If there were more FM and EM joint residencies (like EM/IM) options available would you do both?

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One of my best friends from my high school days is a music teacher. Despite him going to one of the best schools in the country for his field, it still took him 4-5 years to find ANY sort of full time position.

I made more money than him as a resident.
 
KeikoTanaka said:
Also, after speaking with many physicians, I found that burnout is more so due to people who maybe aren’t cut out for the intensity of work of medicine going into medicine for reasons such as money or family influence or prestige... the same people who are burnt out would probably get just as burnt out answering telephones for 40 hours a week...
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Blaming the physicians instead of the system for burn out... Forget EM or FM, I see a bright career in hospital administration ahead of you.
 
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enalli said:
Blaming the physicians instead of the system for burn out... Forget EM or FM, I see a bright career in hospital administration ahead of you.
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I love the premeds that post on here stating that they have an "interest in healthcare administration". They might just as well say right-out: "I am an @sshole", or at least "I have an interest in being an @sshole."
 
enalli said:
Blaming the physicians instead of the system for burn out... Forget EM or FM, I see a bright career in hospital administration ahead of you.
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Never once did I blame physicians or administration, but rather blamed personality characteristics of individuals. Everyone in every profession gets burn out. Do anything for 15 years straight and you’ll wanna shoot yourself lol
 
KeikoTanaka said:
Never once did I blame physicians or administration, but rather blamed personality characteristics of individuals. Everyone in every profession gets burn out. Do anything for 15 years straight and you’ll wanna shoot yourself lol
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So very, very wrong. But hey; don't let that stop you from telling us all how it is.
 
Apollyon said:
Wrong.
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I did preface this in my previous comments that if you go into something for the wrong reasons (money, family influence, prestige) then youre more likely to get burnt out
 
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The fact that EM physicians have a high burnout rate does not mean that people don't get burned out in other careers. Yes, a person answering phones for 40 hours a week would likely hate his/her job and want to hang him/herself. So what? You can always find something worse to compare something to.

Acknowledging that EM has a high burnout rate is the first step in an EM doctor realizing that he/she needs to take concrete steps to minimize this burnout. As Captain Planet said, "knowing is half the battle."
 
KeikoTanaka said:
I did preface this in my previous comments that if you go into something for the wrong reasons (money, family influence, prestige) then youre more likely to get burnt out
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Actually, no, you are wrong on that. Sure, people will get burned out in fields they chose for external reasons, but it's often the best, most dedicated, and most idealistic physicians that get the most burned out.
 
miacomet said:
Actually, no, you are wrong on that. Sure, people will get burned out in fields they chose for external reasons, but it's often the best, most dedicated, and most idealistic physicians that get the most burned out.
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I went into medicine for all the right reasons.
I get pretty toasty at times.

It was at the start of this calendar year that I started looking at work as "Just let me put in my shift and get the hell out of here so I can go back to my home, my wife, and my pets. Eff all y'all."
 
KeikoTanaka said:
burnout is more so due to people who maybe aren’t cut out for the intensity of work of medicine going into medicine for reasons such as money or family influence or prestige
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Here's some advice to keep in mind as you start your medical career:

Stop thinking about burn out as something that happens to "those" people--the ones who aren't cut out for the job or who go into it for the wrong reasons. Burn out is endemic to medicine and it happens to all of us to varying degrees. If you have this attitude before you even set foot in medical school, it will hit you way harder when you inevitably become burned out. You will be miserable, you will be in denial, and you won't know how to fix it because burn out wasn't supposed to happen to you (after all, you were cut out for the job and went into it for all the right reasons!). If by some miracle you never get burned out, then you at least owe it to your colleagues to not be a part of the problem--if you hold on to the above attitude, you will consciously or unconsciously diminish the struggles that many of your fellow physicians will go through.
 
