Why do you wanna do an EM/IM combined residency?

[rs2006]

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Hi everyone

I hope all is well. I just wanted to learn about the pros and cons of an em/im residency-- career options, etc?
Thanks in advance.

 

[Groove]

I don't see the benefits. Most combined programs are more tailored for someone looking for an academic career. I don't think an IM res will make you a better EM doc or vice versa. Theoretically, you could work part time in the ED and part time as a hospitalist or outpatient medicine, etc.. but it's a strange hybrid in my opinion. Most EP's detest inpatient medicine and most medicine docs detest the ED, so I've always found that particular combination rather perplexing. The most easily identifiable advantage would be future options. You could theoretically try to stay active in both fields and if you got burnt in the ED as you aged and advanced in your career, you could transition more to medicine or something less stressful. The combination certainly wouldn't be more lucrative since you can easily make more money working full time as an EP, but then again, the schedule is more chaotic and the work is more stressful.

The primary weakness with EM as a field is our paucity of practical fellowships. If you get to the point later on in your career where you are having difficulty with the schedule, stress, work, etc.. your options are rather limited. You can work less shifts, work in a less busy rural ED for less money, work in an urgent care clinic, etc.. but most of our fellowships are oriented towards an academic EM career, or personal niche skill advancement, etc.. wilderness medicine, ultrasound, bariatric medicine, ems, toxicology. Critical care would probably be our most practically applicable fellowship outside academics.

My 2 cents.

 

[DelawareEMIM]

As a recently trained EM/IM and currently practicing in both fields I feel like I have some skin in this conversation. I do agree that the training does cater more towards an academic career. I would also agree that doing a combined program should not be done to be a better physician in each speciality. However, I would argue against the idea that my extra time in residency and extra board certification does not add anything to my clinical abilities.

Clinical decision units in hospitals are becoming more and more prolific. I believe that EM/IM trained physicians are uniquely suited for this work. Dual board certification definitely does expand your career options compared to having either speciality individually. Career opportunities should not be the reason to do a dual program. You would be much better off choosing what you want to do and choosing that speciality instead of hedging your bets doing two.

I'm happy to try and answer questions further.

 

[K31]

I am planning on going into academics and like both emergency medicine and internal medicine so it seems like EM/IM would be a good fit for me. I came into med school planning on going into IM; however I probably will apply straight EM for a couple reasons:

1. The main reason I wanted to do IM was to go into pulm/CC. However, with the likely chance to get board-certified in critical care after EM residency that reason is less pressing, and I think I'm better suited for EM residency than IM.

2. EM/IM is 5 years and Pulm/CC is 3 years. I've already spent 8 years in med and grad school, and I'd be pushing 40 when I would be looking for my first job. Even if I got one of the few EM/IM/CCM slots, that's still 6 years compared to 5 for EM followed by CC.

 

[sesamecat]

DelawareEMIM- I'm a medical student considering EM/IM because I think I would like to practice in both (part-time EM and part-time IM subspecialty). Is that what you are currently doing and if so, how difficult was it to do once you graduated from EM/IM? Did you have trouble with either EM or IM preferring you to work full-time in just that specialty? And are you in an academic or community center? Thanks in advance!

As a recently trained EM/IM and currently practicing in both fields I feel like I have some skin in this conversation. I do agree that the training does cater more towards an academic career. I would also agree that doing a combined program should not be done to be a better physician in each speciality. However, I would argue against the idea that my extra time in residency and extra board certification does not add anything to my clinical abilities.

Clinical decision units in hospitals are becoming more and more prolific. I believe that EM/IM trained physicians are uniquely suited for this work. Dual board certification definitely does expand your career options compared to having either speciality individually. Career opportunities should not be the reason to do a dual program. You would be much better off choosing what you want to do and choosing that speciality instead of hedging your bets doing two.

I'm happy to try and answer questions further.

 

[megawhizz]

Even if I got one of the few EM/IM/CCM slots, that's still 6 years compared to 5 for EM followed by CC.

EM followed by CCM could also be a 6 year track, if you go to a 4 year EM program or a 3 year CCM fellowship. EMIMCCM graduates will always be considered superior to EM/CCM graduates when looking for jobs in medical ICUs as these are almost exclusively run by IM/CCM graduates

 

[megawhizz]

EMIM is an excellent choice for people wanting a leadership career in EM. Many programs (like the one I trained at, Henry Ford) has leadership tracks customizing your curriculum for Research, Education, Administration, Hospitalist/Proceduralist, Critical Care, etc. Upon graduation you will always be more competitive for any position compared to a recent graduate from an EM-only program.

