Switch from IM to EM residency

[IbsensGhost]

Greetings,

I'm currently in an IM program, just started PGY1 year. I found out very late in my fourth year that my real passion was in fact EM and it was just too late to turn the train around and apply for EM instead. My wife also flat refused to move at that point, so I decided to suck it up and stay in our current home to do IM here. I hoped that I could learn to like. I haven't. Now that my wife sees how miserable I am, she has consented to move and allow me to pursue my dream. So my question is: how much will my year of decreased funding and relative lack of experience hurt me in my application process when I enter the match this year?

A little about me:
Older resident
Step 1:237
Step 2: 237
Passed CS first go
Will be published in Academic Medicine in Spring
Speak several languages, including fluency in Spanish

Downside:
I will have spent my first year of residency in IM, so my funding will be decreased.
I did one official EM rotation in med school, though I'm doing one right now in my current residency. I also spent a great deal of time in local EDs during med school with my preceptor.

To reiterate: In your experience, knowing all that, do I still have a shot at matching in EM this year if I am willing to move pretty much anywhere in the country? (And we are willing to move.) Any advice you could give would be sincerely appreciated.

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[NERDY]

Does your IM program hospital have an EM program? Your best bet may be a transfer in your hospital.

Get your application together STAT!

Keep checking the SAEM website for open spots.

 

[IbsensGhost]

Does your IM program hospital have an EM program? Your best bet may be a transfer in your hospital.

Get your application together STAT!

Keep checking the SAEM website for open spots.

Unfortunately, my hospital only has IM. We have an ED of course, and do rotations there, but no EM program. I've already resigned myself to entering the match next year and starting over as a PGY1. I'm just trying to figure out how much the downsides of my application will weigh me down. I graduated from a mid-level MD program on a full ride, so I'm really hoping I can make this work, but I'm not positive.

 

[NERDY]

Did you talk to your current PD, you will need his/her support. Any chance of doing an "away" EM rotation at a place with a residency? Have you been in contact with your med school to get letters, transcripts,etc? Make sure you have easier/lighter rotations Nov - Jan so you can interview.

 

[gman33]

If you can do an "away" at a place with a residency that would be ideal.

I'd suggest applying to EVERY program this year in the match.
Yes, all of them.

Make sure that you really want EM before going down this road.

 

[IbsensGhost]

I have not as yet talked to my PD because it's only been in the last couple of days that my wife has consented to this radical departure from our plan. I wanted to make sure this was even feasible before I went and told them I needed to leave. I think my PD will support me and want me to be happy, and I realize that I'll need her support before I can really follow through on this.

I'm going to look into doing an away at another institution this fall if it all possible. Obviously, that would require extraordinary patience from my PD, but she might agree to it. Guess we'll just have to see. I hate to up and leave them hanging for a month, but I really need to shore up my application in my view.

As for being sure about what I want, I have never been more sure of anything since I started med school. When I get to work in ED I feel like I've come home, and I'm always a little surprised my shift is done because the time went by so quickly. It suits my personality perfectly, and I love the fast pace and juggling of many disparate issues simultaneously. I always seem to leave with a big grin on my face, no matter who I work with or what kind of patients I saw. IM really hasn't even come close to how I feel about EM. We are paper work lackeys that never get to work with our hands, and we barely spend more time with our patients than the EM docs because we spend so much time typing and dealing with social work issues. Truth is, I would have applied to EM last year if my 8 months pregnant wife hadn't refused to move (which would have been necessary for me to do EM.) I knew as soon as I did my EM rotation late last year that I was making a serious mistake going into IM, but I just couldn't convince her at the time that I had to change.

 

[NERDY]

Make sure you have good reasons why you are switching (which will be part of every interview). Apply at every place and do every interview. Enlist the help of your colleagues to cover for you if needed (and of course pay them back after interview season).

 

[IbsensGhost]

Understood. I actually have a pretty good explanation for why I didn't do EM in the beginning, and I think I can make my case well when the time comes. I interview well, and I think that will count for a lot in this process. We are willing to move pretty much anywhere, and I will send apps to all and sundry to see who bites. As for my current colleagues, they are a very solid bunch, and I think they'll do what they can to help. I'll do my best to pay them back however I can, though interview time will be difficult to arrange. Our schedule for the year is already made, and I am very busy from Dec through Feb. I'll need to sit down with my PD and just come clean and ask for pity/help and pray that she's the kindhearted soul she appears to be.

Do you all have any sense for how much my one year of diminished funding will hurt the application? It's really the only part of my application that can't be fixed no matter what. I've already had one PD tell me that could be a problem, though that program is small and relatively low budget. What do you think?

 

[NERDY]

I don't know about the funding issue but it makes sense that a fresh MS4 that has full funding is more attractive financially vs. a PGY 1 who used up a year.

 

[deuist]

It's a problem for only a few programs. There are others with the resources that a lost year don't really matter.

 

[NERDY]

Make sure you talk to your med school EM faculty ASAP. You'll need their help and they are probably busy advising all the M4 EM bound students right now.

