IM/EM/CC

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cbrons

cbrons

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I was just doing some browsing on FREIDA and I realized that only 4 programs are listed as IM/EM/CC (6 years).

I was wondering if you thought the number of these programs would increase over the next couple of years? Are these programs highly competitive and what are the numbers like?

Additionally, are there places out there that are officially just IM/EM but will allowed you to add on an extra 1 year to get CC?

I realize there are some threads out there that address this but those are a few years old by now.
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Hmm thought there were 3, what 4th one got added? LIJ lets you do EM/IM and if you decide at the end of 1st/2nd year that you want to do a 6th year, you are pretty much autoaccepted and your schedule changes a bit to accomodate this. Not sure on the other programs how they do their fellowship year.
 
East Carolina University just started this year. This is the first new one since Maryland started in 2006 so I doubt more are in the immediate pipeline though who knows.

Allowed to switch into the path up to the start of the 4th year. Curriculum is essentially the same until the latter part of the 5th year when you transition to being a fellow for the remainder of your time.

Will be a multidisciplinary fellowship with protected research time, dedicated MICU, SICU, CICU and electives as a fellow.

The boards are particular about it being formally approved so unless the other programs go through the application process you would have to do a two year fellowship to be board eligible.

Biggest issue is matching EM/IM. The CCM component shouldn't be problematic at any of the existing programs from what I know from friends at other programs and from my days on the interview trail.
 
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From what I understand alot of the EM/IM guys at HCMC choose to do a fell pulm/crit fellowship. Im too old for that and 6 years is long enough for me.
 
sylvanthus said:
From what I understand alot of the EM/IM guys at HCMC choose to do a fell pulm/crit fellowship. Im too old for that and 6 years is long enough for me.
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This is what I've heard also. They do well with it too. One went to Stanford for the full deal. Met another of their grads at ACEP last year who was at UWashington for Pulm/CCM and the academic recruiters were literally all over him.

Personally couldn't eat 8 years though. Serious dedication there.
 
I wanted to add that I think this is probably, arguably, the best foundation to starting critical care.

And before anyone gets hurt feels, I'm not suggesting it's the "only" way. I just like the mix of procedural and medicine cases you get out of both specialties.

Of note though. Critical care is not just resuscitation and procedures. It's NOT. Which is why the additional training is necessary. The practice is very nuanced and it's getting patients who should die, all things being equal, to a place where they will not, at least in the acute sense rapidly leave the earth, is what you do in critical care.
 
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jdh71 said:
I wanted to add that I think this is probably, arguably, the best foundation to starting critical care.

And before anyone gets hurt feels, I'm not suggesting it's the "only" way. I just like the mix of procedural and medicine cases you get put of both specialties.

Of note though. Critical care is not just resuscitation and procedures. It's NOT. Which is why the additional training is necessary. The practice is very nuanced and it's getting patients who should die, all things being equal, to a place where they will not, at least in the acute sense rapidly leave the earth, is what you do in critical care.
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Agreed. I'm an EM guy going into CC (God willing). If I was 100% sure I was doing it out of med school, I would have gone this route. I think EM will be a strong foundation for CC and I've met outstanding CC docs from all fields, but I think this would make you a stud.
 
What are the research requirements (typically what/how much research do good prospects for these programs have)? Also, what range of Step I scores? Hopefully someone might know this...
 
cbrons said:
What are the research requirements (typically what/how much research do good prospects for these programs have)? Also, what range of Step I scores? Hopefully someone might know this...
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These programs are not "competitive" in the traditional sense that dermatology is "competitive". These programs simply want solid, serious candidates. Be able to articulate why you want to do a mixed program.
 
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jdh71 said:
These programs are not "competitive" in the traditional sense that dermatology is "competitive". These programs simply want solid, serious candidates. Be able to articulate why you want to do a mixed program.
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That's good to hear because the research ops at my school are very slim and I really hate doing research. So basically having a good step I score and clerkship evaluations in IM and EM and CC would be good enough? Because I can handle those reqs just fine...

Also I apologize for my ignorance, but as far as clerkships go, what do medical students typically do in the ICU at some of these programs assuming they are accepted for an away rotation? I can't imagine much, but that's why I wanted to ask.
 
Research isn't critical. I had a pretty good amount but that was because I was interested. It definitely helps particularly if something related to both specialties.

It's a little more competitive than EM in general plus you need to have a good story for why you want to do both. In general, you are probably going to have a rough patch nowadays with step 1 <220 unless you come up pretty well on step 2. Also, we are pretty good at smelling out people who are interested only in EM and try to back door into that. You have to interview with EM and IM faculty at most of the programs. If you have a lackluster performance in IM with no IM rotations in 4th year you are not reasonably going to sell a desire to be an Internist. Vice versa as well though I have seen that less often.

What anyone doing this has to remember is that you are committing half of your training to becoming an Internist. You will be rounding on general medicine patients, have a continuity clinic, and be a resident on the H/O inpatient service, etc at whatever program you go to. If you just want to be in the ED this is not the option for you.

It is great training though if you are willing to dedicate the time and a very strong launching point to become an Intensivist. Lots of options for career diversification as you progress in life as well.
 
inspirationmd said:
Research isn't critical. I had a pretty good amount but that was because I was interested. It definitely helps particularly if something related to both specialties.

