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

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VA Hopeful Dr said:
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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Dude. Reread your post above. In point 1, you refer to people you've worked with that try to practice two different specialties. You've worked with enough of such people that you've identified it as a practice quality problem that comes from lack of board certification in at least one of the specialties. Then directly below, in point 2, you say hardly anyone does this, it's not a thing and so there's no point in anyone spending any time getting board certified in all the specialties they practice.

If you've worked with enough people trying to dabble in EM and FM without board certification in one or the other, you should be encouraging students who might end up becoming such people to get dual certification now, so that future doctors don't have to work with people who aren't board certified. You should not be shooting the idea down saying it's a waste of time. Obviously it's not a waste of time if you've worked with enough people who've tried to dabble specialty switch without certification, that you're convinced it's a problem.
 
Birdstrike said:
Dude. Reread your post above. In point 1, you refer to people you've worked with that try to practice two different specialties. You've worked with enough of such people that you've identified it as a practice quality problem that comes from lack of board certification in at least one of the specialties. Then directly below, in point 2, you say hardly anyone does this, it's not a thing and so there's no point in anyone spending any time getting board certified in all the specialties they practice.
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So you don't see a difference between these 2 groups:

Dual-residency grads who on average only practice one of their specialties.

and

Single residency grads who practice a different specialty at some point.

Because they are 2 very different groups.

There are a fair number of dual-residency doctors out there. A lot of them only practice in 1 specialty.

There are also what I assume are a decent number of single residency grads (though its hard to find actual numbers for this group) who later on in their careers decide to practice something different than their specialty.

Now, would that second group have been well served had they been dual-residency grads? Undoubtedly. Is there a correlation between this group and the first group? What I mean is: do we see dual-residency doctors change fields if they get burnt out on one of them? I honestly don't know the answer to that.
 
VA Hopeful Dr said:
... these 2 groups:

Dual-residency grads who on average only practice one of their specialties.

and

Single residency grads who practice a different specialty at some point.

...

Now, would that second group have been well served had they been dual-residency grads? Undoubtedly.
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Thank you for clarifying. I think it's something the medical students need to hear. That there are a certain number of EM residency grads ("single residency grads" as you've referred to them) that end up practicing a different specialty at some point, that might have been "well served had they been dual-residency grads," by doing a combined residency. That's all I was trying to say. It may only be 5% or 1% of people. I don't know the exact number, but there are some who might benefit from this. I see it now. I didn't see it when I was a medical student, resident or even a new attending.
 
Birdstrike said:
Thank you for clarifying. I think it's something the medical students need to hear. That there are a certain number of EM residency grads ("single residency grads" as you've referred to them) that end up practicing a different specialty at some point, that might have been "well served had they been dual-residency grads," by doing a combined residency. That's all I was trying to say. It may only be 5% or 1% of people. I don't know the exact number, but there are some who might benefit from this. I see it now. I didn't see it when I was a medical student, resident or even a new attending.
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You could even consider it burn-out insurance, but its awfully expensive insurance (especially since changing fields in medicine might not actually fix the problem).
 
Dr.McNinja said:
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?
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No, probably a mix of EM and Critical Care, just like an entire community of EM/CC docs out there. Just because I don't plan on practicing general internal medicine and opt for a speciality of IM, doesn't mean there wasn't a value in training in internal medicine.
 
engineeredout said:
No, probably a mix of EM and Critical Care, just like an entire community of EM/CC docs out there. Just because I don't plan on practicing general internal medicine and opt for a speciality of IM, doesn't mean there wasn't a value in training in internal medicine.
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Ok, so I kind of lurk nowadays but I have a little time before I head down for a shift so I wanted to comment.

For those of you who did EM only...I get it. 3 years and a bunch of cash is sexy as hell. Especially if you have the lifestyle and family flexibility to chase locums rates. However, it is a hard truth that ABEM, ACEP, AAEM, etc have not fully accepted that EM as a burnout problem as you get older and have limited options to pull back or want to make a change clinically. I could work EM clinically and do work a decent number of shifts so this isn't me talking from on high. I am early in my career but having worn several hats I am forced to see this. When a few of my former med students, med school classmates, and resident classmates are scaling back in their 30s because they are burned out its a problem. Wellness is important and all of medicine and in particular EM are not always the best at addressing it.

Just like the quoted poster I did a 6 year EM/IM/CCM program. I am primarily an Intensivist that works at a decent community hospital in a fairly large Metro area. I work days only and at night the Hospitalists admit the patients in concert with an E-ICU program my hospital contracts with. I only work 4 holidays a year and 1 weekend a month. From this job alone I make more than nearly all of my EM co-residents (including some who are now partners in their SDG) and though I take care of critically ill patients I am likely less stressed. There is no trauma activation, home boy ambulance, I had a vaginal discharge and figured no line at 3AM, or bull**** door to provider metrics even when the department is blowing up. I also receive W2 benefits. After rounds if there is nothing pressing I can go to my office for some phone calls and my PAs continue to run the floor. If I don't think a patient warrants ICU admission I can defer it to the Hospitalist. There is no push back or if it is attempted it does not go far at all.

