Going from IM sub specialty to EM?

[BelaMedicine]

Hi everyone,
Has anybody heard of someone with an internal medicine (even subspecialty) background go into ER?

First of all are there ERs that will hire board certified IM people? Is there a way to be able to take EM boards or do you have to do another residency?

I have gone through IM and subspecialty training and wish I had done ER for a variety of reasons. Im not sure if at this stage of my life I could do another residency and am wondering if anyone knows if there is another way?

Thanks!!

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[deleted480308]

Hi everyone,
Has anybody heard of someone with an internal medicine (even subspecialty) background go into ER?

First of all are there ERs that will hire board certified IM people? Is there a way to be able to take EM boards or do you have to do another residency?

I have gone through IM and subspecialty training and wish I had done ER for a variety of reasons. Im not sure if at this stage of my life I could do another residency and am wondering if anyone knows if there is another way?

Thanks!!

Some very rural depts might consider hiring you

You will not be em boarded by abem without and EM residency

There is an alternate startup accrediting body that is trying to gestestablished that will let you board after 5yrs ED work but they are definitely not abem

 

[GonnaBeADoc2222]

Has anyone ever heard of someone who is in EM go into pediatric hematology/oncology?

Will Sloan hire ABEM certified people? Do I really have to do a pediatrics residency and heme/onc fellowship or can I just wing it? After all, I do see kids in the ER!

 

[miacomet]

Hi everyone,
Has anybody heard of someone with an internal medicine (even subspecialty) background go into ER?

First of all are there ERs that will hire board certified IM people? Is there a way to be able to take EM boards or do you have to do another residency?

I have gone through IM and subspecialty training and wish I had done ER for a variety of reasons. Im not sure if at this stage of my life I could do another residency and am wondering if anyone knows if there is another way?

Thanks!!

Why? IM subspecialties tend to offer a good lifestyle. Nuts.

 

[BelaMedicine]

Good lifestyle?! Not really!
We have no flexibility like you guys do. At the mercy of seeing patients day in and day out.
I have moonlighted in ERs and am so amazed at the lifestyle! Maybe I’m not seeing everything but it seems super family friendly - you can work as much or as little as you want which you can’t do in IM subspecialty.

 

[link2swim06]

Has anyone ever heard of someone who is in EM go into pediatric hematology/oncology?

Will Sloan hire ABEM certified people? Do I really have to do a pediatrics residency and heme/onc fellowship or can I just wing it? After all, I do see kids in the ER!

I was considering taking the neurosurgery boards just for fun.

 

[GonnaBeADoc2222]

I was thinking of the derm boards in addition to my pedi heme/onc aspirations

 

[RustedFox]

Good lifestyle?! Not really!
We have no flexibility like you guys do. At the mercy of seeing patients day in and day out.
I have moonlighted in ERs and am so amazed at the lifestyle! Maybe I’m not seeing everything but it seems super family friendly - you can work as much or as little as you want which you can’t do in IM subspecialty.

Rather than just mocking your statements (which, admittedly happens a lot on here - and not just to you), I'm going to do you the favor of telling you that you're correct inasmuch as you're NOT seeing everything. Sure, we work less hours per month, but they're so often "screwball" hours which erode your wakefulness, health, patience, and sanity.

 

[BelaMedicine]

Wow you guys are harsh! Was just asking and obviously peds Heme Onc and neurosurgery don’t have nearly the overlap that I am talking about. If one is working in an ed w adult only responsibilities IM training will mostly get you everything (not everything but mostly)

 

[RustedFox]

Wow you guys are harsh! Was just asking and obviously peds Heme Onc and neurosurgery don’t have nearly the overlap that I am talking about. If one is working in an ed w adult only responsibilities IM training will mostly get you everything (not everything but mostly)

 

[theseeker4]

Wow you guys are harsh! Was just asking and obviously peds Heme Onc and neurosurgery don’t have nearly the overlap that I am talking about. If one is working in an ed w adult only responsibilities IM training will mostly get you everything (not everything but mostly)

Yeah, sorry, not even close. You learn adult internal medicine with an IM residency. You get patients who are neatly packaged and stabilized, and you work them up and treat them for the next 1-100 days they are inpatient, then discharge. Or you work in a clinic, and manage chronic /subacute conditions, and if anything dangerous comes in, the patient is sent to the ER.