To get this discussion back on track, working in two different specialties is difficult. The sheer amount of required reading to keep up in emergency medicine already eats up a substantial part of my time. I can't imagine if I also had to stay up to date on all the latest guidelines regarding health maintenance. Some of the other valid reasons for not pursuing dual residency certifications have already been discussed here: missing out on potential income and difficulty finding an employer who will allow you to work part-time. There are certainly reasons to pursue residency training in internal medicine as well as emergency medicine, mostly so that one can go into academics or pursue fellowship training such as cards. Historically, the dual path was the only way to become critical care boarded. Family Medicine, however, does not offer any fellowships which would compliment a critical care / emergency medicine / inpatient track.
 
RustedFox said:
I went into medicine for all the right reasons.
I get pretty toasty at times.

It was at the start of this calendar year that I started looking at work as "Just let me put in my shift and get the hell out of here so I can go back to my home, my wife, and my pets. Eff all y'all."
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How many years have you been practicing EM for?
 
I am sitting in a FSER now drinking coffee and getting ready to watch the basketball game.

You choose your work, you choose your environment.... There are options
 
RustedFox said:
Six.
Remind me later on, and I'll post about the twelve or so items that pissed me off today, as they're pretty representative on the whole as to why EM can really suck hard.
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Reminder!
 
EM combined residencies are a colossal waste of time. I feel the same way about them as I did about those IM/Peds residencies. Make up your mind already. Talk about decision paralysis.. just pick one and own it.
 
Groove said:
EM combined residencies are a colossal waste of time. I feel the same way about them as I did about those IM/Peds residencies. Make up your mind already. Talk about decision paralysis.. just pick one and own it.
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I asked one of the med/peds people what they were going to do with it. He said he was interested in congenital heart disease, and, with patients routinely now living to adulthood, he wouldn't have to stop seeing them at 18 or 21. That's the only good answer I've ever heard.
 
Apollyon said:
I asked one of the med/peds people what they were going to do with it. He said he was interested in congenital heart disease, and, with patients routinely now living to adulthood, he wouldn't have to stop seeing them at 18 or 21. That's the only good answer I've ever heard.
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They probably do better at Allergy as well.

As for adults with congenital heart disease, the ACC has that covered these days:

ACHD Training Program Directory - American College of Cardiology
 
Apollyon said:
I asked one of the med/peds people what they were going to do with it. He said he was interested in congenital heart disease, and, with patients routinely now living to adulthood, he wouldn't have to stop seeing them at 18 or 21. That's the only good answer I've ever heard.
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They always have these seemingly well thought out, logical reasons for choosing it, and then you check back on them in a few years and they are either working 100% as a hospitalist or 100% in a peds clinic somewhere in town. (Usually, the former...)
 
Groove said:
They always have these seemingly well thought out, logical reasons for choosing it, and then you check back on them in a few years and they are either working 100% as a hospitalist or 100% in a peds clinic somewhere in town. (Usually, the former...)
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He was the only one. I would tease some of them by asking, "what's the difference between you and FM?" Generally, they didn't like that.

Edit: this is from after my time, but a minority of Duke med/peds are doing something combining both.
 
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Apollyon said:
Yeah, my experience is from 15 years ago, now.
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First I heard about it was 4 years ago, so its still pretty new. GHS was just getting their first one of those.

Apollyon said:
He was the only one. I would tease some of them by asking, "what's the difference between you and FM?" Generally, they didn't like that.
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They REALLY hate it if the asking if FM.

"So you did an extra year of residency to be my equal... except you don't do OB".
 
parslea said:
Reminder!
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I'll probably compose something and post it in a separate thread.
Not long ago, I posted a humorous (but anecdotally accurate) physical exam of a patient sent to my ED by a NP for "rule-out internal bleeding" after an MVC several days prior to visit that got a good amount of laughs, primarily because the patient was so fat that it obviated the "EMERGENCY!" ultrasound that the NP was ordering.
I figure I can do that again. Cheaper than therapy.
 