I do not practice as a Hospitalist or clinic physician. Certainly these are options later on. I have no doubt that in 10 years I could flip to being a Hospitalist without too much difficulty though I concede it would take me a bit to get back into the clinic game. I would rather retire before I do clinic so I am not too bothered by this.

Miacomet...its not too late man. One of my former co-fellows had a crazy path. He did EM, worked in the community, joined the EM faciulty at my program and was my attending. Then he decided he wanted to do Pulmonary Critical Care...not critical care which would have been 2 years but the full deal. So he applies and gets accepted as a IM resident at my program and becomes my intern though they only made him do that 3 months before they advanced him as a senior resident in PGY2. Graduates the IM program in 2 years and then matches Pulm/CCM where he is finishing his 2nd year now. The entire time he came out and was moonlighting with me to keep his salary up at a local community site for the academic residency that the core faculty don't like to go to. I think he's crazy for that but this is an extreme example. He also notes he likely won't practice EM when he is done. Personally I recommend you do 2 year CCM fellowship. The demand is out here and the lifestyle is far better if you find the right job.

Plus if you desire you can still pick up EM shifts to your hearts content or for need. I need to kill my loans so that I can truly enjoy myself and I still enjoy the ED. Had a 94 year old yoga instructor that fell and broke a rib on the right side and gave herself a PTX. Got to throw in a CT and hear some great stories from a type of patient I wouldn't see in my Med-Surg ICU. I have former grads in my program who are doing combined EM/CCM in community and academic settings. Its easy to be the liaison to multiple departments and you are slated for leadership opportunities if desired.

To those who are considering a combined program. Don't be afraid to make the time investment if you have an interest. I made an EM attending salary my 4th and 5th years of my program as do many EM/IM folks at the other programs moonlighting. The name of the game is options. The more you have the more you'll appreciate in your 40s and 50s. My two cents.
 
inspirationmd said:
Ok, so I kind of lurk nowadays but I have a little time before I head down for a shift so I wanted to comment.

For those of you who did EM only...I get it. 3 years and a bunch of cash is sexy as hell. Especially if you have the lifestyle and family flexibility to chase locums rates. However, it is a hard truth that ABEM, ACEP, AAEM, etc have not fully accepted that EM as a burnout problem as you get older and have limited options to pull back or want to make a change clinically. I could work EM clinically and do work a decent number of shifts so this isn't me talking from on high. I am early in my career but having worn several hats I am forced to see this. When a few of my former med students, med school classmates, and resident classmates are scaling back in their 30s because they are burned out its a problem. Wellness is important and all of medicine and in particular EM are not always the best at addressing it.

Just like the quoted poster I did a 6 year EM/IM/CCM program. I am primarily an Intensivist that works at a decent community hospital in a fairly large Metro area. I work days only and at night the Hospitalists admit the patients in concert with an E-ICU program my hospital contracts with. I only work 4 holidays a year and 1 weekend a month. From this job alone I make more than nearly all of my EM co-residents (including some who are now partners in their SDG) and though I take care of critically ill patients I am likely less stressed. There is no trauma activation, home boy ambulance, I had a vaginal discharge and figured no line at 3AM, or bull**** door to provider metrics even when the department is blowing up. I also receive W2 benefits. After rounds if there is nothing pressing I can go to my office for some phone calls and my PAs continue to run the floor. If I don't think a patient warrants ICU admission I can defer it to the Hospitalist. There is no push back or if it is attempted it does not go far at all.

I do not practice as a Hospitalist or clinic physician. Certainly these are options later on. I have no doubt that in 10 years I could flip to being a Hospitalist without too much difficulty though I concede it would take me a bit to get back into the clinic game. I would rather retire before I do clinic so I am not too bothered by this.

Miacomet...its not too late man. One of my former co-fellows had a crazy path. He did EM, worked in the community, joined the EM faciulty at my program and was my attending. Then he decided he wanted to do Pulmonary Critical Care...not critical care which would have been 2 years but the full deal. So he applies and gets accepted as a IM resident at my program and becomes my intern though they only made him do that 3 months before they advanced him as a senior resident in PGY2. Graduates the IM program in 2 years and then matches Pulm/CCM where he is finishing his 2nd year now. The entire time he came out and was moonlighting with me to keep his salary up at a local community site for the academic residency that the core faculty don't like to go to. I think he's crazy for that but this is an extreme example. He also notes he likely won't practice EM when he is done. Personally I recommend you do 2 year CCM fellowship. The demand is out here and the lifestyle is far better if you find the right job.