 

[IbsensGhost]

Just so this information is available for future applicants:

I have made numerous inquiries the past couple of weeks to figure out if one year of decreased funding will hurt one's chances in switching to EM. Deuist's post above is spot on: All the programs I have contacted have stated that one of year decreased funding will not be a problem for them. Many have also stated that they are willing to consider good candidates with only one SLOR should that be necessary.

 

[xoomn]

what if you want to switch from IM to EM after completion of IM residency? any thoughts or comments.

 

[lost007]

what if you want to switch from IM to EM after completion of IM residency? any thoughts or comments.

I'm also wondering this. I matched at a mid-tier university IM program and just did a 2 week EM rotation that I really enjoyed. Is it possible do 2 separate residencies, one in IM and one in EM?

 

[Makati2008]

Is your program somewhere with EM/IM combined? Two of the places I looked to apply for it stopped taking applicants due to lack of interests.

 

[lost007]

Is your program somewhere with EM/IM combined? Two of the places I looked to apply for it stopped taking applicants due to lack of interests.

Unfortunately, my program doesn't have IM/EM combined, or EM alone for that matter. Anybody know any programs that have taken IM people in the past?

 

[Bostonredsox]

I'm also wondering this. I matched at a mid-tier university IM program and just did a 2 week EM rotation that I really enjoyed. Is it possible do 2 separate residencies, one in IM and one in EM?

Wait till you finish your three years of IM. The thought of going back and doing more years of residency in EM instead of moving on to fellowship or practicing as an attending will be so repulsive you will look back on this thread and laugh. If you want to switch to EM, get out now. Don't finish IM.

 

[Dr Google]

And by the way even though I don't even have a residency yet so don't have any hard data, but I have learnt from some people that ACGME sponsors only a limited number of years of residency/residencies.
So a lot of programs may not look at you favorably since you've already used up the 50% portion of funding that comes from ACGME, making the department to fund the remaining whole 100%.
You heard anything similar?

 

[Kal EI]

As for being sure about what I want, I have never been more sure of anything since I started med school. When I get to work in ED I feel like I've come home, and I'm always a little surprised my shift is done because the time went by so quickly. It suits my personality perfectly, and I love the fast pace and juggling of many disparate issues simultaneously. I always seem to leave with a big grin on my face, no matter who I work with or what kind of patients I saw. IM really hasn't even come close to how I feel about EM. We are paper work lackeys that never get to work with our hands, and we barely spend more time with our patients than the EM docs because we spend so much time typing and dealing with social work issues. Truth is, I would have applied to EM last year if my 8 months pregnant wife hadn't refused to move (which would have been necessary for me to do EM.) I knew as soon as I did my EM rotation late last year that I was making a serious mistake going into IM, but I just couldn't convince her at the time that I had to change.

Are EM and IM that drastically different? It sounds like a hospitalist could work very similarly to a EP. It just seems far fetched to say you'd be ecstatic in one field and depressed in another.

 

[RustedFox]

Are EM and IM that drastically different? It sounds like a hospitalist could work very similarly to a EP. It just seems far fetched to say you'd be ecstatic in one field and depressed in another.

radically different, yes. yes. yes. yes.

I remember saying to myself around match time that I would be a miserable internist.

 

[deuist]

.

Are EM and IM that drastically different? Yes
It sounds like a hospitalist could work very similarly to a EP. Nope, not at all. Do you think an EP could work as a hospitalist?
It just seems far fetched to say you'd be ecstatic in one field and depressed in another. Why don't you ask all of the people who picked one field over another if they would want to go back to residency and specialize in something else?

 

[gutonc]

And by the way even though I don't even have a residency yet so don't have any hard data, but I have learnt from some people that ACGME sponsors only a limited number of years of residency/residencies.
So a lot of programs may not look at you favorably since you've already used up the 50% portion of funding that comes from ACGME, making the department to fund the remaining whole 100%.
You heard anything similar?

You have only a cursory, and essentially incorrect understanding of the funding issue. Please stop spreading misinformation.

Is there decreased funding for a 2nd residency (or additional years after your "clock" starts)? Yes.
Is it 0%? No. How about 50%? No. It varies from program to program but it averages out to somewhere in the 70-75% range...definitely not a dealbreaker for most programs and good applicants.

A program who uses this as an excuse to not take somebody who has done all or part of another residency falls into one of 4 categories:
1. They're trying to let you down easy...they don't want you at all and are using "funding" as an excuse. "It's not you, it's me."
2. They don't understand the rules. This is not uncommon. You can try to fight it but it's probably not worth your trouble.
3. They don't want the hassle of turning an internist/surgeon/pediatrician/neurologist into an EP (this is true for any specialty but this is the EM forum). You're probably going to need a good Marine Corps, Parris Island style beating to rid you of the things you learned in your prior training and they don't have time for that.
4. They're dead-ass broke and truly can't afford it.

 

[deleted547339]

You have only a cursory, and essentially incorrect understanding of the funding issue. Please stop spreading misinformation.

Mr. Madison, what you've just said;... is one of the most insanely idiotic things I have ever heard. At no point in your rambling, incoherent response were you even close to anything that could be considered a rational thought. Everyone in this room is now dumber for having listened to it. I award you no points, and may God have mercy on your soul...