I'm going to go against the grain here, and say that I think joint EM residencies are a great idea, if you're interested. I didn't think that when I was 26 and a 4th year medial student. Back then, I thought it was a stupid idea. But as someone who went back and did a fellowship mid-career, man, it sure would've been if that had already been built in. So for those who are interested and to whom this seems like a good idea, you are correct. If you have the interest and you want two specialties, this is a great way to do it. Yes, obviously, there's a time commitment that is absolutely not worth it, if you're not interested. But if you are interested, or might be after working in EDs for 5-10 years, then it very well might be worth it. It prevents the pidgeon-hole effect we face in EM, where you're limited to one work setting, one patient population, one work schedule in an EMTALA-based environment, hyper-frenetic speed, ruled by strangulating and invisible non-physicians who have daily expectations of the impossible and who are indifferent to your plight.

Plus,

"Haters gonna hate."-Proverbs 9:8
 
Dr.McNinja said:
I learned a nugget on SDN once, so I'll repeat it. "You can't be a stem cell forever, you've got to specialize eventually"
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You have one skill set. Is there are problem if I have two?
 
Birdstrike said:
You have one skill set. Is there are problem if I have two?
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You have to maintain the second one. Not impossible by any means, but it is a decent burden - especially since the majority of people with 2 separate medical skill sets rarely use both.
 
VA Hopeful Dr said:
You have to maintain the second one. Not impossible by any means, but it is a decent burden - especially since the majority of people with 2 separate medical skill sets rarely use both.
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Yeah, it's like someone said above, why most people can't play two pro sports at the same time. Many, many pros could be a pro in one of several sports, but not at once.
 
Apollyon said:
Yeah, it's like someone said above, why most people can't play two pro sports at the same time. Many, many pros could be a pro in one of several sports, but not at once.
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Maybe Birdstrike is the Bo Jackson of medicine?
 
So I'm a little late to this discussion (cramming for boards the past couple weeks). What I've noticed here is a lack of a response from someone who has actually done a combined residency, so this comes from someone who is a few weeks from finishing an EM/IM residency (and in other crazyness, just given a 10 year trophy from sdn forums)

Is doing a combined residency the best financial decision? Of course not. You know what else is a poor financial decision? Med school. As wide-eyed/naive as it sounds, there are some things that are worth more than money. For those of us who choose to do a combined residency and are proud of it, we can deal with not attending salary for a few years. We didn't pick an extended program for the money.

Since MS3 I wanted to practice emergency medicine. Internal medicine was not something that I found terribly interesting. That being said, I wanted to do EM/IM ever since I got to observe the very senior residents in my program. I thought they were badassess. Literally capable of handling every situation that could come up in the hospitals. Running floor codes like a boss, placing their own chest tubes while on floor services, extremely smart, extremely competent, excellent teachers. I looked at them and decided that that is what I wanted to be. Interestingly enough, my wife decided she felt the same way, so she is impending graduation along with me (and I can personally vouch for her badassness)

Hopefully, as a soon to be outgoing PGY5, I have managed to live up to their legacy. What I can say is that I'm proud of my program. We are known and well respected in our hospital system, and in the surrounding systems that we visit. I don't think a single one of us would resent the extra training we have, or debate that we feel it augments our abilities in both fields. A decent amount of us are going on to fellowship, others are taking their attending jobs. Some will be practicing in both specialties, some will stay with just one for now. Many former graduates work at our institution in both fields, and are leaders in the administrative and educational levels.

I happen to resent the implication that we are not capable of practicing competently in two specialties. This is not a new concept. There are plenty of EM-CC people out there who practice both fields. Surgeons can be intensivists. As Birdstrike is here to prove, an ER doctor can be a pain management physician. Does it require having an even more expansive knowledge base? Sure. Can we keep up with two fields? I'd say as long as you actually practice in both you would be able to. No, if you don't practice internal medicine for 20 years and then try to get back into it you are going to have significant difficulty, but if you keep your skills in each field fresh, we absolutely can do it. I will vouch for having rotated at various other institutions, that I would put one of our residents up against any others in the EM or IM fields and expect them to not only hold their own, but completely exceed all expectations.