My clinical practice is mostly in EM and I spend 10-25% of my time rounding on the academic IM floors. The hospital really likes this arrangement and I am the go-to-person for any interdepartmental issues between the two.

 

[Jack is Back]

This seems like an interesting blend, especially to also give an out to the "burned out" EP.

What are the thoughts on the hybrid work? Is it mostly academic? Could you do private jobs where you are part time at both?

What is the end game, do you plan on ending your career solely as IM as EM can become stressful (or overnight shifts are rough)?

 

[turkeyjerky]

EM followed by CCM could also be a 6 year track, if you go to a 4 year EM program or a 3 year CCM fellowship. EMIMCCM graduates will always be considered superior to EM/CCM graduates when looking for jobs in medical ICUs as these are almost exclusively run by IM/CCM graduates

I'm not aware of any 3 year straight CCM fellowships, it seems a little excessive to me. It might be true that IM/CCM grads would be favored, but the attending intensivists I've talked to (all IM trained) have all told me that they think EM to CCM is a great route, and cite the shortage of intensivists, as well as the fact that many Pulm/CC docs tend to focus on pulm later in their careers. Also it seems like EM/CCM would have more flexability to work in SICUs and NeuroICUs.

This seems like an interesting blend, especially to also give an out to the "burned out" EP.

What are the thoughts on the hybrid work? Is it mostly academic? Could you do private jobs where you are part time at both?

What is the end game, do you plan on ending your career solely as IM as EM can become stressful (or overnight shifts are rough)?

Seems like a bad idea going into a field if you think you're going to burn out.

 

[megawhizz]

This seems like an interesting blend, especially to also give an out to the "burned out" EP.

Burning out was mostly seen amongst Emergency Physicians who were not EM trained. It's rarely seen today, IMHO thanks to better candidate selection, appropriate training and physiologic scheduling of shifts, now that EM has matured as a field. I would not recommend EMIM to someone who wants to do EM till they are burnt out and then do IM.

 

[Jack is Back]

Seems like a bad idea going into a field if you think you're going to burn out.

No one thinks they are going to burn out. Who would go into a field they thought they would burn out in? But EPs do experience burnout (so do other docs, though).

One-Third of Emergency Physicians Suffer From Burnout, Most Still Satisfied With Their Career (ACEP).

It's funny because lots of the attending I've had a chance to get info from actually encourage prospective applicants to think about this while residents/applicants seem to ignore it.

Emergency Physicians Monthly: Survey: There Is Life After EM, http://www.epmonthly.com/wellness/work-and-life/survey-there-is-life-after-em/

Half of emergency doctors will suffer burn out http://ec.europa.eu/research/infocentre/article_en.cfm?id=/research/headlines/news/article_10_12_10_en.html&item=Infocentre&artid=19073

Kevin MD
The exhaustion of emergency physicians, and its toll on patients and family

When I applied for residency, the literature suggested that the burnout associated with practicing EM applies primarily to physicians who weren't trained in this specialty. But a recent longitudinal study of EM physicians by the American Board of Emergency Physicians shows something different: It reports that one third of EM physicians report burnout. Other studies suggest an increased incidence of breast cancer, obesity and other comorbidities in night shift workers. One survey of EPs over 55 reported several "age related concerns"; 74% found it more difficult to recover from night shifts, 44% reported a higher level of emotional exhaustion after shifts, 40% were less able to manage high patient volumes, and 36% reported less ability to manage the stress associated with EM practice.

"I suggest that they seek out advice from physicians who are at least 10 years out of residency and leading the type of life they hope to have in the future." This is profound advice for those in all professions. It was the lifestyles of older peers that helped me to redirect my own career path early on. Your post also gave me a greater appreciation for those in EM and the stresses they face. Thank you for your insight and advice.

In conclusion, I'm trying to consider not only a specialty I will enjoy for the first 10-20 years but also for 20-40 years after I'm done with residency. I think it is prudent to at least let these things factor into my decision. I do enjoy EM quite a bit, which is why I've researched it a lot.

 

[megawhizz]

One-Third of Emergency Physicians Suffer From Burnout, Most Still Satisfied With Their Career (ACEP).

IAWTP, however it is worth noting that ACEP members are not necessarily EM-residency trained. Many have trained in other specialties and are merely practicing EM. I will look for evidence to back up my statement that burnout rate for EM-trained and ABEM boarded physicians is low.

Other specialties are also not immune to burnout, as reported in this recent JAMA study.

I think my post is contributing to this thread going off-topic, so I will just reiterate my original opinion that EMIM is not a good strategy for those anticipating burnout with EM.

