Skills of House

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Wassup, everyone?! I've been torn between gunning for an EM/IM dual certification spot or a urology spot. I love pretty much everything about the EM/IM prospects, but urology offers the more specific specialization with amazing surgery potential. Anyway, I feel like a mentor would be helpful in discussing issues like this, but I don't really know how to go about getting one. Do you all think having a mentor is helpful? I mean really helpful...not just a career move or something to add to your personal statement!
 

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I wouldn't really add a mentor to my PS. And I don't know that I would choose the word mentor, either. I prefer advisor. Yes, I think it is very important to have one in your field of choice. They can objectively look over yoru app. They can tell you where the good programs are. They can warn you about bad programs. If they know you well, beyond your app, they can guide you towards the programs they believe you will fit into. Finally, if they are willing to write your LOR, their name alone can often open a few doors into certain residency programs. Name recognition can go far.
 

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Agree with Bertleman.

In terms of finding one, ask around, particularly older med students and residents in the departments you are interested in. See who has been helpful to students in the past, and see who is well connected as Bertleman said. Once you have identified someone, call their secretary and set up an appointment (ideally). You could send an email, but if you don't know this person and they don't know you a response may be slow in coming.
 
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I've been torn between gunning for an EM/IM dual certification spot or a urology spot. I love pretty much everything about the EM/IM prospects

What exactly is it that you love about IM/EM? I've heard EP's refer to this as the $200,000 mistake. You can't practice both IM and EM, simply because you can't be in two departments at once. The only reason I could think of getting this double board is to work at a residency program like this. Any clarification would be appreciated...:thumbup:
 

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What exactly is it that you love about IM/EM? I've heard EP's refer to this as the $200,000 mistake. You can't practice both IM and EM, simply because you can't be in two departments at once. The only reason I could think of getting this double board is to work at a residency program like this. Any clarification would be appreciated...:thumbup:

I appreciate the responses!
Well, I was only using PS as an example...I meant for any "name-dropping" purposes. I understand that "the game" is there regardless, but I hate that type of political bs. And with more specific regard to getting to know them, when is this taking place? Do you work with them? Shadow them? :idea: play golf together?
As for EM/IM...one of the things that I love about EM is that the work hours absolutely DO allow you to be in two departments at once! With EM, when you're off, you're off. And a lot of EM physicians maintain under 50 hours/per week, working 12 hour shifts. This leaves plenty of time to work in a clinic or open a group pratice (obviously it would be near impossible at best for a person to do it alone since you wouldn't really be able to take call, thus the practice and community could suffer). I could still work in a clinic as an EM certified of course, but the training is not the same. I've also considered going the Family Medicine to EM fellowship route, which is becoming more and more popular, but I think there are what? 2 programs in the entire country right now! ...each of which accepting maybe 2 applicants!
 

Biscuit799

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I appreciate the responses!
Well, I was only using PS as an example...I meant for any "name-dropping" purposes. I understand that "the game" is there regardless, but I hate that type of political bs. And with more specific regard to getting to know them, when is this taking place? Do you work with them? Shadow them? :idea: play golf together?
As for EM/IM...one of the things that I love about EM is that the work hours absolutely DO allow you to be in two departments at once! With EM, when you're off, you're off. And a lot of EM physicians maintain under 50 hours/per week, working 12 hour shifts. This leaves plenty of time to work in a clinic or open a group pratice (obviously it would be near impossible at best for a person to do it alone since you wouldn't really be able to take call, thus the practice and community could suffer). I could still work in a clinic as an EM certified of course, but the training is not the same. I've also considered going the Family Medicine to EM fellowship route, which is becoming more and more popular, but I think there are what? 2 programs in the entire country right now! ...each of which accepting maybe 2 applicants!

makes sense, but i don't know anyone who'd pick up a part time job after already working 50 hrs/wk. I'm with you on the FP/EM programs though. They look really interesting. Although I checked FREIDA, and it only turned up one program. :rolleyes:
 

