Questions on EM knowledge base

[Worried-doc]

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Hello current and future doctors,m.s.4 graduate here,taking a year off to decide on which speciality to persue and spend time with my kid.I have a couple of rather vague questions that i'm pondering about.I've already got quite an insight from a kind and helpfull member of this forum,i'd like to get more insight from others into this.
I've been thinking of emergency medicine on the grounds of knowledge base.I want to make use of whatever i've learnt in med school and studied to secure good scores in the mles,to the best possible extent.From what i've gathered an EM physician's knowledge base would be equal to that of family medicine+ acute and acute on chronic emergency care.It this an appropriate/close to accurate judgement?
Comparing the knowledge base between EM and IM i've learnt that EM is more broader and IM is comparitively confined and a lot much deeper.Even so would it be correct to assume that IM requires a lot more knowledge to be board certified?
Also as an EM physician can render primary care probably as good as a family physician,can one trained in EM practice as a family physician?i'm thinking like an outpatient hospitalist.
It be would be nice to know that if the stress gets to me i can rely on working as an FM hospitalist or something along that career path.
Any guidance relating to those questions will be much appreciated.

 

[bashwell]

Hello current and future doctors,m.s.4 graduate here,taking a year off to decide on which speciality to persue and spend time with my kid.I have a couple of rather vague questions that i'm pondering about.I've already got quite an insight from a kind and helpfull member of this forum,i'd like to get more insight from others into this.
I've been thinking of emergency medicine on the grounds of knowledge base.I want to make use of whatever i've learnt in med school and studied to secure good scores in the mles,to the best possible extent.From what i've gathered an EM physician's knowledge base would be equal to that of family medicine+ acute and acute on chronic emergency care.It this an appropriate/close to accurate judgement?
Comparing the knowledge base between EM and IM i've learnt that EM is more broader and IM is comparitively confined and a lot much deeper.Even so would it be correct to assume that IM requires a lot more knowledge to be board certified?
Also as an EM physician can render primary care probably as good as a family physician,can one trained in EM practice as a family physician?i'm thinking like an outpatient hospitalist.
It be would be nice to know that if the stress gets to me i can rely on working as an FM hospitalist or something along that career path.
Any guidance relating to those questions will be much appreciated.

1) @Worried-doc, you are too worried! 🙂 If you're a US med student (DO or MD), passed Step 1, have done well in med school especially clinicals, no red flags, etc., then your knowledge base will be fine for EM. If you haven't yet, then focus on doing well in your classes, Step 1, clinical evals, etc. You'll learn to be an emergency physician in residency after all. Just keep working hard, being disciplined, etc.

2) I "guess" generally speaking yes EM, FM, and IM have overlapping knowledge, although much of that is just medical knowledge in general, but EM isn't for example going to manage longstanding T2DM or hypertension.

3) Also keep in mind the practice settings of EM, FM, and IM are entirely different.

4) It doesn't sound like you're very far along in med school? If not, you should see all this in your clinical years. Just wait until then before coming to any conclusions. For now just focus on Step 1 (and of course doing well in your classes in general) if you're still in your pre-clinical years.

5) And no EM can't do FM or IM work. At least not that I know of. It'd be really strange to say the least. But maybe it exists somewhere rurally, I don't know. I have heard of some FM working in the ED in rural areas though, but that's apparently becoming less and less. I expect someday most will want BC/BE emergency physicians. Just decide if you want FM or EM more.

 

[Cytarabine]

MS4??

 

[Arcan57]

Grammar and lack of knowledge regarding the specialties' areas of expertise make me doubt the MS4 claim or else feel really badly about the OPs med school experience.

I think the biggest challenge in outpatient medicine is figuring out who can/needs to be worked up and in what setting. In EM we have the luxury of presuming that the patient in front of us has an emergency and we are allowed emergent access to resources to rule out emergent diagnoses. I'm sure an EP practicing in an outpt clinic would have a rough time with matching acuity and resources for that population in the same way the FPs often incompletely address emergent diagnoses because of a bias towards health and chronic diseases.

