What is Internal Med-Emergency Med

[sexyman]

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How does it differ from a residency in internal medicine or emergency medicine? Is it sort of a combo residency like it appears?

 

[zinjanthropus]

How does it differ from a residency in internal medicine or emergency medicine? Is it sort of a combo residency like it appears?

Yes, it is a way to complete the requirements for both residency programs (IM and EM) in 5 years

 

[sexyman]

That is interesting. Is it generally more competitive? Does that give you more options as a physician?

 

[RxnMan]

Search for posts by kgunner. He did a EM/IM residency, and he has posted here at length describing pros/cons of these programs. Also check the combined residency forums.

 

[AmoryBlaine]

And talk t alot of people before you go for it. I have infinite respect for my IM colleagues but notice that the vast majority seem to become EM physicians (a process which can be accomplished in 3 years as opposed to 5 with much less memorization of chemo regimens and glomerulonephritidies).

 

[sexyman]

^ EM is 3 year residency not a 4? I was under the impression it was 4. Thanks guys I will check out kgunners posts and the combo forums (didnt know they existed actually).

 

[Drogba]

^ EM is 3 year residency not a 4? I was under the impression it was 4. Thanks guys I will check out kgunners posts and the combo forums (didnt know they existed actually).

Depending on the program its either 3 or 4 years.

 

[zinjanthropus]

EM residency programs can be 3 years (most common) or 4 years (see FAQs)

IM-EM is probably less competitive overall with a small group of people competing for a small number of spots. For the most part, those of us doing EM wouldn't want do IM and those doing IM don't want to do EM. However, some people see a nice niche for their career at the intersection between the two (i.e. critical care, ED boarding, or academics). All of the EM-IM programs are 5 years.

 

[bartleby]

Some folks refer to a fourth year of EM residency (since most programs have you boarded after three) as the "$150k mistake" due to the difference in resident and attending salaries.. That would make the extra 2 years of EM/IM the $300k mistake. If you have some grand plans about being triple boarded in EM/iM/Crit Care, that's one thing. But you're wasting your time if you're doing it as a hedge to "keep my options open". I have never heard any convincing argument about how burnout bad enough to cause you to leave EM entirely could be remedied by switching to an internal medicine practice involving longer hours and, in most cases, call responsibilities. Nor have I ever heard of anyone actually making this transition.

 

[AmoryBlaine]

Some folks refer to a fourth year of EM residency (since most programs have you boarded after three) as the "$150k mistake" due to the difference in resident and attending salaries.. That would make the extra 2 years of EM/IM the $300k mistake. If you have some grand plans about being triple boarded in EM/iM/Crit Care, that's one thing. But you're wasting your time if you're doing it as a hedge to "keep my options open". I have never heard any convincing argument about how burnout bad enough to cause you to leave EM entirely could be remedied by switching to an internal medicine practice involving longer hours and, in most cases, call responsibilities. Nor have I ever heard of anyone actually making this transition.

True words my friend. Younger med students often seem to labor under the delusion that EM/IM will allow you to do a little bit of clinic and work a little ER on the side. This is a pretty uncommon set-up, I sure have never heard of it personally.

Unless you are planning to do one of these (rare) amalgamated practices there is IMHO no reason to do EM/IM. One person I know in an EM/IM residency said that he did it to "broaden his differential diagnosis." Considering it's going to be an extra two years of training and another certification exam I'd rather just read through Harrison's and call it good.

 

[met19]

True words my friend. Younger med students often seem to labor under the delusion that EM/IM will allow you to do a little bit of clinic and work a little ER on the side. This is a pretty uncommon set-up, I sure have never heard of it personally.

Unless you are planning to do one of these (rare) amalgamated practices there is IMHO no reason to do EM/IM. One person I know in an EM/IM residency said that he did it to "broaden his differential diagnosis." Considering it's going to be an extra two years of training and another certification exam I'd rather just read through Harrison's and call it good.

I'm EM- if you only want EM- dont do EM/IM. I've heard arguements that this makes you a better academic job candidate. I have not seen any data to support this assertion. I would think a niche in EM (US, Int EM, tox, EMS, etc) would help you out significantly more.

Actually I know of 2 people (i know a whole two people) who do both IM/hospitalist and Em. One a grad at my program, another is the PD at LIJ. I'm sure there are more, but I don't go seeking people out

From what I hear EM/IM is more competitive than just EM or IM (and thats from the PDs). In EM or IM there are thousands of spots in the match. In EM/Im there are maybe 20 or 30 total and some people don't consider programs b/c of its location.

