Those who recently matched and were torn between EM and IM....

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One objectively sucked and one rocked

Man I still feel an idiot wanting to do IM all throughout med school. Thanks for showing me the way @Tenk

I determined I wasn't interested in continuity of care, and while I liked pathology I found making a diagnosis, even a provisional one, was more fulfilling for me than rounding on them for weeks
 
PossibleEMapplicant said:
Congrats to everyone who matched last month! Question for all you 4th year med students who recently matched; for those of you who were torn between EM and IM, how did you settle on the choice of EM?
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I may not fully qualify as I’ve always been mostly leaning EM, but did consider IM for a little (mostly after thinking about sub-specializing in cardio or pulm/crit), but then quickly came to my senses.

For me my reasons were similar to the poster above. I really enjoyed the undifferentiated patient aspect, acutely managing/stabilizing then getting them out, having life-threatening focused differentials instead of rare/random crap I don’t care about just to say I thought of it, not sitting around for hours talking instead of doing, etc. My school actually makes us do an IM rotation now post-match due to scheduling problems (horrible), and it’s been the most career reaffirming thing ever. IM plain sucks to me now. Even though there’s a ton of stuff in EM that isn’t exciting, I actually find that stuff semi-enjoyable too bc I’m a social dude so it’s cool just getting to help ease people’s concerns and talk them through things. Continuity of care also didn’t matter to me either after I really analyzed my interests. I’d say just spend time in both environments and you should quickly learn what you enjoy more. Best of luck
 
I made this decision maybe 3 years ago. The question for me was EM vs specializing in cardiology after IM.

My approach to the decision was based on some assumptions and life priorities which are the following:

1. A job is a job. There is no such thing as a calling. Every job becomes boring and monotonous after a decade.
2. If given the option between a day off vs being at work, I'll always pick a day off.
3. My Grand scheme goal of building an empire, whether real estate or business. Medicine was to be my stable source of capital to fund my outside interests of market investments.
4. No. 3 requires time off from work and not being at work at all times. Cardiologists work a lot of hours.
5. Opportunity cost of extra years in training from a strictly financial perspective.

In short, EM was the best bang for the number of years of training while spending the least number of days at work, giving me the ability to spend the most amount of time to focus my energy on eventually attaining financial Independence and not needing a paycheck 🙂
 
GonnaBeADoc2222 said:
We are both in EM
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I look forward to a fulfilling career in that case.

By the way..heard much of the same as a student from anesthesia, IM, gen surg, peds, FM, rads. Dunno if EM is the lesser of all the evils but I guess that's a different conversation. For what it's worth, rads had some of the most unhappy people I rotated with in all of medical school and they had former attendings from ENT, neurosurg, and FM
 
I'm probably the outsider here as I went IM.... though when I first started med school, and really during my year or two was dead set on EM.

In my opinion I liked how you asked folks how they decided on one vs the other. In general I think there is way too much "this field sucks" or "this field rocks" statements which does nothing to help someone deciding as it's completely a personal decision dependent on MANY INDIVIDUAL characteristics.

While one person may thrive on having a long term physician-patient relationship and be fulfilled from seeing them longitudinally in an office, someone else is going to absolutely hate that idea and instead thrive on the type of encounters seen more in the ER.

It's certainly worthwhile to get opinions from those of us who have already decided as to why we went one way vs the other though ultimately you will have to spend time in both and see what fits better for you.
 
I’m a current PGY1 who was really torn between the two. I even considered switching halfway through intern year. Did my MICU rotation and fell in love with that, and will be doing a fellowship! I get the best of both worlds.

Be honest with yourself about your reasons for wanting both, and as cliche as it sounds, go with your gut. You’ll know which is “right” for you.
 
Honestly the actual job matters so much less than the lifestyle. Work is work. If you doubled my salary to only see malignant, terrible, abusive patients I would take it in a heartbeat because I could work half as much and have tons more time off. You don’t want to hate your job but you don’t necessarily have to be in love with it as much as you should be in love with your life outside of work. It’s why I always tell medical students to find the specialties that afford you the lifestyle you want and pick the one you hate the least. Nobody dies wishing they would have worked more.
 
EM is the worst specialty in medicine, except for all the other fields (excluding maybe derm?).
 
MelMcT2009 said:
I’m a current PGY1 who was really torn between the two. I even considered switching halfway through intern year. Did my MICU rotation and fell in love with that, and will be doing a fellowship! I get the best of both worlds.

