IM vs EM

[ryryguy]

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I thought I'd ask my question in a forum of people that have already chosen their specialty, that way, I can get additional insight into people that are happy with their choices or have regrets.

In September 2010, I did my IM rotation. I didn't love it, but I liked it a lot. IM's most appealing aspects are how they know so much, how their not afraid to manage complicated patients, and how one can have so many options after finishing residency as far as fellowship choices go. On the other hand, the IM residents more than any other I've seen do not seem as happy, fellowship spots are hard to get, and I'm not sure if I would enjoy staying on as a hospitalist should I not get a fellowship.

Last month, I did an EM rotation at a level 3 hospital. It was like family medicine on steroids. I got to suture lacs, drain abscesses, put in lines...basically a bunch of hands-on stuff, which I like. The downside to the rotation was that I did not see much trauma and only 2 codes. I'm not sure if I would like the stress of trauma and the stress of having to speed through several patients at a busier level 2 or level 1 hospital.

Unfortunately, my schedule, except for my audition (sub-I) rotations is completely full until I graduate. I've already set up 3 IM rotations during my audition months, and need to work on changing them very soon if I'm not wanting to do IM.

What are my options to truly see if I'd like the busier ED setting and if you were me, would you choose IM or EM?

(Some additional facts: I like procedures, hospital and clinic equally, don't want the kind of patient follow-up you'd have in FP but wouldn't mind seeing patients more than once)

 

[gro2001]

There are some very good posts in the FAQ about 'EM fit' and 'EM personality', I recommend taking a look there. From what you posted, sounds like EM could well be a good fit for you. Then again, without knowing you well (or perhaps even knowing you well) no one can really say what speciality is a better fit for you. If you are seriously considering it, I would give it a shot and rotate through EM early on in the year. Try to go to a different type place than what you were at last time (maybe a county hospital if you want to see more action). A LOR from EM would probably be usable in the application for IM if you end up not liking it (likewise an IM letter would be usable in the EM application). No one can really describe what EM is really like (and the same can probably be said for most specialities), you just have to try it.

For what it's worth, while I was doing my 'audition' EM sub-i, a couple of my fellow sub-is were people applying to other specialities that year (one of them was going into IM). There is nothing wrong with career exploration, even during audition season.

 

[smq123]

I thought I'd ask my question in a forum of people that have already chosen their specialty, that way, I can get additional insight into people that are happy with their choices or have regrets.

While I can understand that, it still doesn't make it a residency topic. Moving to Allopathic, where plenty of residents still read and post. You can also read the IM and EM forums - there is an interesting thread in the EM forum about the downsides of the specialty, etc.

 

[Yope]

IM before EM, except after... CM?

 

[Droopy Snoopy]

I think it all depends on whether you want to be on the giving end or the receiving end of bull**** admissions.

 

[J ROD]

I would suggest trying to shadow at a busier ER and see what you think.

I have shadowed just about everything I think I would like....

it has helped me alot. I know there are things I like and dont like.

 

[McLovinMD]

Have you considered going into a combined IM/EM residency?

 

[ryryguy]

Have you considered going into a combined IM/EM residency?

Yes, I have. I talked to some doctors about this and they expressed a concern that there is the possibility that one isn't fully trained in either because of less time being alotted to each one. I'm not really sure what I could do with it either other than administrative stuff.

 

[smq123]

In Mexico it's very common for hospitals to hire IM docs to work in the ER (why? Who knows, not enough ER docs??), so if you're between both specialties, you can simply do an IM residency which is 1 year longer and work in the ER as an attending. You get paid the same so it doesn't matter. Downside would be that you wouldn't be good at treating ped emergencies.

This is NOT the way it works in the United States.

An ER residency is sometimes one year longer than an IM residency. (Some Emergency Medicine residencies are 4 years; IM is pretty much always 3.)

In the US, most emergency rooms require that physicians be board certified IN EMERGENCY MEDICINE. They are no longer allowing regular old IM and FM doctors to work in the emergency room. The exceptions are very very rural hospitals, who will take any physician that they can get.

You DO NOT get paid the same. Like I said, most emergency rooms will only hire people who did an emergency medicine residency.

Please, PLEASE, while I understand that you had good intentions, the Mexican system is very different from the US system. Stop giving out unintentionally bad advice, based on your experiences in a completely different country.

 

[r536]

I'm exactly on the same boat!!! I'm having a hard time deciding between IM and EM... liked medicine but did not loved it and I've only spent time in a non level 1 ER but I loved it... I'm having such a hard time scheduling 4th year as I don't know what to do!!

To make things worse, my dean said being a petite Asian woman with mediocre board scores, I won't be able to match into any EM programs...

 

[Pansit]

I'm exactly on the same boat!!! I'm having a hard time deciding between IM and EM... liked medicine but did not loved it and I've only spent time in a non level 1 ER but I loved it... I'm having such a hard time scheduling 4th year as I don't know what to do!!

To make things worse, my dean said being a petite Asian woman with mediocre board scores, I won't be able to match into any EM programs...

Board scores, yes...but I dont know what the petite asian woman has to do with anything...

 

[tkim]

I'm exactly on the same boat!!! I'm having a hard time deciding between IM and EM... liked medicine but did not loved it and I've only spent time in a non level 1 ER but I loved it... I'm having such a hard time scheduling 4th year as I don't know what to do!!

To make things worse, my dean said being a petite Asian woman with mediocre board scores, I won't be able to match into any EM programs...

If you're a petite Asian woman with mediocre board scores who is willing to learn and a blast to work with, you will match EM.

No, I'm not a petite woman who is a blast to work with, but I *am* Asian. One out of four ain't bad.