In the end, I can really only give one opinion, my own, based on only one residency program. I don't know what I would be like today if I went somewhere else, in a more traditional residency. All I can say is, with residency finally coming to a close, it has been a long and difficult path, but one I have been immensely happy with. If I had to go back five years, I wouldn't change a thing. I can't say that it is the right decision for anyone else, only that it was the right decision for me.

If anyone ever has questions regarding combined residencies and/or my experiences or future plans, feel free to hit me up.
 
VA Hopeful Dr said:
You have to maintain the second one. Not impossible by any means, but it is a decent burden - especially since the majority of people with 2 separate medical skill sets rarely use both.
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It's not as hard as you think.
 
engineeredout said:
As Birdstrike is here to prove, an ER doctor can be a pain management physician.
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So, being an ER doc is like being a marine? I mean, Birdstrike doesn't practice EM anymore. He's made no bones about it. So to say he's being "both" is disingenuous.

Yes, PGY5 residents are baller. But that's because they're basically like 2nd year attendings in most other residencies. It's like the 3 vs 4 year argument. You can tell a difference during the first year out, but not the 5th year out.
I know of many people who did EM/IM. I know of a couple that still do both. Both are in academic positions, because the time requirements are nearly impossible in the private sector.

If people want to put forth the effort into doing it, it is possible to do both. It's just incredibly rare. You yourself are doing a CC fellowship next. Are you telling me you're going to do 1/3 EM, 1/3 IM, and 1/3 CC?
 
Yes, doing a combined residency has a cost in time and money. It's probably not worth it for people not interested. And I'm not saying everyone should do one. I didn't. But the difficulty in "maintaining two specialities" is overblown. If you have a board certification in a specialty you haven't practiced in a while, and you take a board review course, bone up on your reading and transition back into it, it can be done. Yes, there is work to be done. It doesn't require zero work. But it can be done, and the difficulties are being overblown. There are people that leave EM and transition into Family Medicine without ever having even done a Family Medicine residency, at all. But you're going to try to tell me it can't be done by people who've done the specialty before, who've done a residency, and have a board certification in it?

Yeah, whatever.

You take a board review class, jack up your reading and go work for a few months where they really need somebody, and you're up to speed. End of story. Such jobs-in-need, are a dime a dozen. If you have a board certification in a specialty, you can do it. Period.

Blah, blah, blah. "It can't be done." "You can't do it." "You can only do what I say you can do." Blah, blah, blah. The world is full, chock full, of naysayers and people that say you can't do stuff. Jealousy is equally as plentiful. All this, "You can't do it" stuff is just crabs in a bucket.
 
A decade and a half ago, there was a guy at Cornell that was quad boarded EM/IM/CC/Pulm. He would do one month in the ED, and next month in the ICU, alternating service monthly. I don't know if the guy is still there, if he retired, or what.
 
Birdstrike said:
There are people that leave EM and transition into Family Medicine without ever having even done a Family Medicine residency, at all. But you're going to try to tell me it can't be done by people who've done the specialty before, who've done a residency, and have a board certification in it?
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Having worked with some of those people in the past, they do a pretty ****ty job at FM (much like many, if not most, FPs do a pretty bad job at EM).

Look, as with everything in medicine there aren't very many truly "this cannot possibly be done" situations. But the majority of people who train in 2 completely separate fields end up only doing one of them. So for most people, you're giving up time earning attending physician money (and having attending physician time off) to get extra training that you're pretty likely to not actually use. As long as you enter the situation realizing all of that, then by all means go for it.

Fellowships are different as the assumption is your initial training complements your fellowship - hence why not every fellowship is available to every kind of doctor.
 
VA Hopeful Dr said:
Having worked with some of those people in the past, they do a pretty ****ty job at FM (much like many, if not most, FPs do a pretty bad job at EM).
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So, you're saying right here, in a public forum that people that do combined EM/FM residencies and are board certified in both, do a "s***ty job" at both?