 

[racerwad]

Hello current and future doctors,m.s.4 graduate here,taking a year off to decide on which speciality to persue and spend time with my kid.I have a couple of rather vague questions that i'm pondering about.I've already got quite an insight from a kind and helpfull member of this forum,i'd like to get more insight from others into this.
I've been thinking of emergency medicine on the grounds of knowledge base.I want to make use of whatever i've learnt in med school and studied to secure good scores in the mles,to the best possible extent.From what i've gathered an EM physician's knowledge base would be equal to that of family medicine+ acute and acute on chronic emergency care.It this an appropriate/close to accurate judgement?
Comparing the knowledge base between EM and IM i've learnt that EM is more broader and IM is comparitively confined and a lot much deeper.Even so would it be correct to assume that IM requires a lot more knowledge to be board certified?
Also as an EM physician can render primary care probably as good as a family physician,can one trained in EM practice as a family physician?i'm thinking like an outpatient hospitalist.
It be would be nice to know that if the stress gets to me i can rely on working as an FM hospitalist or something along that career path.
Any guidance relating to those questions will be much appreciated.

Taking a year off "to decide on which speciality (sic) to persue (sic) and spend time with my kid" is a terrible idea if you want to maximize your chances of matching. Not only will you be out a year of clinical medicine, programs are going to want to know in what ways you are better now than you were at graduation (ie - research, curing cancer, making a flying car, etc).

@bashwell and @Arcan57 has astutely answered most of your other questions. As it pertains to alternate paths, the nice thing about EM is that there are so many niches (via fellowship training) you can explore: EMS, US, wilderness/disaster, CC, administration, education, hyperbarics, tox, pain, palliative, and sports. This is in addition to all of the entrepreneurial outlets you can explore.

But my advice first is to focus on matching into the specialty.

 

[deuist]

The OP's question is so poorly written and contains so many knowledge gaps that I sincerely doubt that she is a US citizen currently in her 4th year of medical school at a US allopathic program.

As for the question itself: taking a year off is generally a bad idea for emergency medicine. Maybe if you did some awesome research you might be able to spin it into something positive. But in general, program directors are leery of taking anyone other than medical students in the match. The 3 specialties – emergency medicine, family medicine, and internal medicine – do indeed have some knowledge overlap, but are vastly different in experience and practice. An internist will never deliver babies, take care of children, or reduce orthopedic fractures. Likewise, a family physician would generally not be expected to place central lines, perform FAST exams, or provide antidotes for acute poisoning. As an emergency physician, I typically do not start patients on outpatient medications for chronic conditions, perform cancer screenings, or write dialysis orders. Each of these specialties involves a three-year residency and none of them necessarily require "more knowledge" to become board-certified.

Choosing a medical specialty can certainly be difficult. The good news is that sub internships and externships can hopefully provide you with the experiences necessary to make a decision.

 

[Worried-doc]

I've come across a lot of such unneccessary and silly criticism meted out towards people asking legit questions in sdn forums.Picking on their grammar,charachter, judging them,going back and forth arguing about really petty and insignificant stuff.It's really futile and laughable.Why don't you people just answer questions straight and simple rather than focussing more on your sentence framing, your art of writing etc. We're all doctors meant to treat the sick,not grammar nazis posing with stitched titles on our lab coats declaring ourselves literary scholars who can also be soothsayers.I've hardly ever come across any thread being responded to without petty controversies and arguments.Just answer people's questions or there isn't much use for these forums.As long as one speaks good enough english such that he/she is clearly understandable it shouldn't matter.You're here to help,not to be pests.
The person that questioned my citizenship,yes i'm not american,i'm canadian and my 1st language is french.There are indian doctors pioneers in medicine in the u.s. who speak very average english.
Avoid further discussion/criticism on irrelavant matters and answer my questions or dont.
I was pretty clear in my context.
My questions have been answered VERY! poorly.Read them again, understand what i mean and answer to the point,kindly and politely or please keep your silence.I'm waiting for a clear and geuine answer from somebody.

 

[bashwell]

I've come across a lot of such unneccessary and silly criticism meted out towards people asking legit questions in sdn forums.Picking on their grammar,charachter, judging them,going back and forth arguing about really petty and insignificant stuff.It's really futile and laughable.Why don't you people just answer questions straight and simple rather than focussing more on your sentence framing, your art of writing etc. We're all doctors meant to treat the sick,not grammar nazis posing with stitched titles on our lab coats declaring ourselves literary scholars who can also be soothsayers.I've hardly ever come across any thread being responded to without petty controversies and arguments.Just answer people's questions or there isn't much use for these forums.As long as one speaks good enough english such that he/she is clearly understandable it shouldn't matter.You're here to help,not to be pests.
The person that questioned my citizenship,yes i'm not american,i'm canadian and my 1st language is french.There are indian doctors pioneers in medicine in the u.s. who speak very average english.
Avoid further discussion/criticism on irrelavant matters and answer my questions or dont.
I was pretty clear in my context.
My questions have been answered VERY! poorly.Read them again, understand what i mean and answer to the point,kindly and politely or please keep your silence.I'm waiting for a clear and geuine answer from somebody.