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I appreciate the responses!
Well, I was only using PS as an example...I meant for any "name-dropping" purposes. I understand that "the game" is there regardless, but I hate that type of political bs. And with more specific regard to getting to know them, when is this taking place? Do you work with them? Shadow them? :idea: play golf together?
As for EM/IM...one of the things that I love about EM is that the work hours absolutely DO allow you to be in two departments at once! With EM, when you're off, you're off. And a lot of EM physicians maintain under 50 hours/per week, working 12 hour shifts. This leaves plenty of time to work in a clinic or open a group pratice (obviously it would be near impossible at best for a person to do it alone since you wouldn't really be able to take call, thus the practice and community could suffer). I could still work in a clinic as an EM certified of course, but the training is not the same. I've also considered going the Family Medicine to EM fellowship route, which is becoming more and more popular, but I think there are what? 2 programs in the entire country right now! ...each of which accepting maybe 2 applicants!


1. People who do EM/IM work in EDs, not clinics. Alot of people who want to do this route as underclassmen plan for the "ED one day, clinic the next" career but this does not happen.

2. You won't find a job with a group of internists if you are "unable to take call."

3. FM/EM is not a growing field. Except for the fact that they are both generalists, there is almost nothing similar about the fields. The cultures are just worlds apart.
 

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1. People who do EM/IM work in EDs, not clinics. Alot of people who want to do this route as underclassmen plan for the "ED one day, clinic the next" career but this does not happen.

2. You won't find a job with a group of internists if you are "unable to take call."

3. FM/EM is not a growing field. Except for the fact that they are both generalists, there is almost nothing similar about the fields. The cultures are just worlds apart.

Ok...who ordered the pessimism? Anyone? ...got a plate of pessimism here!

1. Obviously if they are working on the EM side of their specialty they are likely in an ED. But I think it's pretty safe to say that if they are working in the capacity of an Internist, they're likely in a clinic.

2. Obviously, it can be done since I'm thinking of doing it and I'm sure I'm not the only person who's considering it, especially given the fact that I personally know physicians who are doing it.

3. WHAT?!?! Have you looked into FM/EM at ALL?! It is near impossible to get those fellowhip spots because so many people want them, and as I and another poster stated there is only one (though I do think it's two...or maybe the second one opens next year) program that offers it. And there are a number of differences, naturally, but I wouldn't say they are "worlds apart." I mean it's not like we're talking about pyschiatry vs. pathology!
 

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makes sense, but i don't know anyone who'd pick up a part time job after already working 50 hrs/wk. I'm with you on the FP/EM programs though. They look really interesting. Although I checked FREIDA, and it only turned up one program. :rolleyes:

Yeah, the "after-work work" is a major concern. But I'm an older (30) med student who's still unmarried and without kids so I figure it's likely that I'll be the "married to the job" type. I considered surgery for the longest time, but if I'm working insane hours like that, I want it to be entirely because I love what I'm doing...not because it's just a part of the job. It's like Matt Damon in "Rounders" ...Always leave yourself an out!
 

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Ok...who ordered the pessimism? Anyone? ...got a plate of pessimism here!

1. Obviously if they are working on the EM side of their specialty they are likely in an ED. But I think it's pretty safe to say that if they are working in the capacity of an Internist, they're likely in a clinic.

2. Obviously, it can be done since I'm thinking of doing it and I'm sure I'm not the only person who's considering it, especially given the fact that I personally know physicians who are doing it.

3. WHAT?!?! Have you looked into FM/EM at ALL?! It is near impossible to get those fellowhip spots because so many people want them, and as I and another poster stated there is only one (though I do think it's two...or maybe the second one opens next year) program that offers it. And there are a number of differences, naturally, but I wouldn't say they are "worlds apart." I mean it's not like we're talking about pyschiatry vs. pathology!

What year are you? I wasn't being pessimistic, just realistic.

I would really like to hear from EM/IM people who are truly practicing both specialties. The fact that you want to do it does not mean that it is possible. Someone was posting on here awhile ago asking about double-boarding in Path and EM, a girl in my class wants to do Ob/Peds, that doesn't mean it's going to happen.

