How Competitive Is The Internal Medicine-Emergency Medicine Combined Residency?

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16846

Does anyone know how competitive the Internal Medicine-Emergency Medicine residency's are compared to just Emergency Medicine alone? Any information is appreciated. Thanks.

Mike
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Why in gods name would you waste an additional two years in residency when you could do straight ER and make > 200,000 a year? Oh, it is not enough for you to see the diabetic with ESRD, psychosis etc. in the ER you really want to see them over and over again in medicine clinic?!

Common. It sounds good on paper but you will not get a better job or make more money. In the end you will practice ER because it affords a better lifestyle and all your medicine training will be wasted. If you are really bent on a medical subspecialty then do internal medicine and do not waste your time in ER.
 
I've heard that IM/EM is pretty competetive simply because there are so few programs around. According to JAMA, there are 9 IM/EM programs in the US, versus the 107 programs for IM/Peds and 127 programs for EM. 91.4% of the IM/EM residents are US medical graduates, versus 87.9% of EM residents being US medical graduates. Basically, I think that you will just have to be very flexible in terms of where you do your EM/IM residency if you really want to do EM/IM since you might not be able to match in the part of the country that you would like to be in.
 
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Originally posted by oldandtired
It sounds good on paper but you will not get a better job or make more money. In the end you will practice ER because it affords a better lifestyle and all your medicine training will be wasted. If you are really bent on a medical subspecialty then do internal medicine and do not waste your time in ER.
Click to expand...

Well, I guess I am wasting my time. Great. wish I knew that before I entered into a 5 year commitment. Damn, wish I read this thread sooner.

First of all. If you want to practice EM, you are more qualified than other applicants and therefore have an easier time getting a job and with the double board you command more money.
With the extra training you will feel more comfortable caring for patients in the clinic, on the floors or in the ED.
It is nice to have a strong understanding of diseases such as heart failure, diabetes, SLE that you would not learn in straight EM. And when you are on medicine you are more efficient than your IM counterparts.
please PM me if you hav any questions.
 
" have an easier time getting a job and with the double board you command more money. "

ER job market is pretty open so I do not think you will need an advantage. No private or academic group of ER physicians will pay you more money for being boarded in medicine!

"With the extra training you will feel more comfortable caring for patients in the clinic, on the floors or in the ED.
It is nice to have a strong understanding of diseases such as heart failure, diabetes, SLE that you would not learn in straight EM"

But will you need this extra training as 99%+ of ER physicians practice without this training and do just fine. With that argument, hell why not do a couple years of surgery and psych wihile you are at it so you can really understand those problems.

Dude, get out of this wateful track and do straight ER. Trust me, you will never want to practice general medicine.
 
my advisor did both (not combined). spends his time soley in er now after years previous where he also had his own practice. he says like with everything, skills atrophy if you don't use them. i love him, but based on my observations, he's right. he's like a straight emergency physician; the IM dept. still second guesses his decisions. dunno, maybe a combined res is different...
 
Common sense and experience makes my statements true. These useless combined programs were created by academics with too much time on their hands to get extra cheap labor. The victims are the medical students who can not decide on a field and think that a dual field will make them better and more complete doctors. Give me a break. Residency is a indentured servitude.

Its a job that you will learn in how to do in residency. You dont need to know specifics about CHF, MI, etc. as an ER doc. Just know how to stabilize them and where to send them.
 
The combined IM/EM residency is 5yrs. So you save a year with the combined program vs doing 2 seperate residencies. I believe IM/EM is a valuable training opportunity for those who desire the greater medicine training. I agree that being dual boarded may not necessarily bring in a greater salary. In fact, if the person is actually splitting his/her time between IM and EM, he/she will probably make less than straight EM because the IM jobs don't pay as much. However, IM/EM may be valuable in an academic setting where being dual boarded would be viewed in a favorable light. Also, being dual boarded creates a world of opportunities. The IM/EM grad can do MORE training. Think about it -- you can go on and do an ID fellowship combined with a toxicology fellowship and become a chemical and biological terrorism expert. You can then go on to complete an EMS fellowshp to help with emergency preparedness for chemical and biological terrorism. After finishing a pulmonary fellowship you can help treat those patients with lung injury from exposures to toxic inhalants from the biologic and chemical terrorism. Then after your heme onc fellowship you can deal with the cancers the patients develop from the nuclear exposures and then you can manage their vents and pressors when they're end-stage after your critical care fellowship.
 
