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?

 

[Birdstrike]

Have you considered either a Pain Medicine or Hospice and Palliative fellowship?

You can go straight into them after EM. There’s no need to retrain. Either gives you a second totally different specialty you can practice with a much more normal lifestyle, in the case of Pain, it’s a completely normal with no nights, weekends or holidays ever again.

Edit: Sorry, I read 3rd year “medical student” as 3rd year “resident.” Ignore what I wrote unless you find yourself in this predicament in a few years wondering why you chose EM. What toll EM can take, the good, the bad, the happy the sad and one man’s walk back from the brink, is what I wrote my book about. I didn’t write it because I wanted to, I had to write it to set myself free, mentally.

 

[Tenk]

Being present for your family >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> a job.

No matter what specialty you choose, everything will get repetitive and boring. In the end, this is just a job to support your family. Choose them.

 

[Groove]

Easy. IM or FM in your home town. You think you want EM but you don’t. If you choose EM, you’ll realize the mistake in, oh about….10 years or so. Maybe 5 or 8 depending on your first couple jobs. Your family will figure it out sooner.

 

[Porfirio]

Definitely IM

 

[JacobMcCandles]

You won't find much love for EM here but it can be a good career. I think being a hospitalist is probably the worst job in the hospital but maybe that's hospital dependent. Either way, if you don't train in EM then you don't have any business working in an emergency department.

 

[Apollyon]

Dude, don't cross post. You agreed to that when you signed up. You're already in violation (but I've never yet see someone banned for it on the first time).