As for FM followed by an EM "fellowship," if you want to do EM, just do EM. I suspect that 95% of departmental heads would take an EM trained doc over an FP with a fellowship. The spots are competitive because people that couldn't get into EM in med school are still trying to finagle their way into the field. It is not a rapidly expanding area of the Emergency Medicine world.
 

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What year are you? I wasn't being pessimistic, just realistic.

I would really like to hear from EM/IM people who are truly practicing both specialties. The fact that you want to do it does not mean that it is possible. Someone was posting on here awhile ago asking about double-boarding in Path and EM, a girl in my class wants to do Ob/Peds, that doesn't mean it's going to happen.

As for FM followed by an EM "fellowship," if you want to do EM, just do EM. I suspect that 95% of departmental heads would take an EM trained doc over an FP with a fellowship. The spots are competitive because people that couldn't get into EM in med school are still trying to finagle their way into the field. It is not a rapidly expanding area of the Emergency Medicine world.
Wow, I didn't know I was actually conversing with the foremost authority on the Emergency Medicine world, and department heads no less, must be nice to be you!
How are you being realistic??? It's not like I'm talking about starting programs that don't exist out of thin air! There are about 7-10 double board opportunities, none of which do I think is just this year being instituted. What do you think...it's some big conspiracy to keep people in training and out of full practice longer? The hundreds of people going through the programs are all under some mass delusion of grandeur? And if the girl in your class matches Ob/Peds, that pretty much makes it happen.
I'm an MSII by the way.
 

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I don't think that AmoryBlaine is being pessimistic or trying to act like a department head, so perhaps you are being a but touchy in jumping all over him. You posted on a message board asking for advice and thoughts and you got what you asked for. Disagreements and challenging viewpoints are part of SDN. If you do decide to get a mentor, be prepared for this, and I would advise not jumping all over them if they offer you what you perceive as discouraging advice to chew on.

As far as the EM fellowship, I have seen that these were mostly done by people who had been trained in IM or FP and found a job in an ER, but as more EM-residency trained grads entered the job market, in order to maintain their working status they needed the formal training. Before I started medical school, I worked in a hospital that decided to open an EM residency, and the non-EM residency trained staff had to either leave or get the appropriate training to get appointed faculty. I doubt many of these people "wanted" to do the additional training, they had to.

In regards to the EM/FM track, the only program currently accredited is at Christiana Health System in Delaware. According to their website, this is the first year they accepted applications, and the first group of residents will start this July. It may be a bit premature to tout the success of this combined training and claim it's popularity. Give it a few years--this may be the next great thing, but right now no one knows.

There was a thread on here not that long ago about someone who wanted to do FM but also figure out a way to get boarded in Cardiology. Many people gave the advice to that poster that I will offer to you: in the next year or so find what you really want to do (EM, IM, FP, Urology, etc.) and do it well. Trying to work 50 hrs a week in an ER and then trying to maintain an IM clinic beyond that (while possible, as there are 168 hours in a week--I'm not going to argue you on that point) will likely burn you out and spread you too thin to do your jobs well. How will you maintain continuity and availability for your IM/clinic patients? EM docs often have to work rotating shifts, so how will you maintain a predictable clinic schedule so your patients can easily schedule with you? What if they have an emergency or need to speak with you? Are you going to walk away from your critically ill ER patients to call back your IM clinic answering service calls? How many hours a week will you be able to give to a clinic? Not many, and this will inevitably mean that your patients are going to have a very long wait to get in to see you. Who is going to maintain your malpractice? Your EM job will not likely cover your IM responsibilities and vice versa. You are looking at having to take out two separate insurance policies $$$$. You mentioned opening a private practice, but stating you obviously would not be able to take call (which is true)...who do you think would take that job? Do you realize how difficult it would be to hire people to work for you who are willing to take on the entire burden of call without any relief from you? You alluded that you know physicians doing this, why don't you spend more time with them and understand the logistics of what they do, and how they feel about it. As an outsider looking in, it is often difficult to fully perceive what goes on "behind the scenes."