Originally posted by jawurheemd
The combined IM/EM residency is 5yrs. So you save a year with the combined program vs doing 2 seperate residencies. I believe IM/EM is a valuable training opportunity for those who desire the greater medicine training. I agree that being dual boarded may not necessarily bring in a greater salary. In fact, if the person is actually splitting his/her time between IM and EM, he/she will probably make less than straight EM because the IM jobs don't pay as much. However, IM/EM may be valuable in an academic setting where being dual boarded would be viewed in a favorable light. Also, being dual boarded creates a world of opportunities. The IM/EM grad can do MORE training. Think about it -- you can go on and do an ID fellowship combined with a toxicology fellowship and become a chemical and biological terrorism expert. You can then go on to complete an EMS fellowshp to help with emergency preparedness for chemical and biological terrorism. After finishing a pulmonary fellowship you can help treat those patients with lung injury from exposures to toxic inhalants from the biologic and chemical terrorism. Then after your heme onc fellowship you can deal with the cancers the patients develop from the nuclear exposures and then you can manage their vents and pressors when they're end-stage after your critical care fellowship.
Click to expand...

Dont forget a geriatric fellowship so you can take care of yourself because you will need one yourself after you are done with all those. 😀
 
"The IM/EM grad can do MORE training. Think about it -- you can go on and do an ID fellowship combined with a toxicology fellowship and become a chemical and biological terrorism expert. You can then go on to complete an EMS fellowshp to help with emergency preparedness for chemical and biological terrorism. After finishing a pulmonary fellowship you can help treat those patients with lung injury from exposures to toxic inhalants from the biologic and chemical terrorism. Then after your heme onc fellowship you can deal with the cancers the patients develop from the nuclear "


Gosh, golly, then the IM/EM grad can go on and get a PhD in chemistry and not only stabilize, admit and treat the CHFers but also invent drugs to cure them. Hell why not do a surgery residency so you could consult yourself in the ER for every medical and surgical problem. GIVE ME A BREAK!! This is getting out of hand.
 
Another benefit to doing the combined residency is the ability to, after graduation, practice both internal and emergency medicine.

It IS possible for some folks to actually like both practices, and to want to do both afterward. A previous poster referred to the financial difficulty in doing so, and that's valid. However, I do believe that since most of what rolls into the ED is internal medicine-based, the combination makes a lot of sense. And the EM training creates a stronger IM physician as well.

Then again, if you happen to be old and tired, then perhaps any residency will do as long as it's as short as possible. It all is what we make of it anyway, right?
 
To OP, considering some other posts on this thread:

Sometime the harder, more difficult way of accomplishing something is the better way to go, so don't discount the merits of combined residencies. Easier does not equal better.
 
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" Easier does not equal better"

On the same token, harder in terms of combined residencies does not equal better either
 
Hey I just did a search on oldandtired (since I am a 4th year with oodles of time on my hands and I can do things like that) and it appears that the only specialties that he has anything nice to say about are surgery/path/and rads. Apparantly all we need do with a patient anymore is image them and then cut out the problem.
Perhaps interventional radiologists have devised a way to image the HIV virus in patients and, under CT guidance, cut the virus out of the body.
Or perchance the era has finally come when we can send the "gomers" who apparantly have no value to our friend oldandtired to the radiologists so that they can image their diabetes and then the surgeons can cut out the insulin deficit.
What a wonderful world we will all live in. Everyone flood into radiology so we can all learn what its like to be a real doctor who has a real impact. Unlike all the rest of us clueless IM/FP/ER/Neurology/Psych docs who do nothing in the hospital other than rounding, thinking about rounding, and then hunting zebras.
 
If you do not like my opinions then ignore them. That is the beauty of open forums like this one.



