ER/IM Combined programs

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snaggletooth

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Can anyone tell me what the benefit of doing an er/im combined program is who is either doing it/knows about it. I am a 3rd year interested in ER but IM has always appealed to me. I just would like to know what the individuals who graduate dual board certified do with their careers.

Also if anyone can tell me how to find where these programs are I'd appreciate it.

:D

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Combined programs are good if you want to become an administrator, or do academic EM and go high. They're also good for some areas that EP's want to do, but there aren't a lot of fellowships for (like critical care medicine, especially, where you can become board-certified - EM CCM fellowships are not yet accredited).

Being double-boarded always allows you leeway, and you have cred to do your own thing - if you have a certain plan, or idea for a new program, or whatever. What if you want to work in a hospital, and do clinic one month, and ER next month, and rotate? That's just an example.

Another benefit is if you do indeed get burned out - as long as you stay current in your medicine, you can segue easily into a different role more amenable to your current life.

One last thing is that combined programs are slightly easier to get into.
 
you can find information about the programs which offer combined EM/IM residencies on the SAEM website. www.saem.org
 
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Not sure if it's easier to get into, considering the fact that this year, there were upwards of 90 applications at one program which has two slots. Also considering the fact that there are only about 8 programs, most with 2 slots each, one can see that there is competition, albeit we don't know how much truly (ie how people set their rank lists, how far down the list the programs go, etc).

There's an article in the latest academic emergency medicine, if you're really interestred, which describes a study of all the graduates of programs up through 1998 (of which there were i think 32 grads). Most go into EM, but some do practice both EM and IM.

The combined EM/IM residents and attendings I've met are very sharp.
 
One last thing is that combined programs are slightly easier to get into. Apollyon

I certainly do not agree with this statement and I am wondering by what path you came to this conclusion?

Are you applying to the programs? Do you have first hand experience?

I am certainly not saying that these programs are more difficult than straight EM. They are equally difficult in their own right.

The EM/IM programs have similar ratios of applicants to spots as the EM programs, and some such as LIJ have in the past have had up to 200+ applicants for 2 spots. That ratio is much higher than the normal EM application:spot ratio.
On average,I would say that EM/IM programs receive between 50 -100 applications depending on the program and location. Most interview 15-25 prospective residents.
Being a part of the present recruiting process, I know that those who received interviews are excellent candidates (LORS, high boards, top evals, and excellent personal statements) and would have no trouble getting interviews and spots at top tier straight EM or IM programs. Atleast at our program, the personal statement was used to help identify those who really showed a specific interest in IM/EM. At my program, the residents have a strong say in the future of the program, because we are a tight knit group and are dedicated to continually strengthening the program.

At present, there are 9 allopathic programs in the US, with news of a potential 10th (not confirmed). The programs are University of Maryland, Univ of Illinois at Chicago, Long Island Jewish Medical Center/Albert Einstein University, UCLA Olive View, Christiana Care--Delaware, Louisiana State Univ/Charity program, Henry Ford Hospital--Detroit, Allegeny Hospital--Pittsburgh, and SUNY Brooklyn.

All programs take 2 new residents per year, with the exception of Christiana which has 3 residents per year, and SUNY Brooklyn which has 6 new residents per year. This is a total of 23 spots in the US for EM/IM. There are also Osteopathic EM/IM programs but I know very little about these programs so I will defer questions to those involved with those programs.

As for career choices for the graduates, the sky is the limit. The training allows graduates to enter academic careers in both EM and IM. Fellowships and combined EM/IM positions are also a possibility. It varies from program to program the ratios of EM, IM and EM/IM positions. My program, UIC, originally had most residents entering into EM positions, but as of late we have begun to send residents into critical care positions, EM/IM combined positions and atleast one of the present residents wants to do an IM fellowship (cards).

there aren't a lot of fellowships for (like critical care medicine, especially, where you can become board-certified - EM CCM fellowships are not yet accredited). Apollyon

I disagree with this statement.

IM/EM grads are able to enter both EM and IM fellowships without difficulty and with the potential for full board certification. We are not limited in our choices.
For example within EM (Tox/EMS/International EM) and IM (cards, pulm/Crit care, GI, nephro, endo, rheum, heme/onc, geri, ID, etc...) are all available to the grads. Second of all, a straight critical care fellowship is available with full board certification based on the IM trainind and ceritification. Yes, EM is not at present able to become board certified in Crit care but the EM/IM grads can without difficulty with the dual board certification. Furthermore, some programs, specifically mine is able to have their residents enter into a 6th year Critical care fellowship and forgo the 2nd year of training. EM/IM grads get very extensive critical care training between 10-12 units in 5 years (micu/ccu/sicu/picu/nsicu/nicu/ctcu) are all possible training sites and each program varies which units there residents rotate through and the number total for 5 years.
 