It's a little more competitive than EM in general plus you need to have a good story for why you want to do both. In general, you are probably going to have a rough patch nowadays with step 1 <220 unless you come up pretty well on step 2. Also, we are pretty good at smelling out people who are interested only in EM and try to back door into that. You have to interview with EM and IM faculty at most of the programs. If you have a lackluster performance in IM with no IM rotations in 4th year you are not reasonably going to sell a desire to be an Internist. Vice versa as well though I have seen that less often.

What anyone doing this has to remember is that you are committing half of your training to becoming an Internist. You will be rounding on general medicine patients, have a continuity clinic, and be a resident on the H/O inpatient service, etc at whatever program you go to. If you just want to be in the ED this is not the option for you.

It is great training though if you are willing to dedicate the time and a very strong launching point to become an Intensivist. Lots of options for career diversification as you progress in life as well.
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I take this to mean you are at a combined IM/EM program, not one of the 4 officially listed IM/EM/CC programs that are specifically 6 years? If yes you are at an IM/EM program, do they allow 4th year residents to more or less elect to do a CC fellowship and somehow allow them to get away with just 2 more years of training to get all 3?
 
No I am at one of the 4 official programs.


There is a movement to ask ABIM to reconsider allowing EM/IM (or IM/EM depending on your preference) grads to be eligible to sit for the ABIM Critical Care boards after 1 year even if not part of these official programs but it hasn't gone anywhere the last time I heard about it a year or so ago.

At this point you have to match at one of the established programs or petition your program leadership to apply to start one if you want to do it elsewhere.
 
I'm interested in hearing what people think nowadays about doing IM/EM. I considered it heavily as a med student, but had heard that it was highly probable that CCM pathway would open up to plain EM. Therefore I did straight EM. Now that I'm 5 years out from med school (3 years EM, 2 years CCM) I'm not sure that 6 years EM/IM/CC would have prepared me more than I am now. Surely the IM component would be much stronger, but what you learn in 2 years of critical care (22 blocks of ICU at my institution, which is relatively painful btw) the medicine in the ICU you need to know. Also I do a lot more ICU months in my 5 years than what I am seeing at almost any other 6 year pathway would have you do (currently will have finished with 28 total blocks).

Personally I think doing 3 years ED (or IM for that matter), 2 year CCM and if you are a glutton for pain do a year of ECMO in a CVICU or a trauma CC fellowship (1yr) if you did mostly a medicine CCM fellowship or vice versa if you did mostly surgical CC fellowship.

the reality probably is you can be good at just about anything if you are dedicated to learning it and do more than just showing up everyday.
 
ORL10 said:
I'm interested in hearing what people think nowadays about doing IM/EM. I considered it heavily as a med student, but had heard that it was highly probable that CCM pathway would open up to plain EM. Therefore I did straight EM. Now that I'm 5 years out from med school (3 years EM, 2 years CCM) I'm not sure that 6 years EM/IM/CC would have prepared me more than I am now. Surely the IM component would be much stronger, but what you learn in 2 years of critical care (22 blocks of ICU at my institution, which is relatively painful btw) the medicine in the ICU you need to know. Also I do a lot more ICU months in my 5 years than what I am seeing at almost any other 6 year pathway would have you do (currently will have finished with 28 total blocks).

Personally I think doing 3 years ED (or IM for that matter), 2 year CCM and if you are a glutton for pain do a year of ECMO in a CVICU or a trauma CC fellowship (1yr) if you did mostly a medicine CCM fellowship or vice versa if you did mostly surgical CC fellowship.

the reality probably is you can be good at just about anything if you are dedicated to learning it and do more than just showing up everyday.
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Care to talk more about your path? I'm an em pgy1 at 3 year program, currently on my second month of MICU and I'm surprisingly really enjoying it so far. If I were to apply to fellowship is there anything you wish you had done or should do to make yourself competitive? Is this even a competitive option? Seems like most EM docs don't go on to fellowship. Thanks!
 
doxycycline said:
Seems like most EM docs don't go on to fellowship.
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Most don't because most of the EM fellowships don't lead to a big practice change. Ultrasound, EMS, Simulation, Peds, etc, don't let you do anything that you couldn't really do eithout them. You'll just be better than the other pit doc at that facet of your work. There may be jobs that prefer an applicant with that special extra training, but most community docs will tell you that it's not a job-changer for them.

The exceptions are tox and CritCare. Those open up a new practice arena that you can't get into without the fellowship. You can opt to stay in the ED and (as with the other fellowships) just be better than your coworkers in that specific area, or you can take the training and work in a different area (some or all of the time).

So I think you don't see many EM docs going on to fellowship because they want to work in the ED.
 
Doctor Bob said:
The exceptions are tox and CritCare.
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Although for many toxicologists, they still end up working in the ED with minimal time dedicated for tox consults. There just aren't a lot of jobs out there for full-time toxicologists. Critical care, sports med, Hospice, and interventional pain are the only fellowships where you can be reasonably certain that you can get out of the ED entirely if you wanted. The rest really don't make much financial sense, and unless you wanted to do academics, I don't see how they would be too beneficial.
 
I really am considering IM/EM/CC and I was looking at the Vidant Medical Center/East Carolina University Program. Anyone have advice on how to set up a 4th year away rotation? I assume it would be in medicine or E.M., so which would be best if I am interested in the 3-combo program?
 
I just saw this! Top contender for the best EM/IM/CC program imho
 
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