I'm 30 and single as well, and I am doing surgery, so I understand your point about "marrying my job," but there comes a point where enough is enough and one needs time to recharge. Plus, in the early years of med school it is easy to get tantalized by different areas of medicine and want to do them all. But at some point you are going to have to pick one residency position and throw yourself into that 110%. If you do decide to do any one of the combined residency programs, more power to you. Just keep and open mind and a realistic eye turned toward your future career, and remember that an overworked over extended physician is not always best for patient care. Whatever you decide, good luck. Hold on to your work ethic as long as you can! :)
 

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I don't think that AmoryBlaine is being pessimistic or trying to act like a department head, so perhaps you are being a but touchy in jumping all over him. You posted on a message board asking for advice and thoughts and you got what you asked for. Disagreements and challenging viewpoints are part of SDN. If you do decide to get a mentor, be prepared for this, and I would advise not jumping all over them if they offer you what you perceive as discouraging advice to chew on.

I'm 30 and single as well, and I am doing surgery, so I understand your point about "marrying my job," but there comes a point where enough is enough and one needs time to recharge. Plus, in the early years of med school it is easy to get tantalized by different areas of medicine and want to do them all. But at some point you are going to have to pick one residency position and throw yourself into that 110%. If you do decide to do any one of the combined residency programs, more power to you. Just keep and open mind and a realistic eye turned toward your future career, and remember that an overworked over extended physician is not always best for patient care. Whatever you decide, good luck. Hold on to your work ethic as long as you can! :)

First of all, I did not jump all over him, he jumped all over me. He didn't say "well, it may be difficult to find physicians to work with, " he said "you will not find [them]" He didn't say "in my experience, most department heads seem to prefer someone who is directly EM trained over someone with a fellowship," he said "95% of department heads would prefer." There is a huge difference between offering advice and telling someone that they can't do something just because you don't agree with their plan. I posted because I want advice...I need advice...I'll be the first to admit the volumes of information I don't know. But you can point out potential challenges without acting like a person is an idiot for what he/she wants to acomplish.
Regarding EM/IM, that's why I said work in a clinic or a GROUP practice (where obviously, my partners would know that I was also an EM physician), thus none of my patients would be left high and dry while I was in the ED. And of course, everyone recognizes that 50 hours in the ED can be pretty intense all its own, but when you have surgeons and Ob/gyns working 80+ hours per week most of their career, successfully, why are you acting like I just asked for the second parting of the Red Sea for mentioning the possibility of working that same 20-30 hours in a much less intense specialty via an established residency program that would allow it to be done?
Oh, and the specific FM/EM program that I am familiar with is at UTenn.
...anyway, good luck to you too. Have you decided on an area of specialization?
 
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lord_jeebus

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There is a huge difference between offering advice and telling someone that they can't do something just because you don't agree with their plan. I posted because I want advice...I need advice...I'll be the first to admit the volumes of information I don't know.

If a plan is futile, the only good advice is to point that out.

(I'm not saying it is, I know nothing about FM/EM. Perhaps try the EM Residency forum? You could also ask in the FM arena if they would be willing to cover for someone who is "also an EM physician" in a group practice)
 

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Regarding EM/IM, that's why I said work in a clinic or a GROUP practice (where obviously, my partners would know that I was also an EM physician), thus none of my patients would be left high and dry while I was in the ED.
You may indeed find a larger, well established group that would welcome a part-time physician to join them, but you mentioned that you might be interested in starting your own group, which I think you would find to be incredibly difficult. Even if you worked a clinic, you might find you have been relegated to the more urgent care, last minute appointments as with the rotating schedule you will have to maintain in the ED, you will find it hard to maintain set office hours. This would make it more difficult for continuity patients to get an appointment with you.

And of course, everyone recognizes that 50 hours in the ED can be pretty intense all its own, but when you have surgeons and Ob/gyns working 80+ hours per week most of their career, successfully, why are you acting like I just asked for the second parting of the Red Sea for mentioning the possibility of working that same 20-30 hours in a much less intense specialty via an established residency program that would allow it to be done?