Originally posted by jashanley
One last thing is that combined programs are slightly easier to get into. Apollyon

"I certainly do not agree with this statement and I am wondering by what path you came to this conclusion?

Are you applying to the programs? Do you have first hand experience?"

Sounds vitriolic. My info came from a member of the RRC for 13 years, Chair of an EM department, original author of one of the major texts in EM, and past president of the ABEM.




there aren't a lot of fellowships for (like critical care medicine, especially, where you can become board-certified - EM CCM fellowships are not yet accredited). Apollyon

"I disagree with this statement."


The only accredited EM fellowships are Peds, Tox, and Sports Med. Unaccredited fellowships range from no good reason why not, to incredibly poor. Had you mentioned the entire quote, you'll recall I said "EP"'s - Emergency Physicians. Moreover, this forum is "Emergency Medicine". There is no logical reason to think that you have fewer opportunities for having more board certs (which I said - that more boards are better). You sound like you were thinking I was referring to IM/EM. I was referring to EM single-boarded people.
 
Just to add something.....Undersea and Hyperbaric Medicine is an approved specialty of Emergency Medicine now as well.
 
It was not meant to be a scathing remark in any way. However, the best way to learn about the programs and form an opinion is to undergo the experience, specifically to apply and interview for these programs.

My only suggestion is that when you make a blanketed statement such as "One last thing is that combined programs are slightly easier to get into." You provide a reference or source for us to find validity. Your source is certainly qualified for EM. But very few EM attendings, even department heads, are aware of the EM/IM programs and reputations.
Many of the attending I talked with as a medical student discredited the concept behind the programs and held them in disregard.

I do admit my reading of your second quote was hasty, I read it with fresh eyes and admit my mistake. I do agree that there are few board certified fellowships available for straight EM, which is a shame. Hopefully in the future more will become available.
 
From the following webpage.
http://www.uhms.org/HBO EXAMS.htm


The American Board of Emergency Medicine (ABEM) and the American Board of Preventive Medicine (ABPM) will administer the certifying examination in Undersea and Hyperbaric Medicine



ABPM EXAM DATE: NOVEMBER 11, 2002



Physicians must submit an application to the board through which they are certified. Physicians certified by an American Board of Medicine Specialties member board other than ABEM and ABPM and who fulfill the eligibility criteria should apply to ABPM. Upon successful completion of the examination, certification is awarded by the board through which the physician submitted the application.

Application materials will be available for ABEM diplomates on March 1, 2002, and will be accepted with postmark dates through July 1, 2002. ABPM diplomates should contact ABPM for application cycle information.



After March 1, 2002 you can CLICK HERE to get to the Exam Information site. Before then, please contact the following:



AMERICAN BOARD OF PREVENTIVE MEDICINE

330 South Wells St., Suite 1018

Chicago, IL 60606-7106

Phone: 312.939.2276

Fax: 312.939.2218


AMERICAN BOARD OF EMERGENCY MEDICINE

3000 Coolidge Road

East Lansing, MI 48823

Phone: 517.332.4800

Fax: 517.332.6370
 
I've heard that the idea behind some of the combined programs (at least awhile ago) was that it would give you a way to hedge your bets if EM did no pan out as a specialty. As it obviously has panned out I think the reasons to consider it today are mainly if you wish to be an academician or adminitrator as stated above.
Overall, IM and EM attract different people for different reasons and you have to examine what you would like better. I really enjoyed my internal medicine rotation as a third year and did well; when I did an AI in general internal medicine as a fourth year it was fine, but I was already starting to realize...I really don't like Medicine rounds and I really don't like chasing people's K or trying to figure out whether it is ceftriaxone Day 4 or 5. In third year it is easy to love the rotations that had the best teachers and residents even if the practice is something that doesn't suit your personality. With some exceptions, I think medicine and EM attract people with different personalities and personal goals (however if your goal is hardcore critical care or cardiovascular research you may be well served double boarding - however no one will stop you from doing that research after doing a fellowship in critical care after an EM residency - you just won't be able to sit for the boards in critical care - I think...). That is my opinion as a fourth year medstudent and future EM doc and my rationale for not pursuing EM/IM (because I did have some Medicine attendings who I respect a great deal suggest I look into it) If you are thinking seriously about it look at some of the webpages for the programs and email the residents and ask them about their motivation and what sorts of jobs they are looking at getting when they are done. (If you can't find emails email the residency coordinators who all have listed addresses on the saem website and ask them) But first you might want to sit down and ask yourself what kind of doctor you want to be or do one of those personality -> specialty questionaires.
 
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