Emergency Medicine/Internal Medicine Resdiencies

[Vash311]

I was just curious (as a D.O. student) what the benefit is to this combined residency. I have alot of interest in both fields, but am not sure what advantage it would be to pursue an em/im combined program? What role do these physicians play in various settings? Any info is more than welcome!

Thanks

Vash the Stampede

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[obecalp]

Bump

 

[PimplePopperMD]

I was just curious (as a D.O. student) what the benefit is to this combined residency. I have alot of interest in both fields, but am not sure what advantage it would be to pursue an em/im combined program? What role do these physicians play in various settings? Any info is more than welcome!

Thanks

Vash the Stampede[/QUOTE

There are about nine of these residencies (allopathic) in the country, and a sprinkle of osteopathic ones.

The benefit to doing it is based on your career goals. If you are interested in practicing both specialties, it is created for you. One such role is practicing as a hospitalist for six months and doing ED shifts for six months.

Another role would be in observation units in the ED.

The idea is that it will allow you to shape your career if you are indeed interested in pursing a more varied path.

Further, the internal medicine makes you a better EM doc, and the emergency medicine makes you a better IM doc. Certainly in code situations on the floor, the IM folks like having the EM folks around. For the complicated AIDS patient or transplant patient or cancer patient, the IM side can assist with the intitial workups from the ED.

It's a long LONG haul, so don't do it for any other reason than really enjoying both specialties.

Any other specific questions, feel free to PM me

 

[Hawk22]

Thanks Pimple,
I'm interested in EM-IM too and that information helps alot. You're definitely correct that its a LONG road, but not that much longer than a 4 year ER residency and a year or so shorter than IM plus a fellowship. I just wish there were more EM-IM residencies in the SW because it would take alot of convincing to get my wife to move up north.

 

[Atlas]

At some hospitals that I know of, IM/ER docs are also the ICU docs alot of the time. So, you could be boarded in IM, EM, or both and because of your IM background, you can also work in an ICU. Plus, I know most Urgent Care (doc-in-a-box) facilities usually have FP's, but some will take IM, EM, IM/EM, retired/burned-out General Surgeons, etc. Keep that in mind as well.

 

[doc05]

im/em means you are better trained than either im or em alone. it means you can have a more varied career. but it also takes longer, and isn't for everyone. keep in mind though, that it's a really good choice if you are undecided..

 

[obecalp]

im/em means you are better trained than either im or em alone. it means you can have a more varied career. but it also takes longer, and isn't for everyone. keep in mind though, that it's a really good choice if you are undecided..

I've heard some friends recommend that I not consider combined IM/EM programs because I won't be trained well enough in either the IM or the EM. Essentially, I'd be spreading myself out too thinly. I'd really appreciate anyone with some insight into this statement. Thanks!

 

[Atlas]

I've heard some friends recommend that I not consider combined IM/EM programs because I won't be trained well enough in either the IM or the EM. Essentially, I'd be spreading myself out too thinly. I'd really appreciate anyone with some insight into this statement. Thanks!

There is "some" truth to that, but that's nothing to really worry about because MOST docs that go the IM/ER route usually...USUALLY board in one or the other and from what I understand...more times than not they choose to be boarded in EM (for paycheck reasons). Basically, most of the IM/ER trained ER docs out there did it that way because they couldn't get a regular EM residency spot. This is NOT a good reason to pursue IM/ER in my opinion.

 

[PimplePopperMD]

There is "some" truth to that, but that's nothing to really worry about because MOST docs that go the IM/ER route usually...USUALLY board in one or the other and from what I understand...more times than not they choose to be boarded in EM (for paycheck reasons). Basically, most of the IM/ER trained ER docs out there did it that way because they couldn't get a regular EM residency spot. This is NOT a good reason to pursue IM/ER in my opinion.

First of all, know that this is not an unbiased answer, as I am IM/EM...

1. I know of no graduate who is not double-boarded. Those who chose to pursue both specialties at the programs I am familiar with have become board certified in both fields.

2. It is not true that IM/EM residents choose to do so as a backup. Again, I know of nobody for whom this is true, and all in our program chose to become IM/EM, and had a BACKUP as either IM or EM.

3. It is not true that IM/EM folks are poorly trained in both fields. In fact, some may argue that they are better trained in both fields. It is a five year residency, and the first 1.5 years, we certainly DO feel a bit remedial, because our colleagues have advanced their knowledge in one field, and we are a bit behind both our IM and our EM colleagues. However, this evens out, and eventually, it seems that the upper-level IM/EM folks are looked to for answers and leadership.

Of course, this IS a biased answer, but my experience really is that IM/EM is a self-selected crew. There are only 18 or so allopathic spots out there, and many more are interviewing. However, several of those those who apply IM/EM as 1) backup or 2) undecided between IM and EM. When we see these applicants, they are immediately sniffed out and the program becomes disinterested.

IM/EM is NOT a good choice for the undecided, because one really needs a committment to BOTH specialites, and you will get burned out unless you absolutely enjoy both fields.

Any other questions, feel free to ask... (but you'll get my bias!)

 

[obecalp]

Pimplepopper and Atlas, thanks alot for the info, it's greatly appreciated. Pimplepopper, how did you come to the decision to go for the combined program? Just from my observation on the EM forums, it seems like it's an either/or situation in terms of preference for IM or EM. Very rarely did I hear people talk about their love for both. Thanks!
jp

 

[PimplePopperMD]

Pimplepopper and Atlas, thanks alot for the info, it's greatly appreciated. Pimplepopper, how did you come to the decision to go for the combined program? Just from my observation on the EM forums, it seems like it's an either/or situation in terms of preference for IM or EM. Very rarely did I hear people talk about their love for both. Thanks!
jp

My point of view was one of IM/EM as a first choice, and EM as a second choice. I really do enjoy both specialties, and the way I am, I realized that internal medicine would not give me the range of presentations that would interest me, would not give me the procedural experience that I enjoy, would not give me the confidence on an airplane if someone were to go down... but I also realized that EM would not give me the cerebral challenge, would not give me as full an understanding of medicine, pathophysiology, disease states, etc... would not give me as deep an understanding of disease progression and evolution, and of course, the continuity of care that we see in the ED is generally not the type of continuity that one appreciates.

