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ER/IM Advantageous???

Discussion in 'Clinical Rotations' started by windsurfr, Feb 19, 2002.

  1. windsurfr

    windsurfr Member
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    Sorry posted it in wrong place last time....
    Anyway does anyone know if there is any advantage in having dual ER/IM residency training in applying for ER jobs???
     
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  3. Freeeedom!

    Freeeedom! Senior Member
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    None what-so-ever. There are very few allopathic EM/IM programs, and for the life of me, I have no idea why anyone would want to do that!
    I believe it is created to give the IM grad an alternative place to practice, it adds nothing to the EM graduate...there are no EM grads in there right state of mind, that would want to do IM!
     
  4. Goofy

    Goofy Senior Member
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by Freeeedom!:
    <strong>None what-so-ever. There are very few allopathic EM/IM programs, and for the life of me, I have no idea why anyone would want to do that!
    I believe it is created to give the IM grad an alternative place to practice, it adds nothing to the EM graduate...there are no EM grads in there right state of mind, that would want to do IM!</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">While I would agree an IM might not be a huge advantage in this favorable environment, I think it is somewhat premature to conclude it is completely useless.

    Further the statement that 'no EM grads in there (their) right state of mind' would entertain this as a possibility is somewhat purblind in my opinion. We have 4 students avidly pursuing just this combination, two of which I am close with. Their reasons include more professional options in the coming years, as ER is a young man's profession. A big concern for ER applicants is lifespan of the profession. The combined degree offers a short pathway to a double board degree. This opens up a wealth of opportunity outside of the ER setting.

    If you are 100% certain that you want to practice ER medicine until you die, than skip the dual degree. The majority of ER phsyicians typically move on to some other field in the latter years. Having a strong medicine background along with the degree opens up a wealth of opportunity.
     
  5. droliver

    Moderator Emeritus 10+ Year Member

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    i'm with klebsiella. I think there would be a lot of value in a double board like that. ER shift work is notoriously unattractive as you get older & the IM board would give you flexibility for inpatient positions. And as for no one in their right state of mind wanting to do IM...... What do you think the overwhelming amount of ER visits are? You're running the world's largest and busiest FP/IM clinics!
     
  6. Freeeedom!

    Freeeedom! Senior Member
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    Sorry Klebsiella, I don't agree with "the majority of ER physicians move on to other field in the latter years"...virtually every doc does something different prior to retirement whether that be teaching or carpentry...so what does that matter?

    Though most of my reply was done jokingly (virtually all EM residents make fun of IM residents because of "IM call" etc), you may kick yourself later if you go IM/EM. It is difficult enough to pass oral and written EM boards, but go with your heart.

    Here are ALL of the current RRC approved IM/EM programs: (NOT MANY OF THEM...SORRY)
    California
    UCLA - Olive View-UCLA Emergency Medicine

    Delaware
    Christiana Care Health System
    Illinois
    University of Illinois at Chicago

    Louisiana
    Louisiana State University Residency Program/Charity Hospital

    Maryland
    University of Maryland

    Michigan
    Henry Ford Hospital
    New York
    Long Island Jewish Medical Center
    Pennsylvania
    Allegheny General Hospital

    As for Klebsiella...who uses the word "purblind"? Ha!
     
  7. dwstranger

    dwstranger Senior Member
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    IMHO, the biggest advantage of the combined EM/IM program is for those of us who are older... I'll be 39 when I START my residency... I figure that if I get something in EM, I can practice, what? 20 years tops, before I get all tuckered out by age 60. Sure as heck won't want to retire that young, and having the IM to fall back on, without having to do another residency (only a fellowship), would be a good thing!
     
  8. tulanestudent

    tulanestudent Member
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    Career flexibility is probaly the best reason to do the combo. Plus,it might be very good for an ER doc to have more perspective on the IM doc's point of view of patient care and vice-versa. I know EM residencies already usually do IM rotations, but it seems that is more often ICU work as opposed to your basic ward work, wheras the combined program gives more of this. Better patient care would be the result of more physicians completely understanding the steps of both the initial workup and the longer-term care.