In emergency medicine, you have to take a patient who may have never seen a doctor, and you are almost always unfamiliar with, interview them, perform an exam, order appropriate tests, provide appropriate interventions, and either admit them or discharge them home, without missing anything major, doing this for 2 to sometimes 3 or more patients every hour of your 8-12 hour shift. During all this, you have to manage patients (multiple) actively trying to die on you, and you need to do everything needed to stabilize them immediately, including all advanced lines, lumbar punctures, intubations, suturing, chest tubes, etc, etc.

You need to take the ESRD patient who hasn't "felt like" going in for dialysis in the past two weeks and is now in acute respiratory failure with a potassium of 8 and stabilize them long enough to get them to dialysis. At the same time, you need to treat that kid who just came in with asthma because his parents don't think there is anything wrong with smoking cigarettes, weed, and crack in the house and keep them from getting intubated if possible. Don't forget about the 98 year old nursing home patient with stage 4 lung cancer, CHF, COPD, who is full code coming in with sepsis for the third time this month and a blood pressure of 70/30. Oh, and a trauma activation was just called, you need to stabilize the car vs pedestrian coming in who has a flail chest, partial leg amputation, and is unresponsive. At the same time, don't forget the 20 urgent care type patients waiting to be seen, who if they complain, or leave before you work them up and treat them, will decrease your pay and make hospital admin have meetings with you about how you are missing your metrics.

There is no way that an IM residency prepares you for being an effective EM doctor.

 

[GonnaBeADoc2222]

I thought IM docs did chest tubes and intubations all the time?

Probably just as many times as I've managed hyperlipidemia and essential hypertension. If I see just adults in clinic can I be an IM doctor?

 

[namethatsmell]

Hi everyone,
Has anybody heard of someone with an internal medicine (even subspecialty) background go into ER?

First of all are there ERs that will hire board certified IM people? Is there a way to be able to take EM boards or do you have to do another residency?

I have gone through IM and subspecialty training and wish I had done ER for a variety of reasons. Im not sure if at this stage of my life I could do another residency and am wondering if anyone knows if there is another way?

Thanks!!

What’s your subspecialty?


Sent from my iPhone using SDN mobile

 

[RustedFox]

The one "skillset" that the IM folks who think that they "can practice EM" is (for lack of a better name)... the "dark arts".

Apologies to Harry Potter fans out there.

If you can't figure out who is lying to you and why (patient, family, RN staff, even the police) then you're gonna have a bad time.
If you can't handle the manipulative axis-II patient in the acute setting, then you're gonna have a bad time.
If you can't tell a patient "this is bull$hit; fuuck you, you're discharged", then you're gonna have a bad time.
If you can't sniff out serious risk even when there is none recorded on paper, then you're gonna have a bad time.

I could go on like this, but I think its better illustrated by an actual conversation between me and a hospitalist (not American-born, has never smoked, drank, etc) that occurred last month:

Hospitalist: "Why are you admitting him for chest pain/rule-out-ACS?! He has NO risk factors and is 39!"
Me: "Listen to me. He's a buttery, smokey, uneducated fella with a good story and plenty of undiagnosed risk factors."
Hospitalist: "What do you mean?! He's not on a statin. He's not on a beeeta (sic)-blocker. He's not ..."
Me: "LISTEN! This is a blue-collar Irish guy from South Boston. Breakfast is cigarettes. Lunch is potatoes and Tullamore Dew (she didn't know what that was, either). He doesn't see a doctor unless he's "sick", and guess what? He's never sick unless he can't work, which is never. If he gets a rash, he doens't go to the office, he goes to the confessional."
Hospitalist: "What about his family history?
Me: "You think that 'Sully' knows if his dad did or didn't have heart disease? He left home at 17 because he either (1) got a girl pregnant, or (2) was tired of his dad beating on him and his mom."
Hospitalist: "Why can't he get outpatient follow-up?"
Me: "You think he's going to follow-up?! He's going to be in railyard in Newark in 2-3 weeks for his next job. Maybe not; he'll be dead because you won't accept the admission."