IF a surgeon or OB works 80+ hours (which I will challenge you that most attendings do not (or at least strive not to) work for "most" of their career) they do so often out of necessity due to the time intensive nature of their patients. If you do an extended operation on a patient and they do poorly post-op, requiring your immediate attention, you will definitely rack up the hours but these hours are spent on a limited number of patients that require significant care. I doubt these surgeons are aiming to work 80 hours a week--if they hit 50 hours in a week and the work is done, the work is done. They do not start hunting for more patients to add another 20-30 hours of work, which is what you are proposing to do with your ER/clinic practice.

All I and some others are doing is to caution you not to overestimate your work capacity. Maintaining the fervent schedule in two seperate specialties is admirable, but is going to require more than 80 hours spent in the ED/clinic. In order to be a good (or even a competent) physician, you will need to stay current on the issues relevent to your field. You will have to do continuing education. You will be reading journals. Do you have any idea how time intensive staying current and on top of you game as both a practicing EM and FP physician will be? Not to mention you did not address other logistic issues such as malpractice, call, availability to your clinic patients (you CAN NOT expect to just dump all off hours emergencies on your partners. Would you encourage your family member to go to a FP that is never, ever available save for the one or two clinic shifts they may work a month? How about a FP that comes in to work clinic after staying up all night in the ED?) Residency is temporary, and no one does that work for the length of their career. I admit I am not an expert on this topic, as I did not complete a combined residency, but from what I do know about these training programs they are to provide these physicians with a more in-depth, complete skill set and knowledge base to have a more in-depth practice, not to set them up to have two completely seperate careers.

As for me, no--not decided yet. I figured (along with the advice I offer you) I will wait a little longer to gauge how tired I am before I commit to any specific specialty!
 

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Oh, and the specific FM/EM program that I am familiar with is at UTenn.

This program is a fellowship for FM trained physicians who have completed their residency. I may have misunderstood you, I thought you were interested in combined EM/IM or EM/FP residency programs. As someone previously said, if you want to do EM, do an EM residency; this fellowship route at UT, despite the shiny spin they may put on it, is likely filled with people that for whatever reason did FP out of med school then decided to do EM, and need to get specific training to get a good job.
 

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If a plan is futile, the only good advice is to point that out.

(I'm not saying it is, I know nothing about FM/EM. Perhaps try the EM Residency forum? You could also ask in the FM arena if they would be willing to cover for someone who is "also an EM physician" in a group practice)
Ahhh Jeebus, good to hear from you again! People were starting to take the other conversation down a pretty dark which is not where I think either of us was heading...such is life in the forums I suppose. I agree, if a plan is futile that would be the only good advice. But I hardly think that applies to this situation (which I know you already said you're not saying it does)...I'm only saying that again, it's not like these programs sprung up last night. And to suggest that they are futile is, as I said earlier, to suggest that they (all who are in them, run them, and have completed them) are all under some mass delusion....and that's pretty damn arrogant coming from a med student.
 

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You may indeed find a larger, well established group that would welcome a part-time physician to join them, but you mentioned that you might be interested in starting your own group, which I think you would find to be incredibly difficult. Even if you worked a clinic, you might find you have been relegated to the more urgent care, last minute appointments as with the rotating schedule you will have to maintain in the ED, you will find it hard to maintain set office hours. This would make it more difficult for continuity patients to get an appointment with you.
Why would I find it so difficult? The situation is the same. Obviously I would have a minority share in the practice in either case. And why do I need to maintain set office hours, obviously this in and of itself is impossible given the rotating schedule of EM physicians...but....it's not like your schedule from day to day, so you can still be organized enough to give your availability each month or at least every 2 weeks...though at the hospital where I work it's monthly rotations, but I don't know if this is standard.