Plus if you desire you can still pick up EM shifts to your hearts content or for need. I need to kill my loans so that I can truly enjoy myself and I still enjoy the ED. Had a 94 year old yoga instructor that fell and broke a rib on the right side and gave herself a PTX. Got to throw in a CT and hear some great stories from a type of patient I wouldn't see in my Med-Surg ICU. I have former grads in my program who are doing combined EM/CCM in community and academic settings. Its easy to be the liaison to multiple departments and you are slated for leadership opportunities if desired.

To those who are considering a combined program. Don't be afraid to make the time investment if you have an interest. I made an EM attending salary my 4th and 5th years of my program as do many EM/IM folks at the other programs moonlighting. The name of the game is options. The more you have the more you'll appreciate in your 40s and 50s. My two cents.
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Very wise. Do NOT underestimate the EM burnout rates past age 40. Realize that even if other fields (IM, for example) SEEM higher, they don't deal with EM's circadian issues, which are almost impossible for many (not all) folks after fifty. If you aren't the type who can crank early and save enough so that you only need to work 4-6 shifts a month or that can be happy in UC, you are going to need an exit plan. That could be Peds or IM after a combined residency, could be CC (for which you do not need EM/IM these days), or an IM/Peds fellowship after a combined. Could be administration, palliative care. Could be alternate streams of income. But you need one. A combined residency is a reasonable route.

I agree ACEP and AAEM are just not addressing the burnout issues, probably because they can't. I'd really like to see a way for EM to do more IM fellowships, but this isn't going to happen anytime soon for a variety of reasons.

Thank you for your wise words, InspirationMD. I'm not sure what I will do- 5-6 more years seems tough and most fields of medicine seem to be falling apart. But I appreciate your wisdom and learning about your path. Thank you.
 
When I read these kind of posts I used to feel like wow that’s way too much time for little added benefits. Now I’ve come to view it more as there being multiple paths to happiness and career satisfaction. Yours wouldn’t work for me in a million years, but mine probably wouldn’t work for you either. To each their own.


Sent from my iPhone using SDN mobile
 
I say you have to go into EM with the mindset to be able to handle the negatives just like EVERY other Job.

I came into EM with the understanding that I will be working Odd hours, nights, holidays, weekends.

But this was an acceptable tradeoff for a 3 yr residency, making 300K/yr, being able to take a week off every month to travel, work 15 dys a month, NEVER being on call, never having patients call me.

My current IC reality is

I work nights, holidays, weekends , odd Hours ONLY if I choose to and only if I get extra $$$
I made 500K working 14 dys a month and about 1 Weekend day a month, and ZERO major holidays last year(new Yrs, Easter, July 4th, memorial day, turkey day, xmas) . I still am never on call, have 100% control over my schedule, and patients never call me.

If I am burned out, then its ALL on me and nothing to do with EM medicine. I knew what I was getting into and NOTHING has changed. EM medicine is actually much more flexible with UC, FSER, locums than when I finished residency 17 yrs ago.
 
emergentmd said:
I say you have to go into EM with the mindset to be able to handle the negatives just like EVERY other Job.
Click to expand...

Of course. Everyone goes into EM knowing this; the negatives of EM aren't a big secret. But there's a big difference between "understanding" the negatives when you sign up as a fourth-year medical student and actually living them from residency onwards. Some people realize that they didn't actually fully grasp those negatives until living them and that's ok.

If I am burned out, then its ALL on me and nothing to do with EM medicine. I knew what I was getting into and NOTHING has changed.
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Come on, man. We know you have a great job, but not everyone else does--there aren't enough unicorn jobs to go around. Just because you love your job 100% doesn't mean you have to throw your fellow EM physicians under the bus. Why blame the doctors instead of the hospitals and CMGs that create the poor working conditions?
 
enalli said:
Of course. Everyone goes into EM knowing this; the negatives of EM aren't a big secret. But there's a big difference between "understanding" the negatives when you sign up as a fourth-year medical student and actually living them from residency onwards. Some people realize that they didn't actually fully grasp those negatives until living them and that's ok.



Come on, man. We know you have a great job, but not everyone else does--there aren't enough unicorn jobs to go around. Just because you love your job 100% doesn't mean you have to throw your fellow EM physicians under the bus. Why blame the doctors instead of the hospitals and CMGs that create the poor working conditions?
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I dont think i have a unicorn job but I made changes for a better lifestyle rather than sit back and blame others for my burned out job. I can blame hospitals, cmgs, insurance, governments metrics all day but that doesnt change anything.