IM likes their patients silver-bells, cockle-shells, and pretty-maids all in a row.
EM is Garfband. Der I'm not drunnnk occifer. I read this on the internet; why are you not testing my child for Erdholtz-Chestnut Disease! don't hurt aNYonE with medicinz DO YOU KNOW DE WHEY!?

 

[BelaMedicine]

Guys your impression of IM is truly off. Residency is mostly inpatient training and we have tons of experience dealing with unstable patients- multiple unstable patients- and have months and months of training in the MICU, CCU, and night float where all hell breaks loose. I think you guys are thinking of family medicine

 

[OccupyTheED]

Guys your impression of IM is truly off. Residency is mostly inpatient training and we have tons of experience dealing with unstable patients- multiple unstable patients- and have months and months of training in the MICU, CCU, and night float where all hell breaks loose. I think you guys are thinking of family medicine

Sorry but this does not even begin to prepare you to be a good EM physician. Wanna do EM and be good at it? Do an EM residency. Sure you see sick patients other places but nothing about your training prepares you to treat and screen patients with an EM doc's mentality. Have you ever had 15 patients dumped in your lap in 90 minutes including a DKA with glucose > 700, a 7 year old with angioedema, a massive LGIB who rolls in 60/30 HR 150s, and a status epilepticus (all from an actual shift I just worked, and not uncommon)? Its apples and oranges, and while I don't think you're intentionally doing so, it really is quite smug of you to think that you can just pick up and do this job well without the requisite training and preparation based on your experiences in another field.

 

[deleted859535]

If one is working in an ed w adult only responsibilities IM training will mostly get you everything (not everything but mostly)

No. So much no, it's worth repeating.

Guys your impression of IM is truly off. Residency is mostly inpatient training and we have tons of experience dealing with unstable patients- multiple unstable patients- and have months and months of training in the MICU, CCU, and night float where all hell breaks loose. I think you guys are thinking of family medicine

So I would probably work alongside IM before FM in a critical case, yes, but still no. And with apologies to our FM breathren -- I love you guys, and you fill an awesome role.

The very nature of our specialty is emergency care. ICU rotations are valuable, and I did a bunch too. And we see a lot of easy stuff. But I promise you that just as well as you can handle a typical IM case day with nuanced honest to goodness IM cases better than I can, I can handle a string of critically ill people interspersed with respectable level 4 or 5 charts better than you can. Hence our own board and specialty.

 

[GonnaBeADoc2222]

There's no ED that "just sees adults" unless it's a part of a facility that has a separate pedi ed. You may have done ICU rotations, but this is not adequate preparation for the ED. How many of the following have you done?

Crash central lines
Non central vascular access
Chest tubes
Direct laryngoscopy
Video laryngoscopy
Trauma resuscitation
Pedi resuscitation

Someone alluded to it before, but suggesting that you should be able to sit for the ABEM boards without residency training is in fact insulting.

 

[Brigade4Radiant]

I'm sure you can get a job at the VA

 

[DO3]

In short, as an EM physician, I don’t feel qualified to do the things an IM physician does like be a hospitalist, work in a clinic, manage chronic problems like BP, cholesterol, diabetes, etc.. Why, specifically, do you think you are qualified to do my job?

 

[engineeredout]

Guys your impression of IM is truly off. Residency is mostly inpatient training and we have tons of experience dealing with unstable patients- multiple unstable patients- and have months and months of training in the MICU, CCU, and night float where all hell breaks loose. I think you guys are thinking of family medicine

Having done both, I’m gonna go with a no here.

As they say, “you don’t know what you don’t know”

 

[deleted547339]

Guys your impression of IM is truly off. Residency is mostly inpatient training and we have tons of experience dealing with unstable patients- multiple unstable patients- and have months and months of training in the MICU, CCU, and night float where all hell breaks loose. I think you guys are thinking of family medicine

I’m doing CCM through a strong department of medicine. There’s not one senior resident here that could run a pod in the ED. They’re good residents, but a good internist does not an EP make. It’s literally worlds apart.