Be honest with yourself about your reasons for wanting both, and as cliche as it sounds, go with your gut. You’ll know which is “right” for you.
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I did EM/CCM. Feel free to PM.
 
I was torn between EM, IM and Peds. While EM has allowed me to save a chunk of cash, don't underestimate the circadian issues. Now I'm mid forties, I don't want to work nights or weekends, and the path forward seems harder.
 
They are completely different. Long term versus short term care....
 
From an IM perspective vs EM perspective.

EM -> stabilization, "hi-bye" medicine, provisional diagnosis, temporazing measures. Very heuristic, high volume. Lots of procedures if you want them.

IM -> management. continuity of care, nailing down all diagnosis (eg not just sepsis with AKI and hypoxia, but infectious endocarditis, with infectious glomularnephritis, acute MR rupture, ring abscess, etc etc), definitive management. Much more cerebral at the expense of procedures and volume. Also fellowship options.

People figure this out quickly. I was far more interested in seeing what the hospital course was for an admitted patient than whatever walked in from triage or EMS during my EM rotation. During residency, I hated the mostly low acuity (but minefield fraught) of most EM presentations. Not a huge fan of general medicine wards, but the problem solving was satisfying.
 
I agree with whomever said "it's a job". I only know of a handful of people who think their job, in whatever line of work it is (investment banking, engineering, physician, etc.) is a calling.

A job is a means to an end...which is making money, setting up yourself for retirement, being able to do things you want to do in life.

You should enjoy your job, you should enjoy and look forward to going into work, but finding ultimate ethereal fulfillment is unlikely in your primary job.

Every area of medicine has huge problems, every single one. IM, EM, Cardiology, Dermatology, Allergy, you name it it's there.

If one is considering IM or EM or CCM or whatever and they are not sure, they should take a step back, maybe 5 steps back, and just overall envision what job they will be happiest in. Then match into that. Very high level stuff.

As much as I like talking to patients, and I love doing it, my personality doesn't lend to being a physician behind a desk. I just couldn't envision being behind a desk, hearing a complaint, then ordering tests and waiting a week or two to get the results. Or never getting the results. Or treating chronic orthopedic pain. Would drive me nuts.
 
I did EM/IM/CC, couldnt pay me enough to do pure IM though. Prior auths, interdisciplinary rounds, social work/dispo nightmares, etc etc suck my will to live.
 
throwaway1939 said:
From an IM perspective vs EM perspective.

EM -> stabilization, "hi-bye" medicine, provisional diagnosis, temporazing measures. Very heuristic, high volume. Lots of procedures if you want them.

IM -> management. continuity of care, nailing down all diagnosis (eg not just sepsis with AKI and hypoxia, but infectious endocarditis, with infectious glomularnephritis, acute MR rupture, ring abscess, etc etc), definitive management. Much more cerebral at the expense of procedures and volume. Also fellowship options.

People figure this out quickly. I was far more interested in seeing what the hospital course was for an admitted patient than whatever walked in from triage or EMS during my EM rotation. During residency, I hated the mostly low acuity (but minefield fraught) of most EM presentations. Not a huge fan of general medicine wards, but the problem solving was satisfying.
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I wouldn’t necessarily say that IM is more cerebral. Having a patient admitted with hypoxia and pna is pretty straight forward. A CHF exacerbation is pretty simple. Chest pain. Copd. These are the bread and butter hospitalist patients.

Neither are particularly cerebral in 95+% of patients.
 
TimesNewRoman said:
I wouldn’t necessarily say that IM is more cerebral. Having a patient admitted with hypoxia and pna is pretty straight forward. A CHF exacerbation is pretty simple. Chest pain. Copd. These are the bread and butter hospitalist patients.

Neither are particularly cerebral in 95+% of patients.
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Lol ....cerebral....so essentially ER docs just don’t think....that’s actually more impressive than being cerebral...why did you have to correct him?
 
pencilcase said:
Lol ....cerebral....so essentially ER docs just don’t think....that’s actually more impressive than being cerebral...why did you have to correct him?
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I think TNR is implying the opposite. The hospitalist is admitting "CHF exacerbation" and will not need to think much for the treatment plan-- the ED received undifferentiated shortness of breath, and thinking is what got them to the diagnosis and admission.
 
Except often times "CHF exacerbations" diagnosed in the ED are later found to be something else during the patient's hospitalization.

Regardless hospital medicine is only one part of IM. Residency in IM gives you access to all of it's subspecialties which are much more "cerebral" - CCM for example, as well as others like nephro, rheum, endocrine etc.
 
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