 

[bartleby]

I've started a new EM/Proctology program. It's just like a regular EM residency, but you spend an extra year following me around and doing all my rectal exams. The benefits are great too...if you remain in good standing, you're given the privilege of washing my car twice weekly. This is an extremely competitive program. Over 10 med students are in the running for just one spot! Act now or lose out on this unique opportunity!

From what I hear EM/IM is more competitive than just EM or IM

 

[Prop]

I've started a new EM/Proctology program. It's just like a regular EM residency, but you spend an extra year following me around and doing all my rectal exams. The benefits are great too...if you remain in good standing, you're given the privilege of washing my car twice weekly. This is an extremely competitive program. Over 10 med students are in the running for just one spot! Act now or lose out on this unique opportunity!

Uhhh, that's exciting, where do I sign up??? Would it be harder for me to get since I'm a FMG?
Also, just to clarify, when You say do your rectal exams, do You mean on the patients or on You??? I'd sign up for both just to secure that residency position I've been dreaming of;-)

 

[Dr.Evil1]

Some folks refer to a fourth year of EM residency (since most programs have you boarded after three) as the "$150k mistake" due to the difference in resident and attending salaries.. That would make the extra 2 years of EM/IM the $300k mistake. If you have some grand plans about being triple boarded in EM/iM/Crit Care, that's one thing. But you're wasting your time if you're doing it as a hedge to "keep my options open". I have never heard any convincing argument about how burnout bad enough to cause you to leave EM entirely could be remedied by switching to an internal medicine practice involving longer hours and, in most cases, call responsibilities. Nor have I ever heard of anyone actually making this transition.

I have heard the 4th year referred to as the $100 K mistake as well. It is not the 100K mistake. I am looking at jobs right now and I would refer to it more as the $250K-400K mistake, and that is just for 1 year. 2 years would be at least a $400K mistake if you were just going to go into the community and practice community emergency medicine.

That being said, most people who want to do this really aren't looking at how to make the most money in the least time. If you are going to do a combined residency it is because that is the only thing that you could imagine doing...kind of like becoming a surgeon. EM/IM is a good way to get into administration as well as academics. Several department chairs and program directors are EM/IM boarded. You can also get into interesting research areas with this dual focus. All in all, getting double boarded won't be the fastest way to afford a huge house and a trophy wife, but it could be the best way to get to do what you really want to do.

 

[WallowaWanderer]

I've always thought the hundred thousand dollar mistake terminology seems kind of silly. If you find a program you love, where you want to live, and where you feel like you will receive the best training . . . then I think it would be a million dollar mistake to not choose it just because it is a year longer.

 

[zinjanthropus]

I've always thought the hundred thousand dollar mistake terminology seems kind of silly. If you find a program you love, where you want to live, and where you feel like you will receive the best training . . . then I think it would be a million dollar mistake to not choose it just because it is a year longer.

you may be willing to "pay" the penalty for a four year program, but the concept itself isn't silly, it's a monetary fact.

an extra year of residency training that pays $50,000 costs you about $150,000. So, I agree, if you really love a program you should go to it - but you should go to a four year program knowing that you are essentially paying $150,000 in tuition that last year!

the way I look at it, besides the monetary argument, is that a four year program leaves me with four years of residency training. A three year program + a fellowship leaves me as an "expert" in something and the ability to pick up higher paying shifts during the fellowship period.

 

[WallowaWanderer]

you may be willing to "pay" the penalty for a four year program, but the concept itself isn't silly, it's a monetary fact.

an extra year of residency training that pays $50,000 costs you about $150,000. So, I agree, if you really love a program you should go to it - but you should go to a four year program knowing that you are essentially paying $150,000 in tuition that last year!

the way I look at it, besides the monetary argument, is that a four year program leaves me with four years of residency training. A three year program + a fellowship leaves me as an "expert" in something and the ability to pick up higher paying shifts during the fellowship period.

I definitely agree that you are giving up income if you do a four year residency. It's just when people call it a mistake that it rubs me the wrong way. I mean, by that reasoning medical school would be called the "$500,00 mistake" or buying a new car would be a "$30,000 mistake." Just because something costs money doesn't mean that it's a mistake! Over a 20 year career I think the difference in overall income between a 3 year and four year resident would be miniscule.