IF a surgeon or OB works 80+ hours (which I will challenge you that most attendings do not (or at least strive not to) work for "most" of their career) they do so often out of necessity due to the time intensive nature of their patients. If you do an extended operation on a patient and they do poorly post-op, requiring your immediate attention, you will definitely rack up the hours but these hours are spent on a limited number of patients that require significant care. I doubt these surgeons are aiming to work 80 hours a week--if they hit 50 hours in a week and the work is done, the work is done. They do not start hunting for more patients to add another 20-30 hours of work, which is what you are proposing to do with your ER/clinic practice.
That's interesting, because I have yet to meet a practicing surgeon or Ob physician who works less than 60 hours/week. I say 60 instead of 80 because I also know several EM physicians who only work 40 hours per week, which still leaves the minimum 20 hour window that we are discussing. So if you do, then I'd love to hear about their practice and how they manage to keep such reasonable (given the specialty) hours. And I "propose to do" it as you say not for some ego boost or to be able to say "look at me, this I have done!" I will do it because that's what's important to me.

All I and some others are doing is to caution you not to overestimate your work capacity. Maintaining the fervent schedule in two seperate specialties is admirable, but is going to require more than 80 hours spent in the ED/clinic. In order to be a good (or even a competent) physician, you will need to stay current on the issues relevent to your field. You will have to do continuing education. You will be reading journals. Do you have any idea how time intensive staying current and on top of you game as both a practicing EM and FP physician will be? Not to mention you did not address other logistic issues such as malpractice, call, availability to your clinic patients (you CAN NOT expect to just dump all off hours emergencies on your partners. Would you encourage your family member to go to a FP that is never, ever available save for the one or two clinic shifts they may work a month? How about a FP that comes in to work clinic after staying up all night in the ED?) Residency is temporary, and no one does that work for the length of their career. I admit I am not an expert on this topic, as I did not complete a combined residency, but from what I do know about these training programs they are to provide these physicians with a more in-depth, complete skill set and knowledge base to have a more in-depth practice, not to set them up to have two completely seperate careers.

I didn't respond directly to the other logistics issues because I was hurriedly trying to summarize by saying "group practice", as I said in my OP, because I had to go to class. But malpractice is not an issue. I mean it's an issue of course, but it's not like malpractice insurance would be unique to my situation...I would have to have it regardless of being there for one hour or 100 hours, so I'm not understanding the point of your question. 1.) I would not be "dumping" them on my partners, they would be the ones taking them if I wasn't there any way! 2.) Most (again, in my admittedly limited experience of talking to and shadowing internists) after hours calls are for consultation. If they are having an "emergency" they would end up seeing me anyway in the ED!
3.) As far as advising my family members...we clearly have very different background experiences. You seem to be under the impression that there is just a world of healthcare that is available to everyone and everyone has a multitude of options. Well, I don't live in that world. I didn't see a physician outside the ER until I was 18 and on my own in the military, and I can tell you authoritatively that this is true of most people who live in underserved areas. It is this type of area that I would want to lend my services. And, as I keep repeating, it would still be a group practice, so the fact that I was there 2-3 shifts per week (not month) would not stop these people from receiving healthcare. 4.) I'm not naive, I never said nor suggested that any additional work would be a cake walk, but you and your friend Amory act like it's impossible, or even near impossible. What about students who are successful in med school, despite being married with kids? What about people who moonlight, despite working 70 hour weeks during residency? People who go to med school but still have to work 30+ hours per week to live? If I listened to everyone who told me I "can't" do something I'd be on some street corner right now.

As for me, no--not decided yet. I figured (along with the advice I offer you) I will wait a little longer to gauge how tired I am before I commit to any specific specialty!
Well, good luck in your decision making!
 

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This program is a fellowship for FM trained physicians who have completed their residency. I may have misunderstood you, I thought you were interested in combined EM/IM or EM/FP residency programs. As someone previously said, if you want to do EM, do an EM residency; this fellowship route at UT, despite the shiny spin they may put on it, is likely filled with people that for whatever reason did FP out of med school then decided to do EM, and need to get specific training to get a good job.
I was talking about EM/IM, in which case my plan was to still have the credentials to eventually leave EM and open my own practice full time. But I also said that the FM residency followed by an EM fellowship was attractive. I think you all are missing the motive of a lot of people who do it. I think a lot of people try for it because it stills leaves a great deal of options. If you do EM then, of course there are options, but in FM there are options in pretty much every direction. And I'm saying this without too deep an interest in FM, not a bias. I always thought it was Internal with kids, which is why I steered clear.
 

