How to decide between ER and IM

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I think you will find this choice considerably easier after rotating in both of these specialties as a medical student.
 
The personality and workflow in the two specialties is completely different. I was very interested in EM as a medical student, but by the time I did rotations in both, I knew that medicine was more of the right choice for me.

There's one easy way to choose though: Simply ask yourself, do you prefer chess or checkers? If it's the former, medicine is more your style 😛
 
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I had intended to write a snarky comment but have since thought it better to bite my lip..

We'll see how this thread plays out
 
EM is way better.

Btw, no one in medical school or beyond calls it ER, I should qualify that with those that know about or are involved in any way in EM.

Also, this is more of an M2/M3 question than a pre-med question.

Little one you have so much more to do.
 
The specialty is EM but the physician is an 'ED physician'.

Do you want to be the jack of all trades? Do you want to run a private practice one day? Do you like shift work? Do you want to subspecialize? These are the questions you need to be asking yourself when you finish basic science and start your rotations. You have much to learn, young grasshopper.
 
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I think OP is actually a med student, despite the pre-med tag.
 
You don't have to. There are combined EM/IM programs. You can roll all the misery together in one nicely wrapped package.
Just go FM.
 
pietachok said:
op is a med student & legitimately seeking residency advice
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His status is listed as pre-med.

Given this thread and others posted by him ("will I get all the hot chicks when I get my MD?), its easy to see why I assumed he was still a pre-med student.
 
Honestly, they're very different fields. Just rotate in both fields, and if you still end up liking them both equally, then do EM/IM.
 
The real utility of those is honestly for academic careers or for being leaders in helping in continuing education. Most of those who do those paths don't do it for the utility, they do it for the personal satisfaction and gain in overall clinical knowledge that either field alone can't provide.
 
link2swim06 said:
EM/IM pays considerably less than EM alone.
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Also, this has no basis in reality considering there is no data out there at all on salaries of EM/IM graduates that I am aware of. Quite a few have leadership positions, so we have no clue how much these guys are making. 37% do both EM/IM and again, it depends on the area they work and other factors. So, no we do not know that EM/IM pays "considerably less than EM alone."
 
sylvanthus said:
Also, this has no basis in reality considering there is no data out there at all on salaries of EM/IM graduates that I am aware of. Quite a few have leadership positions, so we have no clue how much these guys are making. 37% do both EM/IM and again, it depends on the area they work and other factors. So, no we do not know that EM/IM pays "considerably less than EM alone."
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My point is if you are boarded in EM and spend a portion of your year as an IM doc you would be decreasing your salary because IM pays almost always less. Not to mention the 2 years of lost attending income during residency (which is easily 200K per year plus interest ).

Also, I'd guess more EM/IM people end up in academics which generally pays less (this is a guess).

I agree we don't have numbers....so it's possible I am wrong...but my conclusions above make me think I'm not.
 
Pretty much any personality can fit into IM. Type-A or "surgical" personalities are all over cards, pulm/CC, and even hospital medicine. Touchy-feely, motherly types seem to flock to gen medicine/primary care. And everyone else on the personality spectrum can find something they enjoy well enough. Theres really a niche for everyone.

EM, on the other hand, is only for the thick-skinned. They garner a large number of haters on a regular basis, so you should really only consider it if you have a strong personality or simply DGAF about what other doctors or patients think about you. If you're the type that can ignore the noise, then its a great (and well-compensated) field.

I have a huge amount of respect for ED docs, but they are truly the most shat upon physicians in medicine.
 
link2swim06 said:
My point is if you are boarded in EM and spend a portion of your year as an IM doc you would be decreasing your salary because IM pays almost always less. Not to mention the 2 years of lost attending income during residency (which is easily 200K per year plus interest ).

Also, I'd guess more EM/IM people end up in academics which generally pays less (this is a guess).

I agree we don't have numbers....so it's possible I am wrong...but my conclusions above make me think I'm not.
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Again, it totally depends. If you are splitting your time between EM and IM, are you staffing a community, private hospital ICU and the ED? If thats the case, the pay is more than likely the same compared to doing EM at that same hospital fulltime. Or are they working as a hospitalist and ED doc? Pay then would likely be lower than ED alone. EM and IM at an academic center compared to EM at an academic center? Likely negligible difference in salary. In charge of the clinical decision unit, or doing something similiar to what Scott Weingart (spelling?) does? Toss in leadership roles and who knows how much extra admin duties may pay or how many extra hours it may add. Plus, some areas of the country hospitalists make bank.

