IM vs EM

[orthoguy]

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I am a lost 3rd year getting ready for 4th year planning and all of the joy that it brings and I am stuck deciding b/w EM and IM. It seems to me that IM would be more cerebrally challanging but ER would be a lot of fun with a nicer more flexiable lifestyle.

Any advice from any of you?

 

[Coleman]

More cerebral? IM?

Let's see:

90% of all patients admitted to IM go through . . . . the ED.

Maybe 20-40% of all patients (depending on location) seen in the ED get admitted, some to surgery, most to medicine. That leaves 80-60% of all patients that have been seen, treated, and d/c'd and IM never sees them.

 

[Iron Horse]

Overall, IM does seem more challenging in terms of the breadth of knowledge required, the complexity of cases, and the challenges that continuity presents (caring for a patient with multiple illnesses/Rx, e.g. the 55 y/o w/diabetes, HTN, depression, etc.). Obviously EM presents its own set of challenges, but again, IM seems more intellectually challenging. Several of my profs have said as much, and it makes sense to me based on the little I have seen. I don't know how one arrives at "90% of IM patients are seen in the ER first". I guess this may be true if you're referring to hospitalists, but a non-hospital based internist sees most patients without having them go through the ER first.

Curious to hear what others have to say.

 

[mikecwru]

Originally posted by Iron Horse
Overall, IM does seem more challenging in terms of the breadth of knowledge required, the complexity of cases, and the challenges that continuity presents (caring for a patient with multiple illnesses/Rx, e.g. the 55 y/o w/diabetes, HTN, depression, etc.). Obviously EM presents its own set of challenges, but again, IM seems more intellectually challenging. Several of my profs have said as much, and it makes sense to me based on the little I have seen. I don't know how one arrives at "90% of IM patients are seen in the ER first". I guess this may be true if you're referring to hospitalists, but a non-hospital based internist sees most patients without having them go through the ER first.

Curious to hear what others have to say.

I don't think EM is less cerebral. The mindset is different. When a patient presents in IM, you answer "What is most likely to be causing this?" When a patient presents in EM, you have to answer "What are the most dangerous things that can be causing this and how can I keep this from killing the patient?" ED docs treat patients with multiple illnesses in a lot of EDs for several hours before they can get admitted due to bed shortages.
You're just going to hear biases from both side.... IM docs will call the ED docs "triage nurses" and obviously, the ED docs will show the IM docs for the fleas they truly are. 🙂

mike

 

[Snoopy]

Despite being completely gung ho EM throughout medical school, I found myself torn between EM and IM after doing IM in the spring of my third year. I decided to do AIs/Sub-Is in EM and IM to break the deadlock and ultimately decided on EM. I have never looked back. I think it came down mostly to a personality fit. I loved my time in the ED and I liked the people that I worked with. During my month in IM, I loathed the endless rounding, constant conferences, and social issues. I think most people who like EM love the disease process that IM involves but hate the daily mechanics of the IM world. If you're truly torn, take a hard look into both.

Good luck!

 

[jashanley]

Or be an idiot.....er.....an inquisitive guy and train in both.


Go for it.....live on a residents salary for five years when all your friends are leaving after three. 2 extra years of crappy call months. Sound exciting yet?
no seriously .....I wouldn't give up this spot for anything. Well, nearly anything............