    Another consideration is the EM doc who wants to be heavily involved in academic teaching. Of course, there are lots of EM faculty positions, but there are TONS more IM faculty positions in this country. So having the board certification and training experience can add to your opportunities on that front, if that is one of your future goals in your career. Again, I think having the background in both would make a more well-rounded academic physician.
     
  9. tulanestudent

    tulanestudent Member
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    Oh, I didn't mention the big disadvantage: FIVE years of residency, as opposed to 3 or 4 for EM alone or just 3 for IM alone. That's a major time committment to think about.
     
  10. Dr. Wexler

    Dr. Wexler Member
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    Correct me if I'm wrong, but isn't one of the reasons many EM docs have chosen to move onto other areas is that they weren't EM educated/certified? I understand EM is still a very demanding specialty, but as the specialty has become more respected/organized, etc. isn't it reasonable that this burnout (or whatever you want to call it) will decrease, resulting from people who decided right out of med school that EM was how they wanted to spend thier entire careers.
     
  11. godfather

    godfather Member
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    having considered er/im myself and having worked with them at hfh here's my 2 cents. Er/Im people tend to want to do academic medicine more than community. Alot of them will tell you that they choose this because they want to do er until their about 40-50 and then fall back into clinical IM. This was what actually spurred my initial interest. I should also point out that some of these ER/IM guys are some of the sharpest people around. Part of this probably has to do with the fact that their PGY4 and 5 compare to the regular im and er residents that are pgy1,2,and 3. I should also point out that having finished interviewing at many institutions, the facts are that i've run into 4 different middle aged ER docs that were now doing a second residency because they got sick of ER. Another field that i've noticed many people switching over after completing their residency are males that went into ob-gyn. In their case the vibe i got was that it was difficult to get one's own practice going. Another thing i want to point out to the younger med students (i hope i don't come across as dogging er, because it definately is a great field) so that thier well informed is that er is not as a procedure oriented field as it's name might suggest you to believe. There are 2 residents where i'm at that actually switched over to general surgery after finishing their 2nd year of er for this reason. So if your looking to do alot of procedures you might want to do something more surgical. However if you want to make the initial diagnosis, not deal with insurance companies, deal with all kinds of patients, get lots of time off, do shift work and make good money Er will be a great career choice.
     
  12. doughboy

    doughboy Senior Member
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    Don't you think the IM boards might be difficult to pass...plus, don't you have to re-certify every 10 years...I don't know if that would be fun to do considering most ER docs don't want to deal with IM during their ER years...either way I think most people who pick the ER/IM route know what they are getting into. I have two friends going into the program and they are confident they are making the right choice. Plus, I have met some ER/IM residents and they are all smart as hell...definitely the most knowledgable of either the ER or IM residents.
     
  13. godfather

    godfather Member
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    oh also forgot to point out that having trained in both em and im you'll be much more marketable and less likely a victim of the cyclical fluctuations in the job market as you can always work in the field in which the job market is hot.
     
  14. godfather

    godfather Member
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    doughboy no i don't believe the im boards will be tough to pass, since there's like a 75% overlap in ER and IM.
     
  15. nyskindr

    nyskindr Senior Member
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    Sarting this year is new ER/IM residency is at SUNY Downstate Medical Center
     
  16. Mr. happy clown guy

    Mr. happy clown guy Senior Member
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    I would tend to agree with Freeeedom here...most EM docs tend to stop working as intended (as most people do) so they can pursue jobs in their areas of hobby/interest and only work 1-2 days a week!
    I think that is WHY people go into EM!

    And, if you wish to make yourself more marketable (being BC in EM is enough!), you can do a 1-2 year fellowship in EMS, Toxicology, Sports Med, Forensics, or Peds rather than the combined IM/EM thing.
    Most EM docs prefer to throw that pager away and enjoy the free time most EM docs have! It allows them time to pursue other business interests...that is the point!!

    The list that Freeeedom! gave was the list on the <a href="http://www.saem.org" target="_blank">www.saem.org</a> website and are the only RRC approved EM/IM programs around.
     
  17. dwstranger

    dwstranger Senior Member
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    Mr HCG,

    Just FYI, I originally got the list of EM/IM residencies from FREIDA...

    <a href="http://www.ama-assn.org/ama/pub/category/2997.html" target="_blank">http://www.ama-assn.org/ama/pub/category/2997.html</a>
     

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