1) I (among others) actually attempted to respectfully answer your questions. Not sure why you think otherwise.

2) Ironically, your own reaction isn't exactly a very polite and respectful reaction.

3) Also, sure, people can be respectful in answering questions, but people should also be respectful in asking questions. It's a two way street. However, you originally didn't exactly provide people with a whole lot of detail which would be relevant in answering your questions, so in this sense you're not asking in a way where others can best help you. How is this a respectful way of asking questions?

4) Since practice environment matters in EM, FM, and IM, if you're French Canadian, and if you intend to practice in Canada (e.g. Quebec), then you would probably find better answers if you addressed your questions to emergency physicians familiar with the Canadian health care system. This should've been made clear in your original question too.

 

[da8s0859q]

My questions have been answered VERY! poorly.Read them again, understand what i mean and answer to the point,kindly and politely or please keep your silence.I'm waiting for a clear and geuine answer from somebody.

You have gotten some very pertinent replies above.

You're also about to get some very pertinent replies to this bit of obnoxiousness.

 

[Tenk]

I'm waiting for a clear and geuine answer from somebody.

42.

 

[Doctor Bob]

I'm waiting for a clear and geuine answer from somebody.

Consider something other than EM. We don't want you.

Let me know if I need to make it clearer and/or more genuine.

 

[Arcan57]

Some of the assumptions you were making regarding knowledge base make a lot more sense coming from a system where many EPs are what would essentially be considered fellowship trained FPs in the US. As mentioned above, your original post left out some important background details as an equivalent post from an AMG would be essentially non-sensical. If you are super sensitive to criticism, an upfront "I'm an MS4 in Quebec" would have been a significantly better place to start the conversation. FWIW, taking a year off after med school to figure out specialty in the US without pursuing an advanced degree or obtaining a nationally known scholarship (Robert Wood Johnson fellow or equivalent) would lead to not being considered for an interview in many IM and EM programs. I would address your question specifically to Canadian EPs since the question you're asking doesn't make sense in the training and practice environment most American EPs inhabit.

 

[Worried-doc]

42.

43426

 

[Worried-doc]

1) I (among others) actually attempted to respectfully answer your questions. Not sure why you think otherwise.

2) Ironically, your own reaction isn't exactly a very polite and respectful reaction.

3) Also, sure, people can be respectful in answering questions, but people should also be respectful in asking questions. It's a two way street. However, you originally didn't exactly provide people with a whole lot of detail which would be relevant in answering your questions, so in this sense you're not asking in a way where others can best help you. How is this a respectful way of asking questions?

4) Since practice environment matters in EM, FM, and IM, if you're French Canadian, and if you intend to practice in Canada (e.g. Quebec), then you would probably find better answers if you addressed your questions to emergency physicians familiar with the Canadian health care system. This should've been made clear in your original question too.

I wasn't reffering to you in my response.Thankyou for guidance.

 

[Worried-doc]

Some of the assumptions you were making regarding knowledge base make a lot more sense coming from a system where many EPs are what would essentially be considered fellowship trained FPs in the US. As mentioned above, your original post left out some important background details as an equivalent post from an AMG would be essentially non-sensical. If you are super sensitive to criticism, an upfront "I'm an MS4 in Quebec" would have been a significantly better place to start the conversation. FWIW, taking a year off after med school to figure out specialty in the US without pursuing an advanced degree or obtaining a nationally known scholarship (Robert Wood Johnson fellow or equivalent) would lead to not being considered for an interview in many IM and EM programs. I would address your question specifically to Canadian EPs since the question you're asking doesn't make sense in the training and practice environment most American EPs inhabit.

I've went to medical school in the U.S. and plan on settling in the U.S. I'm currently serving in a clerkship program and plan on serving in more.

 

[Worried-doc]

Consider something other than EM. We don't want you.

Let me know if I need to make it clearer and/or more genuine.

Make it "clearer and/or more genuine" would you as you're the grand puba of emergency medicine. "We don't want you":a very common and cheap attempt to deride people by making them feel unlikable and set aside from a group.I "dont want" your opinion.

 

[Worried-doc]

Like i said i just wanted my questions answered in the manner i asked them.
To those who've given their sincere and helpful responses without the extra un-required advice,thankyou,really.
To those who're just trying to be smart mouths and bully a student because of hierarchy in their current positions as compared to mine,you're just wasting your time.
As usual a thread that has been tended to in a controversial manner.