 

[Kal EI]

.

curious why you would hate being a hospitalist. Please enlighten me.

Are EM and IM that drastically different? Yes
It sounds like a hospitalist could work very similarly to a EP. Nope, not at all. Do you think an EP could work as a hospitalist?
It just seems far fetched to say you'd be ecstatic in one field and depressed in another. Why don't you ask all of the people who picked one field over another if they would want to go back to residency and specialize in something else?

I would love to hear from people who do IM/EM why those chose hospitalist over EM. I guess I was saying I could see myself training to do either. Unfortunately, medical school isn't set up to give us experience in everything in our 3rd year - so some of this is a guessing game helped out by reading a few posts here or there on the internet.

You do find combined IM/EM residencies though, so I wouldn't think the two specialties are so diametrically opposed. I'm still learning.

Wait till you finish your three years of IM. The thought of going back and doing more years of residency in EM instead of moving on to fellowship or practicing as an attending will be so repulsive you will look back on this thread and laugh. If you want to switch to EM, get out now. Don't finish IM.

Didn't you say you applied EM but ended up being a hospitalist? Could you talk about the difference from your standpoint on the two positions.

 

[deuist]

I would love to hear from people who do IM/EM why those chose hospitalist over EM. I guess I was saying I could see myself training to do either. Unfortunately, medical school isn't set up to give us experience in everything in our 3rd year - so some of this is a guessing game helped out by reading a few posts here or there on the internet.

There is a combined forum on SDN here where you could ask your questions.

You do find combined IM/EM residencies though, so I wouldn't think the two specialties are so diametrically opposed. I'm still learning.

Yeah, they exist. It also takes 2 extra years to get certified in both---so maybe that aren't so similar after all. If you are interested in the (very limited) research being done out there, do a PubMed search with the following string:

"emergency medicine"[ti] AND "internal medicine"[ti] AND (residency OR residencies)

Most people who did EM/IM work in ED's only.

 

[RustedFox]

Kal El: I'll answer your question, but not right now - stay tuned to this thread.

Long-story-short.... chasing someone's renal function around and being the 'go-to-boy' for every other service on the planet is.... a decent way to earn a living.. but offered me no satisfaction personally.

I used to be like you, thinking to myself: 'Yeah, I could do either, and bounce back-and-forth with authority."


Nope. Dudn't happen that'way in real life.

 

[racerwad]

... guess I was saying I could see myself training to do either...

There is a difference between seeing yourself able to be interested in completing either training program but a totally different thing to say that X and Y are interchangeable for each other.

Obviously, they both practice medicine on human patients but most of the context in which that medicine is practice is very different. That requires a different perspective from the physician and that difference in perspective probably would make a great EP a meh internist and vice-versa.

 

[Kal EI]

There is a difference between seeing yourself able to be interested in completing either training program but a totally different thing to say that X and Y are interchangeable for each other.

Obviously, they both practice medicine on human patients but most of the context in which that medicine is practice is very different. That requires a different perspective from the physician and that difference in perspective probably would make a great EP a meh internist and vice-versa.

So this conclusion would follow: A great IM doc could never be a great EP, and a great EP could never be a great IM doc.

 

[racerwad]

So this conclusion would follow: A great IM doc could never be a great EP, and a great EP could never be a great IM doc.

I don't think so.

Besides, what difference does it make? Why would a great EP be working on the floor or vice versa?

 

[Kal EI]

I don't think so.

Besides, what difference does it make? Why would a great EP be working on the floor or vice versa?

No difference. I'm just learning about everyone's perspectives on medical specialties. If that is true then it helps my decision making process.

 

[Dr Google]

You have only a cursory, and essentially incorrect understanding of the funding issue. Please stop spreading misinformation.

Is there decreased funding for a 2nd residency (or additional years after your "clock" starts)? Yes.
Is it 0%? No. How about 50%? No. It varies from program to program but it averages out to somewhere in the 70-75% range...definitely not a dealbreaker for most programs and good applicants.

A program who uses this as an excuse to not take somebody who has done all or part of another residency falls into one of 4 categories:
1. They're trying to let you down easy...they don't want you at all and are using "funding" as an excuse. "It's not you, it's me."
2. They don't understand the rules. This is not uncommon. You can try to fight it but it's probably not worth your trouble.
3. They don't want the hassle of turning an internist/surgeon/pediatrician/neurologist into an EP (this is true for any specialty but this is the EM forum). You're probably going to need a good Marine Corps, Parris Island style beating to rid you of the things you learned in your prior training and they don't have time for that.
4. They're dead-ass broke and truly can't afford it.

Hey, thanks for the detailed info, I can see that the funding issue is not as 'straightforward' as I was told.
By the way, please don't judge me so easily as someone trying to spread misinformation. I am a genuine EM-hopeful who's trying to gather more 'correct' information rather than spread 'incorrect' information.
Your elaborate explanation of the issue was exactly what I was looking for when I posted the question in the first place, and thanks again for that.