I really like switching back and forth. It really keeps my interest, and challenges me.

I reread the previous posts, and I am a bit interested in the outlook of the others, who don't have as favorable a picture of IM/EM trainees. I wonder, are you training at one of the sites which has IM/EM, or are these thoughts from interview experiences, or from colleagues?

 

[obecalp]

Hi Pimplepopper,
I'm an MS-II that's going to finish up the classroom portion by Christmas of this year. I plan on starting my third year rotations in February (a week or so after step 1). I guess I've just been asking for advice from friends who have already begun their residency programs and those who have been practicing for a couple of years.
I can relate to your post in that I would like to be a well rounded physician - having the experience to take care of any emergency while having the depth of knowledge to diagnose and treat. Yeah, but like I said, I haven't started rotations yet, so what do I know. I guess I'm just testing the waters.
Do you know of any IM/EM programs in the midwest? I know that UIC has one.

 

[dkwyler94]

Hi Pimplepopper,
I'm an MS-II that's going to finish up the classroom portion by Christmas of this year. I plan on starting my third year rotations in February (a week or so after step 1). I guess I've just been asking for advice from friends who have already begun their residency programs and those who have been practicing for a couple of years.
I can relate to your post in that I would like to be a well rounded physician - having the experience to take care of any emergency while having the depth of knowledge to diagnose and treat. Yeah, but like I said, I haven't started rotations yet, so what do I know. I guess I'm just testing the waters.
Do you know of any IM/EM programs in the midwest? I know that UIC has one.

First, I am thinking about IM/EM. Mostly because I love the cerebral challenge of IM, but really would miss the procedures. I am also looking at one program that has a combined IM/EM/CC a lot of work, but oh well.
I was wondering how competitive these programs tend to be. Are there certain programs that are more respected and some to trully avoid?

Thanks


You can find all about the different programs on the Freida website. I can't recall its actual address but go to the www.ama-assn.org and you will find it. I think it is www.ama-assn.org/vapp/freida/
David

 

[Freeeedom!]

One of the things I have noted in all the dually trained guys I have run accross is that they all practice EM exclusively (except for one faculty member I know). It makes one wonder if the same goals could be achieved in less time since the outcome is essentially an EM exclusive practice. That being said perhaps a 2-4 program or a 1-4 program is what you could look at..

 

[DrQuinn]

I did a rotation where PimplePoppy is doing the IM/EM residency, and I tell you, one of the IM/EM guys was like the smartest resident I had ever met... not sure if he still there or not, but I think he was PGY4 and was like a damn attending. Props go to them!

I know one IM/EM guy in the community down here in St. Petersburg, and he's pretty sharp. he's actually head of the Pinellas EMS, but is a damn good EP... his colleagues tell me that "he catches a few more zebras than we do" but that was about the only difference.

Q

 

[KGUNNER1]

One of the things I have noted in all the dually trained guys I have run accross is that they all practice EM exclusively (except for one faculty member I know). It makes one wonder if the same goals could be achieved in less time since the outcome is essentially an EM exclusive practice. That being said perhaps a 2-4 program or a 1-4 program is what you could look at..

Be careful making decisions on limited experience. I know 5 EM/IM grads who did critical care fellowships and are currently practicing both EM/CCM (present company included). I also know about another dozen or so of my past residency crew that are practicing EM/IM in a hospitalist capicity.

I also know several who do just limit their practice to EM, but they all have rapidly been promoted up the academic ranks.

Just make sure you're not limiting yourself by placing blinders on.

Kyle

 

[Hawk22]

Can anyone comment on the competiveness of these residencies in general? I'm really considring these combined programs, but I'll most likely be an average applicant at best and I'm a little worried since there aren't many positions (especially since a few programs are in locations that I don't want to live).

Also, does anyone know if ECU is accepting dual IM-EM this year? I've gotten mixed messages from various websites. And are there any new dual programs in the works anywhere?

 

[PimplePopperMD]

Can anyone comment on the competiveness of these residencies in general? I'm really considring these combined programs, but I'll most likely be an average applicant at best and I'm a little worried since there aren't many positions (especially since a few programs are in locations that I don't want to live).

Also, does anyone know if ECU is accepting dual IM-EM this year? I've gotten mixed messages from various websites. And are there any new dual programs in the works anywhere?

It's tough to say year in and out, because with such few spots, it is entirely dependent on the applicant field.

Everyone who applies for combined programs should have a backup plan, of either IM or EM, depending on your preference.

The essay and interviews for combined programs are particularly key.

Good luck!

 

[Hawk22]

Thanks PimplePopper.
That's kind of what I figured. I wish there were mroe programs, but alas there's not much we can do about that at this stage in the game. Thanks for all the advice.

Another question for anyone out there. Someone told me today that if you do EM or IM that most programs would take at least 6 months off your next residency. So if you did EM and decided to go back to do IM, you would only have to do 2.5 years (and vice versa). They said that most places count an intern year as equivalent in this situation. Anyone know if this is true? If it is, it makes doing both residencies seperately a little more attractive (5.5 vs. 5 years), especially if you could space them out over time. Any thoughts?

 

[Seaglass]

I doubt you would get a full six months from either since the intern years for both are quite different. For example we only have two "medicine-type" months our intern year.