 

[deuist]

Guys your impression of IM is truly off. Residency is mostly inpatient training and we have tons of experience dealing with unstable patients- multiple unstable patients- and have months and months of training in the MICU, CCU, and night float where all hell breaks loose. I think you guys are thinking of family medicine

You are clearly mistaken as to what skills you will have learned in the intensive care unit. You certainly did not learn how to deliver babies, take care of pregnant women, children, orthopedic injuries, work up undifferentiated abdominal pain, how to perform cricothyrotomies, abscess incision and drainage, facial laceration repair, or wrestle a psych patient while on your night float. I respect you for the knowledge that you learned during your residency and fellowship, and would likely consult you in the future, but do not think that there is enough overlap between our training regimens that you could do my job.

 

[inspirationmd]

Guys your impression of IM is truly off. Residency is mostly inpatient training and we have tons of experience dealing with unstable patients- multiple unstable patients- and have months and months of training in the MICU, CCU, and night float where all hell breaks loose. I think you guys are thinking of family medicine

Did EM/IM/CCM and practice both EM and CCM. Trust me you are going to get yourself in trouble and I really recommend you let this go unless you're planning on doing an EM residency. The training and thought processes required to do EM and IM are different and IM will get you in trouble. As an Internist our training is geared towards a wide differential and what is this most likely. As an Emergency Physician you perform the wide differential but are compelled to think "what would kill this person" and work back from that. Its hard to have that mindset when you aren't used to it. For example: leg pain "Oh you just got tackled and have some pain or you walked too much so its overuse. Take some medication, RICE and follow-up." Except you forgot to consider acute vascular occlusion or popliteal artery injury, didn't do a complete vascular exam, or check ABIs and now the leg is being chopped off". (real case seen by an Internist in a community ED that my ED attending who does malpractice review was called for). The standard you will be held to will be that of an Emergency Physician not an internist. The FM folks are playing with fire and a lot of them know it. I get a lot of questions from FM trained folks who I am on with. There is a reliance on consultants that sometimes are not too happy about it or care suffers. Example: FM trained guy who didn't know how to do a CT for a large PTX and General Surgery was busy. So Youtube got employed at nurses station and a fake it till he made it approach happened. Not exactly ideal patient care. Can you place a CT? Do you know how to perform ABI and what the appropriate ranges are? Know how to splint a leg?

If you insist then you need to get a job at a VA where the malpractice is comprehensive since patient's are suing the US government and you will likely have trainees who can come down and consult to help you a lot. They used to hire.

What's your IM subspecialty? Might be better to just grab a CCM fellowship and then make a transition. At least then you would get some training for the job you're trying to do.

 

[theseeker4]

Guys your impression of IM is truly off. Residency is mostly inpatient training and we have tons of experience dealing with unstable patients- multiple unstable patients- and have months and months of training in the MICU, CCU, and night float where all hell breaks loose. I think you guys are thinking of family medicine

I have done ICU rotations as well, and have responded to rapid responses and ICU codes. The fact that you think responding to an ICU code or decompensating patient is equivalent to resuscitating an acutely ill patient in the ED shows you just don't get it. We do in fact know what IM residencies do, we know that most is impatient, and we know that that experience doesn't prepare you for being an EM physician. It is kind of like me saying "I see heart failure and MI patients in the ED all the time, I should be allowed to sit for the cardiology board and become a board certified cardiologist without having to complete a fellowship." It is obvious that your impression of EM is truly off, and the fact that you keep insisting your training qualifies you to work in the ED means you just aren't ignorant of what you are missing, you would be dangerous if you did work in an ED because you are insisting you aren't missing anything.

 

[engineeredout]

I think one of the under appreciated skills of Emergency Medicine that Internal Medicine (or any other specialty for that matter) simply doesn't prepare you for is how to run an emergency department. Maintaining patient flow, dispo-ing efficiently, managing your train wreck septic shock as well as a slew of 12 hours of cold symptoms, keeping up with your documentation, managing medical command, keeping straight the 5-80 year old ladies with vague abdominal pain, getting yourself out on time, all while not missing the serious, while keeping all the "customers" happy, is an art. It's infinitely harder to learn than any procedural skill.

 

[RustedFox]

I think one of the under appreciated skills of Emergency Medicine that Internal Medicine (or any other specialty for that matter) simply doesn't prepare you for is how to run an emergency department. Maintaining patient flow, dispo-ing efficiently, managing your train wreck septic shock as well as a slew of 12 hours of cold symptoms, keeping up with your documentation, managing medical command, keeping straight the 5-80 year old ladies with vague abdominal pain, getting yourself out on time, all while not missing the serious, while keeping all the "customers" happy, is an art. It's infinitely harder to learn than any procedural skill.