 

[Doctor Bob]

Make it "clearer and/or more genuine" would you as you're the grand puba of emergency medicine. "We don't want you":a very common and cheap attempt to deride people by making them feel unlikable and set aside from a group.I "dont want" your opinion.

It's spelled poobah.

I will leave the rest of the grammatical/spelling errors uncorrected.





(but Grand Poobah should also be capitalized...)

 

[Cinematographer]

Thankyou.

Sorry. I had to.

 

[Arcan57]

Like i said i just wanted my questions answered in the manner i asked them.
To those who've given their sincere and helpful responses without the extra un-required advice,thankyou,really.
To those who're just trying to be smart mouths and bully a student because of hierarchy in their current positions as compared to mine,you're just wasting your time.
As usual a thread that has been tended to in a controversial manner.

The questions you are asking in your first post are questions we typically see from either pre-med, pre-clinical, or early M3 med students. It's unclear to me if you were actually asking a "What's the difference between IM,FM, and EM?" question that's been answered multiple times previously or if you had some deeper thought that your English failed to convey. Your question raises all sorts of red flags that the majority of the initial posters were trying to clarify as your actual questions were answered by bashwell as well as should have been imparted during med school. Given these red flags (depending on Step scores, etc) EM may not be a realistic option for you. If you are concerned regarding burnout and transitioning to a less stressful job I would strongly suggest reviewing any of the threads on "Can EPs work in a clinic?" that have populated this forum in the last decade.

Finally, the only truly insulting comment was Doctor Bob's and that occurred after you went way off the rails in your response to our responses. Rightly or wrongly, EM requires a thick skin and the ability to deal with jackasses who also happen to be correct about the factual information they are conveying. What you perceive as bullying is a combination of concern and frustration from a group that has some of the highest scores for emotional exhaustion and depersonalization among all of the medical specialties. The fact that you got 9 replies in before someone made a directly disparaging post I think showed a fair amount of restraint. Anyway, your questions are probably best addressed in a 1-on-1 fashion using verbal communication. Anyway, I hope everything is ok with your kid and that you end up matching into a specialty that you find fulfilling.

 

[rjdiii]

Looks a lot like a troll.

 

[Doctor Bob]

Finally, the only truly insulting comment was Doctor Bob's and that occurred after you went way off the rails in your response to our responses. Rightly or wrongly, EM requires a thick skin and the ability to deal with jackasses who also happen to be correct about the factual information they are conveying. What you perceive as bullying is a combination of concern and frustration from a group that has some of the highest scores for emotional exhaustion and depersonalization among all of the medical specialties. The fact that you got 9 replies in before someone made a directly disparaging post I think showed a fair amount of restraint. Anyway, your questions are probably best addressed in a 1-on-1 fashion using verbal communication. Anyway, I hope everything is ok with your kid and that you end up matching into a specialty that you find fulfilling.

Yep... hit the nail on the head with that one.

To the OP...
Your original post had some valid questions in them; questions we are all too happy to answer. Sure we might tire of seeing the same questions asked over and over, but we still answer them to the best of our ability. Those last 6 words are key... to the best of our ability. The quality of the answers we give are directly related to the quality of the information we have to work with. Just as with our patients, if things don't seem right, or if the information doesn't pass the sniff test, it raises alarms with us. I don't want to write a long thought out response to someone who is just trying to jerk me around or troll the forum, or "is asking for a friend" or a myriad of other reasons.

It's the same with belligerent people. If you come into my ED genuinely asking for help, I'll help. If you start acting like an ass, my compassion quickly runs out. Post #7... that's where my compassion ran out.

We are (a lot of us) attendings in the field. You are presumably a med student who wants to get into the field. There is nothing you can do to us other than make disparaging comments and snark at people (I couldn't care less about that... I have drug seekers say worse things to me to my face on a weekly basis; a faceless internet person has no effect). On the other hand, you came here looking for information and guidance, both of which we can provide... and which we would be happy to do so long as you're polite.

Sometimes people don't like the advice we give, or think it's harsh, or mean. It's not. It's real life. Everyone doesn't get a trophy, there's no A for effort. Some people are cut out for EM, some aren't. Being able to get into an emergency medicine residency is very much personality dependent. We reject people all the time because of personality. I don't care about your knowledge base, I can train that into (or out of) you. But if you're a jerk, I don't want to have to work with you.

Which is why... consider doing something other than EM. We don't want you.

Unless you change your tone.