Residency Predicament - Advice?

[treyc]

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I’m a current third-year medical student setting up audition rotations and would appreciate some advice regarding specialty choice and residency strategy.

For context, I have a wife and a young child. We currently live in our hometown in a house that is fully paid off, and both of our families live here. Having family support nearby is a big benefit for us.

Emergency Medicine is the specialty I enjoy the most and what I would ideally like to do. However, I’m also very aware of the burnout rates in EM and the limited long-term flexibility if I eventually decide to move away from the emergency department. Internal Medicine, particularly hospitalist medicine, is a close second for me.

In my hometown there are two hospitals, both with Internal Medicine residency programs:

Hospital 1

• Larger hospital
• More established IM residency program
• Affiliated/in-network with a top international hospital system
• Level II trauma center
• IM residents only do one EM rotation in the curriculum

Hospital 2

• Smaller hospital
• Brand new IM residency program
• Level III trauma center
• IM residents can do multiple rotations in the ED
• IM physicians and FM physicians currently work in the ED
• IM program leadership has said residents could potentially moonlight in the ED during third year
• Actively trying to recruit me to their program

My long-term goal is to ultimately practice in this town.

Right now I’m struggling with whether I should:

1. Leave town to pursue a full Emergency Medicine residency and get more formal EM training, or
2. Stay in my hometown and complete an Internal Medicine residency, with the possibility of doing some ED work locally afterward.

Hospital 2 leadership has told me that after completing their IM residency they would likely allow me to work in the ER if I wanted. My hesitation is that this isn’t guaranteed forever, since hospitals could eventually require EM board certification. I also worry about the quality of training since the IM program is brand new and the patient population is smaller.

Another factor is lifestyle flexibility. While I love EM, I’m aware of the burnout rates and I’m hesitant about being locked into EM/urgent care long-term. If I burned out after 5–10 years, I like the idea of having the flexibility to transition into outpatient or other IM-based work.

My biggest priorities are:

• Becoming well trained in whatever specialty I choose
• Being present for my family

My current plan is to:

• Do one or two EM audition rotations
• Try to obtain one or two SLOEs
• Apply to both EM and IM

That would give me more time before rank lists are due to make the final decision.

I’d really appreciate hearing perspectives from:

• EM physicians who considered IM
• IM physicians who considered EM
• Anyone who chose residency based heavily on family/location considerations

What factors should I be thinking about that I might be missing?

 

[dozitgetchahi]

Don’t do an IM residency thinking you’re going to practice some EM on the side when you’re done. IM residency isn’t really great prep for EM no matter how many rotations you do in it (you don’t see kids, much GYN, or pregnant women in IM residency for starters).

FM would make somewhat more sense as a “Jack of all trades” specialty where you might still do some EM on the side - at least then you have some experience with peds and OB - but even then doing an FM residency is not necessarily great training for doing EM. EM is its own specialty with its own mindset and skill set. The vibe of day to day EM work is a lot different from IM too - most EM docs dread things like rounding and clinic.

You could consider combined residencies. There are EM/IM residencies out there, and EM/IM/CCM. Otherwise you kinda need to make a choice here.

If you want to do IM, go to program #1 (sounds like the more mature of these programs, and better quality) and practice IM. If you want to do EM, don’t go to either of these programs and match an EM program. It won’t be terribly hard given how much the competitiveness of EM has declined recently.

You probably want to post this in the EM forum to get a clear sense of what they think of the idea.

 

[anonperson]

I’m a current third-year medical student setting up audition rotations and would appreciate some advice regarding specialty choice and residency strategy.

For context, I have a wife and a young child. We currently live in our hometown in a house that is fully paid off, and both of our families live here. Having family support nearby is a big benefit for us.

Emergency Medicine is the specialty I enjoy the most and what I would ideally like to do. However, I’m also very aware of the burnout rates in EM and the limited long-term flexibility if I eventually decide to move away from the emergency department. Internal Medicine, particularly hospitalist medicine, is a close second for me.

In my hometown there are two hospitals, both with Internal Medicine residency programs:

Hospital 1

• Larger hospital
• More established IM residency program
• Affiliated/in-network with a top international hospital system
• Level II trauma center
• IM residents only do one EM rotation in the curriculum

Hospital 2

• Smaller hospital
• Brand new IM residency program
• Level III trauma center
• IM residents can do multiple rotations in the ED
• IM physicians and FM physicians currently work in the ED
• IM program leadership has said residents could potentially moonlight in the ED during third year
• Actively trying to recruit me to their program

My long-term goal is to ultimately practice in this town.

Right now I’m struggling with whether I should:

1. Leave town to pursue a full Emergency Medicine residency and get more formal EM training, or
2. Stay in my hometown and complete an Internal Medicine residency, with the possibility of doing some ED work locally afterward.

Hospital 2 leadership has told me that after completing their IM residency they would likely allow me to work in the ER if I wanted. My hesitation is that this isn’t guaranteed forever, since hospitals could eventually require EM board certification. I also worry about the quality of training since the IM program is brand new and the patient population is smaller.

Another factor is lifestyle flexibility. While I love EM, I’m aware of the burnout rates and I’m hesitant about being locked into EM/urgent care long-term. If I burned out after 5–10 years, I like the idea of having the flexibility to transition into outpatient or other IM-based work.

My biggest priorities are:

• Becoming well trained in whatever specialty I choose
• Being present for my family

My current plan is to:

• Do one or two EM audition rotations
• Try to obtain one or two SLOEs
• Apply to both EM and IM

That would give me more time before rank lists are due to make the final decision.

I’d really appreciate hearing perspectives from:

• EM physicians who considered IM
• IM physicians who considered EM
• Anyone who chose residency based heavily on family/location considerations

What factors should I be thinking about that I might be missing?

If you want a normal home life, doing a specialty where nights are the norm is not it.

Also working holidays etc.

Practicing EM with only IM training is a bad idea. You may be able to deal with a lot of stuff but you'll have no peds, gyn exposure etc.

Legally, you'll be held to the standard of care of a board certified EM physician. That's not a small thing.

Also, doing night shift work is associated with an increased risk of heart attack, stroke and cancer. These are real risks.