This, alone. Geez, ladies.

 

[W19]

There is a particular SDN member (@jhamaican) who thinks EM should be an IM subspecialty (1 yr fellowship)... I kind of agree with him. I noticed in my EM rotation 2 months ago that ~90% of what came to the ED could have been handled by IM docs... How fast they could have handled these cases is up for debate.

Disclosure: I am starting IM residency in 6 wks...

 

[BoardingDoc]

EM should be an IM subspecialty (1 yr fellowship)... I kind of agree with him.....
Disclosure: I am starting IM residency in 6 wks...

I'm not sure what you're trying to accomplish by starting out by saying "I think that XXX type of doctor is basically capable of doing YYY job" and then following it up by saying "I literally have no training whatsoever in either XXX or YYY which would justify my opinion"

The combination of arrogance and naivety is astounding.

 

[TheComebacKid]

There is a particular SDN member (@jhamaican) who thinks EM should be an IM subspecialty (1 yr fellowship)... I kind of agree with him. I noticed in my EM rotation 2 months ago that ~90% of what came to the ED could have been handled by IM docs...

 

[W19]

Here is the link of similar debate in the med forum:

MD - PSA: Incoming Medical Students - Don't overlook EM

 

[Zebra Hunter]

There is a particular SDN member (@jhamaican) who thinks EM should be an IM subspecialty (1 yr fellowship)... I kind of agree with him. I noticed in my EM rotation 2 months ago that ~90% of what came to the ED could have been handled by IM docs... How fast they could have handled these cases is up for debate.

Disclosure: I am starting IM residency in 6 wks...

I personally believe IM should be an EM subspecialty. You gotta learn how to handle the emergencies before you can handle the mundane. Plus, nearly 100% of IM presentations could be handled by EM docs. I mean, we already essentially run a clinic in our fast tracks.

 

[W19]

I'm not sure what you're trying to accomplish by starting out by saying "I think that XXX type of doctor is basically capable of doing YYY job" and then following it up by saying "I literally have no training whatsoever in either XXX or YYY which would justify my opinion"

The combination of arrogance and naivety is astounding.

Other specialties think you guys are a bunch of incompetent physicians who consult for everything under the sun anyway...

 

[TooMuchResearch]

Other specialties think you guys are a bunch of incompetent physicians who consult for everything under the sun anyway...

Remember that time when the student showed up to troll the attendings?

 

[engineeredout]

There is a particular SDN member (@jhamaican) who thinks EM should be an IM subspecialty (1 yr fellowship)... I kind of agree with him. I noticed in my EM rotation 2 months ago that ~90% of what came to the ED could have been handled by IM docs... How fast they could have handled these cases is up for debate.

Disclosure: I am starting IM residency in 6 wks...

I’m going to use my superior triage skills to say that you are going to be actively disliked in your residency. Good luck - you’re gonna need it.

 

[deleted859535]

There is a particular SDN member (@jhamaican) who thinks EM should be an IM subspecialty (1 yr fellowship)... I kind of agree with him. I noticed in my EM rotation 2 months ago that ~90% of what came to the ED could have been handled by IM docs... How fast they could have handled these cases is up for debate.

Disclosure: I am starting IM residency in 6 wks...

So basically, you don't know what you're talking about. Done.

Other specialties think you guys are a bunch of incompetent physicians who consult for everything under the sun anyway...

Kind of like those stereotypes about IM docs who consult cardiology for things that clearly don't require their help and/or ID because they can't be bothered to formulate an appropriate antibiotic regimen themselves, right? Or maybe the ones about mental masturbation that accomplishes nothing. Oh, and ortho docs are dumb jocks.

Remember that time when the student showed up to troll the attendings?

Seriously. Trolling or just clueless.

 

[BoardingDoc]

The combination of arrogance and naivety is astounding.

Other specialties think you guys are a bunch of incompetent physicians who consult for everything under the sun anyway...

Thank you for proving my point

 

[Birdstrike]

Question for @BelaMedicine

If you’re looking for a change, why not consider a different IM fellowship, instead of starting over in EM?