I did a full time sdg/cmg job for 15 yrs and never complained or feel burned out bc i was accepting of the negatives. I worked at a huge hospital where everything gets transferred in and sae 3+pph for yrs.

When i got tired of it i made changes.

Thats the beauty of EM medicine as it is flexible. If your burned out go to urgent care or work 6 shifts a month. Its your choice to work 15 dys, fell burned out, and continuing to live a 300k lifestyle.

Try being an OB doc and work part time. I would have no sympathy for an OB doc who was burned out bc they got tired of coming in at 2am to deliver babies or doing pelvic exams.
 
It's hard. Even the most stable groups constantly run the risk of losing their contracts or can become corrupt over time, or can and will vote out partners. All jobs, including EM, just seem to require a ton of flexibility and the ability to quit at a moment's notice. Many of us want to settle in, but can't.
 
So how many people do you know in most industries stay with the same company. I know many Engineers and Techies, IT, software people who jump jobs every few yrs for better pay/position.
 
emergentmd said:
So how many people do you know in most industries stay with the same company. I know many Engineers and Techies, IT, software people who jump jobs every few yrs for better pay/position.
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Yes, of course, but it doesn't mean people like it.
 
Birdstrike said:
It's very easy to get a low burnout rate for teachers. You just send the survey's out during summer vacation.
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Honestly, teachers burn out for the same reasons we do at this point. Yes, they get paid less, but even the highly paid ones burn out.
It's because they do work that is ostensibly good. They pour their hearts into it. But bad things still happen because it does. And in the millenial snowflake generation, nothing is the kid's fault, ever. So the teachers get blamed for outcomes they cannot control. Administration keeps coming up with newer and newer things to rate them on and for them to do. Our Press Ganey's are their standardized tests.
So yeah, at least they get summers off.
 
Dr.McNinja said:
Honestly, teachers burn out for the same reasons we do at this point. Yes, they get paid less, but even the highly paid ones burn out.
It's because they do work that is ostensibly good. They pour their hearts into it. But bad things still happen because it does. And in the millenial snowflake generation, nothing is the kid's fault, ever. So the teachers get blamed for outcomes they cannot control. Administration keeps coming up with newer and newer things to rate them on and for them to do. Our Press Ganey's are their standardized tests.
So yeah, at least they get summers off.
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I agree. Teachers should get summers off, they have a hard job with unreasonable expectations placed on them, and should get paid more. My point was not to begrudge teacher's summers off, but that it's incredibly easy to manipulate survey results, by how, what, when and which questions are asked, and thus the reference to "summers." Similarly, ask one group of EM physicians if they're burnout out, during the last hour of a long stretch of night shifts, ask another group after a stretch of 5 days off, and compare the results. Then, publish the results of group 1 and present those survey results to a pre-med interest group. Serve the second group of results to a group of EP's looking to improve practice quality in their CMG job. Hence, the paid polling industry in a nutshell.
 
Dr.McNinja said:
Honestly, teachers burn out for the same reasons we do at this point. Yes, they get paid less, but even the highly paid ones burn out.
It's because they do work that is ostensibly good. They pour their hearts into it. But bad things still happen because it does. And in the millenial snowflake generation, nothing is the kid's fault, ever. So the teachers get blamed for outcomes they cannot control. Administration keeps coming up with newer and newer things to rate them on and for them to do. Our Press Ganey's are their standardized tests.
So yeah, at least they get summers off.
Click to expand...
Meh.....some are good and poor their hearts into the kids

Some definitely don’t
 
sb247 said:
Meh.....some are good and poor their hearts into the kids

Some definitely don’t
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There's also some terrible doctors out there. Most go into it for the right reasons. I doubt there are a lot of teachers who go into it for the money though.
 
Dr.McNinja said:
And in the millenial snowflake generation, nothing is the kid's fault, ever. So the teachers get blamed for outcomes they cannot control.
Click to expand...

RustedFox said:
Last time I used the terms "millennial" and "snowflake", I got all sorts of hell from... millennial snowflakes.
Click to expand...

Millennial snowflake checking in.

Remember how eight- and nine-year old millennials banded together and forced tournament directors to give them participation troph--oh wait, that makes absolutely no sense; it was their mentally-fragile Baby Boomer parents who couldn't handle having a kid below first place.

Millennials are only starting to have kids old enough to be in middle school and above. Problem parents have existed for a much longer time; the prototypical problem parents are in fact, you guessed it, Baby Boomers.

I want you two to say the following words out loud: "Can I speak to the manager?" Did you just picture a millennial, or did you picture someone like this?: http://i0.kym-cdn.com/entries/icons/original/000/018/181/managerhaircut.jpg

I put it to you two that any supposed problems with millennials were actually caused by the generation who gave us our current politicians and the source of all that has led America to become a nation in decline economically, societally, and morally: Baby Boomers.
 
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