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I wrote a long, drawn out post challenging some of your posts but decided to delete it. The fact is, nothing posted here will change your mind about this plan, nor will I change my mind about its feasibility.

Honestly, I do wish you well. I am a little envious of your enthusiasm and drive. As one of the med students you alluded to in your post that had to work 20-30 hours/wk in a healthcare job on the side to get by, I am admittedly a bit tired of wearing two hats--perhaps this is why I am skeptical about your proposed career. But of you can make it work, go for it.

To touch on your original question, I think you absolutely need a mentor, both an ED as well as an IM or FP attending. I'd also recommend you talk to someone in private practice and see what that really entails. Plus talk to someone in Urology--its a great field.

GOOD LUCK! :)
 

AmoryBlaine

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I wrote a long, drawn out post challenging some of your posts but decided to delete it. The fact is, nothing posted here will change your mind about this plan, nor will I change my mind about its feasibility.

Honestly, I do wish you well. I am a little envious of your enthusiasm and drive. As one of the med students you alluded to in your post that had to work 20-30 hours/wk in a healthcare job on the side to get by, I am admittedly a bit tired of wearing two hats--perhaps this is why I am skeptical about your proposed career. But of you can make it work, go for it.

To touch on your original question, I think you absolutely need a mentor, both an ED as well as an IM or FP attending. I'd also recommend you talk to someone in private practice and see what that really entails. Plus talk to someone in Urology--its a great field.

GOOD LUCK! :)


I'm glad someone jumped in on my side, although I wasn't really trying to fight...

To the OP, once again I would encourage you to try to find a mentor who is making this lifestyle work. I think Bitsy raised the best points so I won't repeat them. He is correct when he says that there is at this point 1 combined residency offered in FM/EM.

I have nothing invested in your final decision, I was just trying to offer some realistic advice about practice patterns. I certainly wasn't trying to portray myself as the national authority on the matter, although I might point out that you seem just as certain that this 50 hours in the ED + clinic work lifestyle is being practiced somewhere and I would most definitely challenge that assertion.

I mean let's face it, how many of us heard some version of this during our first two years of medical school...

"So my plan is do my residency in EM/IM followed by a Critical Care and then Infectious Disease fellowship. Then I will work at an academic center and split my time equally between teaching, ER shifts, and underserved outpatient HIV clinic. Hopefully I'll work in the ICU at least one month of the year so I'm sure the ED chief will understand and not schedule me during that time. Of course, I'll probably just work part-time for a few years so I can be with my kids but I'm sure that won't be a problem. Oh yes - there will also be the 4-6 months I plan to spend doing International Medicine in Africa each year."

I'm exaggerating of course, but my overall point rings true: you have to find a job.
 

Skills of House

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I wrote a long, drawn out post challenging some of your posts but decided to delete it. The fact is, nothing posted here will change your mind about this plan, nor will I change my mind about its feasibility.

Honestly, I do wish you well. I am a little envious of your enthusiasm and drive. As one of the med students you alluded to in your post that had to work 20-30 hours/wk in a healthcare job on the side to get by, I am admittedly a bit tired of wearing two hats--perhaps this is why I am skeptical about your proposed career. But of you can make it work, go for it.

To touch on your original question, I think you absolutely need a mentor, both an ED as well as an IM or FP attending. I'd also recommend you talk to someone in private practice and see what that really entails. Plus talk to someone in Urology--its a great field.