You said it better than I could - "Everyone flood into radiology so we can all learn what its like to be a real doctor who has a real impact. Unlike all the rest of us clueless IM/FP/ER/Neurology/Psych docs who do nothing in the hospital other than rounding, thinking about rounding, and then hunting zebras"

AGREE 100%
 
Originally posted by oldandtired
You said it better than I could - "Everyone flood into radiology so we can all learn what its like to be a real doctor who has a real impact. Unlike all the rest of us clueless IM/FP/ER/Neurology/Psych docs who do nothing in the hospital other than rounding, thinking about rounding, and then hunting zebras"

AGREE 100%
Click to expand...


Atelectasis vs infiltrate
Must correlate clinically.
Must be nice to hedge all the time.
 
I did 5 years of EM/IM and don't regret a minute of it. I love both fields and the time went by very fast. I knew I wanted to do academics and after finishing I am doing both academic EM and IM. As a combined resident It is clear we have an advantage getting the jobs we want or molding our career. EM and IM complement themselves, as far as knowledge base, much more that say Med/Peds (which is 4 years?.. go figure). I would get exremely bored if I were not doing both, and many of my fellow colleagues I know are the same. However please employ this advice with caution as clinical correlation is recommended!

On a side note, EM/IM is more competative than EM and much more competative than IM.

SH
 
SHOX, would a Step 1 score of 223 be competitive enough for EM/IM combined? I'm highly interested in specifically the combined program, as I love both fields, and like you, I would be bored doing just one or the other. But since you say IM/EM is even more competitive than just EM, I'm not sure if my step 1 score can cut it. I recently started MS-3, and so I don't really have any clinical grades yet (although I'm giving a lot of effort in my rotations!). (no preclinical honors though)

I'm planning to take a year off for research, perhaps with one of the prestigious fellowships, but if not, then at the very least at my medical school. Would that help me any for IM/EM?

Thanks for the advice.
 
I works/ teach in the ED with EM residents and occasionally cover the IM ward service as well. I also do Research and Administrative work 2 days per week. A number of our grads do EM and Hospitalist- mostly private, some academic. Some go on to fellowship (ie. ICU).

A 223 should be enough to get your foot in the door at all programs. From there clinical scores (3rd/ 4th years) help if they are good as well as a LOR from well known people in their respective field. Research helps some. Having varied interests and a real life outside of medicine helps. I know at our program the interview counts for a lot! Our philosophy is we would rather work with someone who scores a 210 and has a personality than take someone with a 250 who is a booksmart automaton (plenty of these folks out there!).

SH
 
sorry for this generalization but most ER docs suck. they do not do enough IM and they end up admitting all this BS. part of the problem is that they are swamped with patients and could use PA's or NP;s to help out with the easier patients.
 
That's funny because during the 5 years of my residency (EM/IM) in medicine morning report, I would hear complaints like yours about the ED. My reply was simple: wait until you practice in the real world (as opposed to an academic center with an EM residency). In community EDs without a residency, EM is practiced quite differently... and if you do not like the "lack of a work-up" you are getting now, just wait till you see what's out there. Many of my IM colleagues who have graduated, whom I have kept in-touch with, and have gone on to smaller hospital settings have come to realize how good they had it in residency where the ED residents actually, believe it or not, did a pretty good job. I can't argue with the need for more IM training among ED residents (please do not send me hate mail but it's true).

Many EDs already have PAs or NPs working in FT. Why are EDs so busy... we among many other things in small part it is due to a failure of primary care in addition to the american need for a quick fix/ 24-7 quickie-mart mentality... not to mention all the extensive work-ups we do (just kidding).

SH
 
I don't know if someone mentioned this, but I'll just add, an IM/EM residency gives you a better foundation to go into a different fellowship (after residency) if you practice emergency medicine a few years then find out is sucks ****.
 
Originally posted by radonc
sorry for this generalization but most ER docs suck. they do not do enough IM and they end up admitting all this BS. part of the problem is that they are swamped with patients and could use PA's or NP;s to help out with the easier patients.
Click to expand...

That was a wonderfully astute statement........"Sorry for the generalization but here is one".....

This is like saying "No offense but all rad onc docs can do is use one antiquated treatment modality to unsuccesfully treat one type of disease"

And like your universal negative it just cannot be argued with.

As I said you are wonderfully astute.

Bravo :clap:
 
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