if you are willing to work.

Hmmm, you sound vaguely familiar. I wonder why. *g*


The burnout issue is adressed ad nauseum. There is a thread around here somewhere. I also liked surgery alot. However, for many many reasons, I knew I didn't want to be a surgeon, despite really liking the OR. The ER is varied. I love the fact that I get to do procedures (from intubations, to I&D's, lines... it runs the gamut). I also love seeing a variety of medical patients. And then a little peds and a little OB/gyn.

It is getting harder and harder for FP's and IM to work in ED's. And with good reason. My step mom is a CRNA in a small town. She takes call from home. The ED is staffed by FP's and notn EM trained EM's. They call her *from home* to intubate patients in the ED. And to put in 'difficult lines'. This is scary adn this is why ED's should be staffed with EM physicians.. (just some of many reasons).

I think you will find that *most* of us in EM love what we do. And it seems people either really love EM or don't. It's a great career, if you love working in the ED.