GOOD LUCK! :)
It's too bad you deleted it. I, like you, can be a lot more verbose than I intend when I write (I'm actually very quiet in person). But I definitely enjoy engaging in stimulating conversation (I refuse to give some of the women I've dated the satisfaction by saying that I like to "argue"!) I don't think it should be about trying to change someone's mind. It's simply about expressing your opinion. I respect your opinion...that's why I asked for it! As long as a person can express that opinion as an opinion and not a matter of absolute fact (unless of course it is) or as if they are an expert on the matter (unless of course they are)...then I see nothing wrong with expressing different opinions, even if it never changes the opinion of the other person. I mean you're right, nothing's going to discourage me from pursuing my goals to the extent that I believe I can, but reading you all's opinions alerts me to some challenges that I may not have considered, which is the whole point.
Yeah, I think I need a mentor also. Although, I do know several physicians in private practice. And it is in working with them that the notion of double boarding was born. And they were each giving back to the community through working either in a clinic or in a group practice. One was also a hospitalist and another a researcher. One also had his own church. So, I can assure you if the desire and skill are there, then it's more than possible. I spent most of my life in the inner city so that's part of the reason I have the desire. God willing I will continue to gain the skill. And I'm here to get people's opinion on the easiest course. And I too fit in the 'working med student' group, so I know about the multiple hats as well.
I love the prospects of urology, but I fear that type of specialization will greatly hinder the whole clinic possibility. It seems like an excellent field. Well I hope you'll post your decision about your specialty choice!
 

Skills of House

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I'm glad someone jumped in on my side, although I wasn't really trying to fight...

To the OP, once again I would encourage you to try to find a mentor who is making this lifestyle work. I think Bitsy raised the best points so I won't repeat them. He is correct when he says that there is at this point 1 combined residency offered in FM/EM.

I have nothing invested in your final decision, I was just trying to offer some realistic advice about practice patterns. I certainly wasn't trying to portray myself as the national authority on the matter, although I might point out that you seem just as certain that this 50 hours in the ED + clinic work lifestyle is being practiced somewhere and I would most definitely challenge that assertion.

I mean let's face it, how many of us heard some version of this during our first two years of medical school...

"So my plan is do my residency in EM/IM followed by a Critical Care and then Infectious Disease fellowship. Then I will work at an academic center and split my time equally between teaching, ER shifts, and underserved outpatient HIV clinic. Hopefully I'll work in the ICU at least one month of the year so I'm sure the ED chief will understand and not schedule me during that time. Of course, I'll probably just work part-time for a few years so I can be with my kids but I'm sure that won't be a problem. Oh yes - there will also be the 4-6 months I plan to spend doing International Medicine in Africa each year."

I'm exaggerating of course, but my overall point rings true: you have to find a job.
Well, in fact I don't personally know anyone who has completed the EM/IM program. But one of the physicians I shadowed before starting school was a hospitalist who averaged close to 50 (well 45-50) hours in the hospital, but still worked about 20-25 hours in an inner city clinic. I hear you about people with the 1000 aspirations of altruism. I just don't see how I come close to fitting in that category. Assuming I don't match in urology (and my interests stay the same of course) and I try to match EM/IM, we're talking about 25 hours in a group practice or clinic (and yes we're talking about medicine, so the paperwork alone practically doubles your workload...I get that) but I don't see why that has to be likened to the laundry list you described. Just out of curiosity, where do your medical interests lie at the moment?
 

JohnnyOU

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I have a mentor from the previous class... he's worthless.
You need one about as bad as you need a Big Chief writing tablet.
 

Tired

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I mean let's face it, how many of us heard some version of this during our first two years of medical school...

"So my plan is do my residency in EM/IM followed by a Critical Care and then Infectious Disease fellowship. Then I will work at an academic center and split my time equally between teaching, ER shifts, and underserved outpatient HIV clinic. Hopefully I'll work in the ICU at least one month of the year so I'm sure the ED chief will understand and not schedule me during that time. Of course, I'll probably just work part-time for a few years so I can be with my kids but I'm sure that won't be a problem. Oh yes - there will also be the 4-6 months I plan to spend doing International Medicine in Africa each year."

These are usually the folks who get their Step 1 scores back, and immediately start saying, "What are you talking about? I've always wanted to do Psychiatry . . . "
 
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