IM vs. EM

[sydney_ne]

Anyone trying to decide between IM and EM? Our ROLs are due next week, so this is a bit of an eleventh-hour question. But I'd love to know how you arrived at your decision, or what issues you're trying to resolve before making your decision.

I'm not asking for people to say why they like IM or EM. (I'm sure you have important things to say, but this topic has been covered elsewhere.) Instead, I'd really like to hear from people who are trying to decide.

Thanks.

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[stubby]

I interviewed in both.
I chose IM because although ER is a "great lifestyle", I think in the long run the lifestyle would not have worked well for me. Having swing shifts, and working nights, and being off schedule with the rest of the world I think really would've messed with me. SO I think you need to ask your self if working the flip flop hours is a good thing or bad thing.

I also felt with ER that I didn't want to be "gripped" all the time. I think in the end I realized I am a chill guy, who doesn't mind a little down time at work and time to bull**** around. In the ER, the ebb and flow is kind of chaos intermixed with relative calm

I also entered med school really interested in patient interations. In the ER, ultimately, time with the patient becomes very limited, because you a rushing around all the time. For me, I enjoy in IM that I can take my time talking to patients and no one is rushing me all the time.

However, it was a struggle, there are things I really like about the ED and things I do not necessarily like about IM--rounding. But, I am doing my sub I now and its not bad at all. Plus, I think in IM you just have tons a options. If you want high acuity, procedures with long term patient interactions and good pay---cardiology. So I think in IM you can have it all.

hope that helps

Stubby

Anyone trying to decide between IM and EM? Our ROLs are due next week, so this is a bit of an eleventh-hour question. But I'd love to know how you arrived at your decision, or what issues you're trying to resolve before making your decision.

I'm not asking for people to say why they like IM or EM. (I'm sure you have important things to say, but this topic has been covered elsewhere.) Instead, I'd really like to hear from people who are trying to decide.

Thanks.

 

[Furrball]

I had trouble with this too. I finally decieded on IM. What it came down to is I do not like Women's Health and Pediatrics makes me want to slam my head in a car door. I like treating adults and I like acuity. I even like rotations at the VA-Spa. So rather then choosing a specialty where I would spend 80% of time doing something that drives me nuts I would do something I enjoy. Also I'm pretty sure that I want to go into critical care and at the present time you can not become a board certified intensivist if you are an ED doc. I also was tired of people assuming that I was interested in EM for the "lifestyle."

 

[GGale]

Tortured myself with this until I had done a few interviews in both. It's strange, in lots of ways I felt like I fit in better personality-wise with the EM residents but I got sick of hearing the EM-residents go on and on about how EM left them plenty of time for surfing, rock-climbing, etc. and not talking about what about EM interested them beyond the adreneline rush of traumas and codes. I like those things too, (who doesn't?) but let's face it, even at a really good inner city ED, the really crazy exciting stuff constitutes <30% of your time.

Meanwhile the med residents seemed more tired and resigned to long days and a lifetime of crappy hours BUT almost every single one I met really seemed really interested in what they were doing, the actual medicine. They were also also interested in life outside of work but they just seemed more into their jobs as well.

This is just an opinion, based on some gross generalizations of the people I met on the trail. The final thing that pushed me to rank IM programs only was that I want to work with sick people. I'm not interested in primary care and I realized that I was really, really not interested in the kind of primary care that goes on in the ED.

Despite all this, I'm still a little afraid that I'll have an epiphany aout nine months from now after my fourth hour of continuous rounding that maybe I should have gone for EM.

Eh. We'll see.

 

[Jackie1.]

Tortured myself with this until I had done a few interviews in both. It's strange, in lots of ways I felt like I fit in better personality-wise with the EM residents but I got sick of hearing the EM-residents go on and on about how EM left them plenty of time for surfing, rock-climbing, etc. and not talking about what about EM interested them beyond the adreneline rush of traumas and codes. I like those things too, (who doesn't?) but let's face it, even at a really good inner city ED, the really crazy exciting stuff constitutes <30% of your time.

Meanwhile the med residents seemed more tired and resigned to long days and a lifetime of crappy hours BUT almost every single one I met really seemed really interested in what they were doing, the actual medicine. They were also also interested in life outside of work but they just seemed more into their jobs as well.

This is just an opinion, based on some gross generalizations of the people I met on the trail. The final thing that pushed me to rank IM programs only was that I want to work with sick people. I'm not interested in primary care and I realized that I was really, really not interested in the kind of primary care that goes on in the ED.

Despite all this, I'm still a little afraid that I'll have an epiphany aout nine months from now after my fourth hour of continuous rounding that maybe I should have gone for EM.

Eh. We'll see.

I was in the same situation between choosing EM and IM. I know there are people on SDN who know who I am and will read this and they think I "copped out", but oh well, I'm happy. I did 2 months of ER rotations and I did love the work they do. I loved not having to deal with rounding each day, pondering over a potasssium of 3.4, picking our brains to see if this is "significant or not", and actually being a well-rounded person able to deal with all aspects of health care. After these 2 rotations and working with a particular GI doc however, I realized how happy she was and I also liked the idea of having OPTIONS when I'm done. I also thought I'd be cool to have the "lifestyle" that they have and "easier" residency, but on further investigation I realized they work just as hard as an IM doc their intern year being on the floors half the time and they are always "on". OPTIONS is the main thing that swayed me though. If you for some reason cant handle the lifestyle of an ED doc (burnout rate of 7 years on average) you have limited choices, maybe open up an urgent care clinic, but GUESS WHAT! An IM doc can also open up one of those or he can do a fellowship or he can practice primary care if he doesnt want to continue into fellowship. The final thing that swayed me was the fact that I did not get off to trauma like some of my friends did. I tended to shy away from traumas and would rather workup the person with pyelo or SOB. I felt like the just passed off their trauma to trauma surgeons and didnt really get to do much for them, besides save their life, as some ER docs will say. I think however if you wanted to practive in general for onyl a few years and not dedicate your life to medicine, I think ER is a good option. I know most of them have very good non-medicine career interests. Anyways, enough rambling, but I switched like literally in September, I had ER places ready to go and all, but I deleted them from ERAS and chose IM and I don't regret it! Not to bash ER though, I think its a great profession and they are to be well respected, it just wasn't for me.

 

[ntmed]

If you for some reason cant handle the lifestyle of an ED doc (burnout rate of 7 years on average) ....

The burnout rate for EM is discussed anecdotally, especially in the EM Forum. Do you have a reference for this burnout rate?

There's an article from 1996 on this (Academic Emergency Medicine, Vol 3, 1156-1164) that predicts EP attrition rates of 7.5% over 5 years and 25% over 10 years. I wonder if there's more recent data?

Thanks