 

[Jack is Back]

IAWTP, however it is worth noting that ACEP members are not necessarily EM-residency trained. Many have trained in other specialties and are merely practicing EM. I will look for evidence to back up my statement that burnout rate for EM-trained and ABEM boarded physicians is low.

Other specialties are also not immune to burnout, as reported in this recent JAMA study.

I think my post is contributing to this thread going off-topic, so I will just reiterate my original opinion that EMIM is not a good strategy for those anticipating burnout with EM.

Yes, but it's also your opinion that EM isn't a good strategy for those anticipating burnout with EM. Which is really a silly contention, because no one enters any field anticipating burnout. It's like people entering marriages expecting to get divorced, no one does. BUT prenuptials still exist. There are some people in life that make plans for the unexpected.

To the bolded: There aren't any studies for United States EP that show that burnout isn't a factor in EM trained physicians.

 

[Groove]

The burnout thing is only relevant if your salary requirements are extremely high. What other specialty allows you to work literally...hell, #4 12h shifts/mo and make a 6 digit salary?

If you burn out from that, you'd have burned out with just about anything. I can't take full credit for the 4 shifts perspective as a recent graduate made that one for some potential med student applicants who asked the same thing.

You can literally hate every aspect of your job, but 4 days out of 30, and making over 6 digits? C'mon... Burnout from boredom, maybe...

 

[Jack is Back]

The burnout thing is only relevant if your salary requirements are extremely high. What other specialty allows you to work literally...hell, #4 12h shifts/mo and make a 6 digit salary?

If you burn out from that, you'd have burned out with just about anything. I can't take full credit for the 4 shifts perspective as a recent graduate made that one for some potential med student applicants who asked the same thing.

You can literally hate every aspect of your job, but 4 days out of 30, and making over 6 digits? C'mon... Burnout from boredom, maybe...

Agreed!

 

[GroovyMed]

.

 

[Hamhock]

EMIMCCM graduates will always be considered superior to EM/CCM graduates when looking for jobs in medical ICUs as these are almost exclusively run by IM/CCM graduates

😕
Nonsense.
On what are you basing this opinion/prediction?
...and to say it with such an authoritative tone?😕

HH

 

[megawhizz]

😕
Nonsense.
On what are you basing this opinion/prediction?
...and to say it with such an authoritative tone?😕

HH

I was merely stating my opinion based on experience and knowledge of the field. As IM/CCM has been around for way longer than EM/CCM, I believe it is 100% true that most medical ICUs are staffed by IM trained people (as opposed to EM). While EM trained people bring a unique perspective to critical care, an IM-trained chair of a medical ICU department will naturally prefer an EM-IM-CCM trained person over an EM-CCM trained person due to familiarity with training. Again, IMHO.

To avoid flame wars I will no longer respond in this thread. It be useful to see what data prompted the very authoritative opinion that my post was "Nonsense."

 

[Hamhock]

It be useful to see what data prompted the very authoritative opinion that my post was "Nonsense."

This is based on the fact that there is not one EM/CCM boarded doc yet...no one has gone through the process yet...to make a statement like that about something that doesn't even exisit (and therefore, no data or experience at all) is at best conjecture.

HH

 

[icaruswalks]

Since the new application cycle is quickly coming upon us all, thought I'd bump the thread.

The reason why I wanna do EM/IM, is because I love both equally. I'm loving my shifts in the ED, and I love hospital medicine. My thinking is that I would be a generalist of both more acute conditions and chronic conditions as well. I love the diagnostic thinking of internal medicine, the approach to diagnoses, and I also love the procedural/fast paced/thinking on your feet aspect of EM.

I always get the weirdest responses from both sides at my institution, EM people say, "well EM docs dont like medicine" and the medicine department they say "that's just a waste of time." Am I alone here? I find being a generalist exciting... Anybody? Tips? Maybe I should go one way or another. I am completely at a loss at what I should do, and currently being pressured by the medicine department chair to focus just on medicine...

Help...

 

[sylvanthus]

Im there with ya. I plan to apply to all EM/IM programs since there are not that many and then make a decision when I visit the programs and get a feel for things. Who knows, maybe I will get rejected from all EM/IM programs and then the decision will be made for me.

 

[inspirationmd]

Im there with ya. I plan to apply to all EM/IM programs since there are not that many and then make a decision when I visit the programs and get a feel for things. Who knows, maybe I will get rejected from all EM/IM programs and then the decision will be made for me.