So, there are far too many variables to say for certainty that doing both pays less.
 
Scott Weingart is triple boarded, not double boarded. I don't know any hospitals that staff icu's with non-critical care trained physicians unless you're talking units where anyone can have a patient (in which case they would also be dealing with floor patients). So I think you're confusig EM/CC with EM/IM when trying to say the critical care portion would make things equivalent. I agree that doing leadership roles or extra duties will make up for it. If you're doing it just for the knowledge base and just wanna be a worker bee, EM is going to generally net you more. If you manage to carve out a nice niche, then you can make more money doing whatever it is you want.

Weingart likely makes a lot less than the average community ED doc simply because he's in NYC (low pay high tax region) working in academics. He just happens to be an extremely good, widely known EM/IM/CC guy who has a very wide audience, is a great educator of residents and attendings, and is an all around nice guy from what I've seen. If he makes any significant money, it's going to be from the lecture circuit. The extra board certifications just means that he's gonna talk on critical care portion of our field as opposed to general EM
 
Rendar5 said:
Scott Weingart is triple boarded, not double boarded. I don't know any hospitals that staff icu's with non-critical care trained physicians unless you're talking units where anyone can have a patient (in which case they would also be dealing with floor patients). So I think you're confusig EM/CC with EM/IM when trying to say the critical care portion would make things equivalent. I agree that doing leadership roles or extra duties will make up for it. If you're doing it just for the knowledge base and just wanna be a worker bee, EM is going to generally net you more. If you manage to carve out a nice niche, then you can make more money doing whatever it is you want.

Weingart likely makes a lot less than the average community ED doc simply because he's in NYC (low pay high tax region) working in academics. He just happens to be an extremely good, widely known EM/IM/CC guy who has a very wide audience, is a great educator of residents and attendings, and is an all around nice guy from what I've seen. If he makes any significant money, it's going to be from the lecture circuit. The extra board certifications just means that he's gonna talk on critical care portion of our field as opposed to general EM
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You can work an ICU at small hospitals with just IM training.
 
sylvanthus said:
You can work an ICU at small hospitals with just IM training.
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if a hospital is small enough that they can't have an intensivist, is that person in the icu the sole icu provider? And is there really enough volume to get them a high salary? I haven't seen that format in any of the places I've been to, honestly. Besides that, you can make the same point that you can work an ER at a small hospital with just IM training or just midlevel training. It's possible, but you're not talking high paying ER jobs in that case.

I guess my point is that you're suddenly throwing in Critical Care as a subspecialty, and that's a field onto itself, and really shouldn't be used to compare salaries. Apples and Oranges.


Honestly, if you look at pure patient care, then community EM pays more than any mixed branch of EM simply because it's currently near the higher end of the pay spectrum except for a few surgical specialties. It pays more than IM and CC, period, if you take out all other factors. And if you go academics, the argument is suddenly moot because then you're not on the higher end of the pay spectrum. There are a lot of other factors that will affect your pay even more. And if you niche yourself, then it doesn't matter if you're EM or EM/IM, the niche can get you even more money. NOw yes, the EM/IM guy in Florida will make more than the pure EM guy in NY, but again, applies and oranges.

In the end, pay difference should not be the deciding factor between EM/IM and EM. The only question is, what do you want out of your career, and can you get it without doing a dual residency. If you can accomplish what you want to without a dual residency, you honestly should. If you can't, then suck it up and do extra residency and work a couple years less as an attending. It will be worth it, and if you really relaly want the extra money, niche it up (most people don't care that much because you will live comfortably no matter what if you're careful with money).
 
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Rendar5 said:
if a hospital is small enough that they can't have an intensivist, is that person in the icu the sole icu provider? And is there really enough volume to get them a high salary? I haven't seen that format in any of the places I've been to, honestly. Besides that, you can make the same point that you can work an ER at a small hospital with just IM training or just midlevel training. It's possible, but you're not talking high paying ER jobs in that case.

I guess my point is that you're suddenly throwing in Critical Care as a subspecialty, and that's a field onto itself, and really shouldn't be used to compare salaries. Apples and Oranges.