Wow. I wonder what ABEM and ABFM would have to say about that? I wonder what dual certified, dual residency trained Emergency/Family Physicians would have to say about that?

Bold stance.
 
VA Hopeful Dr said:
Having worked with some of those people in the past, they do a pretty ****ty job at FM (much like many, if not most, FPs do a pretty bad job at EM).

Look, as with everything in medicine there aren't very many truly "this cannot possibly be done" situations. But the majority of people who train in 2 completely separate fields end up only doing one of them. So for most people, you're giving up time earning attending physician money (and having attending physician time off) to get extra training that you're pretty likely to not actually use. As long as you enter the situation realizing all of that, then by all means go for it.

Fellowships are different as the assumption is your initial training complements your fellowship - hence why not every fellowship is available to every kind of doctor.
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What about fellowships in the ER for FP?
 
Birdstrike said:
So, you're saying right here, in a public forum that people that do combined EM/FM residencies and are board certified in both, do a "s***ty job" at both?

Wow. I wonder what ABEM and ABFM would have to say about that? I wonder what dual certified, dual residency trained Emergency/Family Physicians would have to say about that?

Bold stance.
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If anything I think they’ll be better cuz they have a wider scope of things to look at ... especially if they’re actively working both!
 
Birdstrike said:
So, you're saying right here, in a public forum that people that do combined EM/FM residencies and are board certified in both, do a "s***ty job" at both?

Wow. I wonder what ABEM and ABFM would have to say about that? I wonder what dual certified, dual residency trained Emergency/Family Physicians would have to say about that?

Bold stance.
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Dude, first, as seems more common for you lately, you don't need to sound so combative.

He's not talking EM/FM dual boarded. He is saying EM people doing FM suck, just like many FM in the ED suck.
 
Birdstrike said:
So, you're saying right here, in a public forum that people that do combined EM/FM residencies and are board certified in both, do a "s***ty job" at both?

Wow. I wonder what ABEM and ABFM would have to say about that? I wonder what dual certified, dual residency trained Emergency/Family Physicians would have to say about that?

Bold stance.
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You didn't say dual FM/EM.
 
Apollyon said:
He's not talking EM/FM dual boarded. He is saying EM people doing FM suck, just like many FM in the ED suck.
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Okay. Maybe I read him wrong. Maybe you can help me clarify. At first he was saying that getting dual boarded in EM and FM is a waste of time because no one uses both. Then he said, people do use both, he's worked with them and they're *sh**ty* doctors.

So, which is it? Is he trying to say dual certified EM/FM people are *sh**ty* doctors?
Or is he trying to say non-dual certified EM/FM doctors are "sh**ty" and that they should stay that way, because getting certified in both is a waste of time?

Because it seems he boxed himself in to effectively saying one or the other of those, whether he meant to, or not.
 
Birdstrike said:
Okay. Maybe I read him wrong. Maybe you can help me clarify. At first he was saying that getting dual boarded in EM and FM is a waste of time because no one uses both. Then he said, people do use both, he's worked with them and they're *sh**ty* doctors.

So, which is it? Is he trying to say dual certified EM/FM people are *sh**ty* doctors?
Or is he trying to say non-dual certified EM/FM doctors are "sh**ty" and that they should stay that way, because getting certified in both is a waste of time?

Because it seems he boxed himself in to effectively saying one or the other of those, whether he meant to, or not.
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I thought I was pretty clear (since at least one person understood my point), but I'll try again.

Point 1: If you are single boarded in EM, you can technically practice FM but every time I see that the EM doc in question hasn't been good at FM. The converse of that is also likely true, though as I don't work in an ED I can't comment from personal experience like I can for the EM doc who is doing FM.

Point 2: Most dual-boarded (in primary specialties, not fellowship trained docs who keep their primary specialty certification active) don't practice in a way that uses both. So for most people who do this, it is a waste of time as they spent extra time getting a second certification that they don't use.

So no, I didn't box myself in. You only think that because you misinterpreted my post.
 
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