 

[GonnaBeADoc2222]

There is a particular SDN member (@jhamaican) who thinks EM should be an IM subspecialty (1 yr fellowship)... I kind of agree with him. I noticed in my EM rotation 2 months ago that ~90% of what came to the ED could have been handled by IM docs... How fast they could have handled these cases is up for debate.

Disclosure: I am starting IM residency in 6 wks...

Other specialties think you guys are a bunch of incompetent physicians who consult for everything under the sun anyway...

This is just ******* hilarious! The med students with literally no ED experience beyond following 1-2 patients over 4 hours chiming in! Seriously, thanks for making my day post shift!

Wow! Where to begin? I can't tell you the number of asymptomatic hypertension, abscess drainage, etc "referrals" I get sent from IM every single day. One of my all time recurrent dispo freakouts is the IM admission of a pregnant person with a non obstetrical complaint. "Has OB been consulted?" "No, they have a pneumonia and they happen to be pregnant." "Oh, well this patient should be admitted to OB." LOLZ. Or the patient who needs admission to IM who is 17.5 years old. Has to go to peds cause they're not 18!

You realize that every patient sent from IM/pediatrics/surgery/ob/etc etc is essentially a consult to the ED, right?

I love most of my IM consultants and we get along great. I can't cath a patient, nor can I egd them for a gi bleed, nor can I manage their chronic diabetes - they do that and are happy to help me out. You are in need of a major attitude adjustment in residency or else you're in for a bad time.

 

[RustedFox]

This is just ******* hilarious! The med students with literally no ED experience beyond following 1-2 patients over 4 hours chiming in! Seriously, thanks for making my day post shift!

Wow! Where to begin? I can't tell you the number of asymptomatic hypertension, abscess drainage, etc "referrals" I get sent from IM every single day. One of my all time recurrent dispo freakouts is the IM admission of a pregnant person with a non obstetrical complaint. "Has OB been consulted?" "No, they have a pneumonia and they happen to be pregnant." "Oh, well this patient should be admitted to OB." LOLZ. Or the patient who needs admission to IM who is 17.5 years old. Has to go to peds cause they're not 18!

You realize that every patient sent from IM/pediatrics/surgery/ob/etc etc is essentially a consult to the ED, right?

I love most of my IM consultants and we get along great. I can't cath a patient, nor can I egd them for a gi bleed, nor can I manage their chronic diabetes - they do that and are happy to help me out. You are in need of a major attitude adjustment in residency or else you're in for a bad time.

What's worse is the IM/FM folks who send the patienr to the ED "for admission".

Oh, your chronic GI bleeder has a hemoglobin of 5? Pick up the phone, call the hospitalist, get them directly admitted. I already have 3 ambulances en route. Kthxbye.

 

[emergentmd]

There is a particular SDN member (@jhamaican) who thinks EM should be an IM subspecialty (1 yr fellowship)... I kind of agree with him. I noticed in my EM rotation 2 months ago that ~90% of what came to the ED could have been handled by IM docs... How fast they could have handled these cases is up for debate.

Disclosure: I am starting IM residency in 6 wks...

I am EM for 17 Yrs and I am quite confident that I could be a IM hospitalist tomorrow at my tertiary hospital with about 1 wk inpatient computer training. I am quite serious about this.

I could not way be a hospitalist at a in the middle of nowhere hospital unless I had extensive training.

Why? b.c when you are at a hospital with all the specialists in the world, all IM does it consult and do discharge planning. Seriously.... I have done chart reviews and EVERY daily progress notes is just a regurgitation of the specialists note or their previous note. Then suddenly the Discharge summary is a synopsys of what the specialists says.

For any IM without any EM training or extensive EM experience would FLOUNDER and kill someone at my teriatry hospital. They may be able to mask their inexperience if they were double coverage and cherry picked charts but eventually they will pick one up and really hurt someone.

I remember a FM trained doc with "Em experience" who lasted about 5 shifts b/c she had no clue how to put in a central line and had to have the director come in on his day off to help put one in..... WTF????

 

[deleted480308]

I am EM for 17 Yrs and I am quite confident that I could be a IM hospitalist tomorrow at my tertiary hospital with about 1 wk inpatient computer training. I am quite serious about this.