Honestly, if you look at pure patient care, then community EM pays more than any mixed branch of EM simply because it's currently near the higher end of the pay spectrum except for a few surgical specialties. It pays more than IM and CC, period, if you take out all other factors. And if you go academics, the argument is suddenly moot because then you're not on the higher end of the pay spectrum. There are a lot of other factors that will affect your pay even more. And if you niche yourself, then it doesn't matter if you're EM or EM/IM, the niche can get you even more money. NOw yes, the EM/IM guy in Florida will make more than the pure EM guy in NY, but again, applies and oranges.

In the end, pay difference should not be the deciding factor between EM/IM and EM. The only question is, what do you want out of your career, and can you get it without doing a dual residency. If you can accomplish what you want to without a dual residency, you honestly should. If you can't, then suck it up and do extra residency and work a couple years less as an attending. It will be worth it, and if you really relaly want the extra money, niche it up (most people don't care that much because you will live comfortably no matter what if you're careful with money).
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Agreed, pretty much need to have a good reason for doing EM/IM, otherwise it could very well be wasted time. For me, it is the ability to do EM/IM/CC in 6 years at the program I am at. Then my plan is to divide my time between the ED and the ICU. My back-up was to do EM and then CC fellowship. However, the 6 year program allows me to finish all 3 in about the same time as I would have completed EM and CC (1 year longer if doing a 3 year EM program), gives me additional IM knowledge that may be beneficial in critical patients, do not have to apply for the limited CC fellowship spots that EM grads can apply to (no more than 25% of IM CCM spots can go to EM grads apparently at many if not all programs), and do not have to move the wife for fellowship since we can just stay where we are at. So, in the end the path, I think, will be a good choice for me.

However, for those thinking about this path, make sure you have a valid reason for wanting to do both EM and IM, else you may regret the extra time in the future when you EM buddies are all graduating.
 
Rendar5 said:
The real utility of those is honestly for academic careers or for being leaders in helping in continuing education. Most of those who do those paths don't do it for the utility, they do it for the personal satisfaction and gain in overall clinical knowledge that either field alone can't provide.
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This is the reason I've started considering EM/IM. I would ultimately love to be a clerkship director and/or teach a clinical skills course alongside EM, and it's my understanding that while I can definitely do this with an EM degree, the IM portion is just helpful for building a broader knowledge base, particularly about the management of chronic conditions.
 
Raryn said:
The personality and workflow in the two specialties is completely different. I was very interested in EM as a medical student, but by the time I did rotations in both, I knew that medicine was more of the right choice for me.

There's one easy way to choose though: Simply ask yourself, do you prefer chess or checkers? If it's the former, medicine is more your style 😛
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Would you mind sharing what made up your mind with the rotations? I'm a second year interested in EM and I haven't gotten around to shadowing our EM docs yet.
 
Akali said:
Would you mind sharing what made up your mind with the rotations? I'm a second year interested in EM and I haven't gotten around to shadowing our EM docs yet.
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I actually like the continuity of care, seeing what happened to my inpatient's day to day. And I enjoyed working through the patient's systematically, having the time to go through it and gather more data, and yes, I even enjoyed rounding.

On the other hand, in the ED you get a lot more completely undifferentiated patients with very limited information. There's no one lower down to filter out at least some of the bull****, it's your job. You often make the decision of who needs to stay and where they need to go, but it's a different satisfaction doing that compared to actually "tuning up" that patient over a few days.

Both involve problem-solving but the pace of work is completely different. ED providers work very few hours (relatively speaking) at a frequently frantic pace. Internists are slower, usually more methodical, and the culture is just different. Yes, as time goes on and one is seeing 30+ patients a day in clinic or 20 inpatients and also doing their best to "move the meat", there's similarities in the workflow, but it is still fundamentally different. Different subspecialties emphasize different things as well, but even the cardiologist cowboy who is doing his best to turn himself into primarily a proceduralist is an internist.

As I said in my initial post, one isn't better than the other. But they're different enough that having experience in both should make it pretty clear for 90% of students which they prefer. (Or, if they prefer neither, which of the umpteen other specialties they prefer)
 
it's nice to see someone mention they enjoy rounding. I only ever see complaints about it and began to think maybe I'm missing something.
 
Anastomoses said:
it's nice to see someone mention they enjoy rounding. I only ever see complaints about it and began to think maybe I'm missing something.
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Rounding is no bueno.

Usually people who enjoy rounding also love living at the hospital.
 
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