I could not way be a hospitalist at a in the middle of nowhere hospital unless I had extensive training.

Why? b.c when you are at a hospital with all the specialists in the world, all IM does it consult and do discharge planning. Seriously.... I have done chart reviews and EVERY daily progress notes is just a regurgitation of the specialists note or their previous note. Then suddenly the Discharge summary is a synopsys of what the specialists says.

For any IM without any EM training or extensive EM experience would FLOUNDER and kill someone at my teriatry hospital. They may be able to mask their inexperience if they were double coverage and cherry picked charts but eventually they will pick one up and really hurt someone.

I remember a FM trained doc with "Em experience" who lasted about 5 shifts b/c she had no clue how to put in a central line and had to have the director come in on his day off to help put one in..... WTF????

Were they a new grad? I know they aren’t EM at all but I thought FM was teaching central lines (at least enough that an ED interested grad would learn that)

 

[W19]

I think ACGME should phase out EM/FM/Gas and let NP/PA take over these specialties...

 

[deleted547339]

There is a particular SDN member (@jhamaican) who thinks EM should be an IM subspecialty (1 yr fellowship)... I kind of agree with him. I noticed in my EM rotation 2 months ago that ~90% of what came to the ED could have been handled by IM docs... How fast they could have handled these cases is up for debate.

Disclosure: I am starting IM residency in 6 wks...

That’s cute. Let us all make changes in our formal training programs based on this insightful 3 week old doctor.

 

[Redpancreas]

I thought IM docs did chest tubes and intubations all the time?

Probably just as many times as I've managed hyperlipidemia and essential hypertension. If I see just adults in clinic can I be an IM doctor?

Hell no!

 

[GonnaBeADoc2222]

I think ACGME should phase out EM/FM/Gas and let NP/PA take over these specialties...

Wow. You've totally just exposed yourself as an overt troll.

You, sir or madam, are the Donald Trump of SDN.

This thread should be closed.

 

[Redpancreas]

I am EM for 17 Yrs and I am quite confident that I could be a IM hospitalist tomorrow at my tertiary hospital with about 1 wk inpatient computer training. I am quite serious about this.

I could not way be a hospitalist at a in the middle of nowhere hospital unless I had extensive training.

Why? b.c when you are at a hospital with all the specialists in the world, all IM does it consult and do discharge planning. Seriously.... I have done chart reviews and EVERY daily progress notes is just a regurgitation of the specialists note or their previous note. Then suddenly the Discharge summary is a synopsys of what the specialists says.

For any IM without any EM training or extensive EM experience would FLOUNDER and kill someone at my teriatry hospital. They may be able to mask their inexperience if they were double coverage and cherry picked charts but eventually they will pick one up and really hurt someone.

I remember a FM trained doc with "Em experience" who lasted about 5 shifts b/c she had no clue how to put in a central line and had to have the director come in on his day off to help put one in..... WTF????

Honestly these procedures take a little time to learn, but anyone can learn to do them and I’ve already got good at lac repairs, put in multiple ABGs, getting better at U/S access/FAST, and I’m sure I’ll get some central lines in ICU rotations. Certain EM physicians here and on the thread that’s actually speaking highly of EM are kind of reminding me of the angry nurses who confuse work experience and a short lived gap procedural skills with medicine.

tl;dr EM physician thinks they’re the most useful because they do a few procedures anyone can learn with a procedural month (none of which they’re the best at).

 

[GonnaBeADoc2222]

Honestly these procedures take a little time to learn, but anyone can learn to do them and I’ve already got good at lac repairs, put in multiple ABGs, getting better at U/S access/FAST, and I’m sure I’ll get some central lines in ICU rotations. Certain EM physicians here and on the thread that’s actually speaking highly of EM are kind of reminding me of the angry nurses who confuse work experience and a short lived gap procedural skills with medicine.

Please, continue to grace us with your medical student wisdom and impress us with your prowess in laceration repair and abgs.

 

[W19]

Was EM even a speciality 35 years ago?

 

[Redpancreas]

Please, continue to grace us with your medical student wisdom and impress us with your prowess in laceration repair and abgs.

Please demonstrate what makes your field so special that a procedural month couldn’t teach any physician or techs couldn’t do? No one said I’m amazing them, but I can blend in in the ED 😛