I am a 2nd year EM/IM resident so I think I can help you two somewhat with this. EM/IM is a very good choice for people who enjoy aspects of both EM and IM and believe that their careers would be enriched through study of both. The two fields are actually very synergistic despite the hatred that each side spews at the other. Knowing what is going to happen upstairs is very useful when you are working up an acute exacerbation of a disease downstairs just as knowing the reasoning of doing something downstairs helps managment upstairs. A perfect example is when I was on Cardiology service recently. We had a 65 y/o F who had severe bradycardia into the 30s after taking her Clonidine, Nifedipine, and Metoprolol. She was started on a Glucagon gtt in the ED with improvement in her HR to the low 40s which dropped back down to the high 20s to low 30s when I stopped it. This made the peaked t wave inducing hyperkalemia difficult to shift while the Kayexlate worked its magic but that's not the point. The next day when I presented the patient to the Cards attending and IM senior residents after admitting her none of them knew why that the Glucagon was started in the ED as an antidote for the Beta blocker and CCB toxicity. I explained this to them as the intern on the service. EM Tox knowledge translated directly to benefit treatment on Cardiology inpatient services.

As of one of the previous posters in the thread alluded there are many options for an EM/IM graduate. EM only, Hospitalist/Proceduralist, Academic opportunities for both, fellowships in either, etc. I think the two most exciting options are the use of both in a critical care career after fellowship and pursuit of a career in observation medicine.

There are two things that I have discovered are the hardest things about this road:

1) The 5 years of residency is very difficult to endure particularly as you get tired of being a resident and your friends begin to move toward getting their jobs and residency completion. I haven't experienced this yet but I have heard from some senior residents at my program and others that this can kind of suck. It isn't as bad at some programs where EM is 4 years (ie. SUNY, LSU) but it happens. I personally have started looking at it as a residency with a built in fellowship since the additional training does help in your career for job prospects as well as knowledge expansion just as a fellowship would. Another way to blunt the financial burden is to go to a residency that allows moonlighting which can minimize the feeling that you are losing cash by staying in residency longer.

2) The reading schedule is a B****! I switch from Rosens to MKSAP in a systematic manner and it is kind of hard. There are some differences in approach to various diseases and remembering the differences can be hard. It gets a little confusing but I am getting better at it. I have consistently heard it gets better as a 3rd year when you put it all together and I believe that is probably about right.

Ultimately, you need to form a general idea about what you want to do with the training. There are two papers I think everyone who is considering EM/IM needs to read:

http://www.ncbi.nlm.nih.gov/pubmed/19673705

http://www.ncbi.nlm.nih.gov/pubmed/20370766

Good luck this application season.

 

[AlmostJesus]

This is based on the fact that there is not one EM/CCM boarded doc yet...no one has gone through the process yet...to make a statement like that about something that doesn't even exisit (and therefore, no data or experience at all) is at best conjecture.

HH

Scott Weingart? The guy that puts out the emcrit podcast? He did a CCM fellowship at Shock Trauma in Baltimore...

 

[K31]

Scott Weingart? The guy that puts out the emcrit podcast? He did a CCM fellowship at Shock Trauma in Baltimore...

Plenty of EPs have done CC fellowships (most at Pitt and Maryland), but prior to this year there was no pathway to US board certification. I'm sure plenty of those who have previously done fellowships will apply for certification (there's a 5-year grandfathering period) but there hasn't been a set of exams since EM/CCM graduates became eligible.

 

[Chakrabs]

I have no clue how EM/IM works outside of residency, but you know how upon discharge from the ED, the instructions usually say "follow up with PMD?" Now the patient says, "I don't have a PMD"! And you say, "well, now isnt that something. Why don't you come to my office hours on such and such date for continuing care". With the way our healthcare system is headed towards rewarding more primary and preventative care, I can see EM/IM being very lucrative down the line...

 

[sylvanthus]

Huh, wonder if you can admit to yourself. You know those times when the hospitalist refuses to admit a patient and you know they can't just go home. Can you admit to yourself and just see the patient upstairs later on?

Probably a totally ******ed question, but it just popped into my head.

 

[deuist]

We have community pediatricians who occasionally moonlight in our peds ED and admit to themselves.

 

[icaruswalks]

That Sept. 15th ERAS date is fast approaching and my dean's office is very kind to remind me via email, etc.

I just wanted to bump the thread. Any of you possibly thinking of applying IM and EM separately? Esp, IM->Pulm/CCM vs. EM->CCM only... Not sure what to do at this point. There are some shifts in the ED where I'm like yes, this is awesome. But then other shifts where you can only give so much droperidol, handle so many belligerent drunk patients, that I think my diagnostic skills are being wasted. Any of you guys feel the same?

It's really too bad that EM/IM isn't more of a popular option like Med/Peds is... 🙁

 

[inspirationmd]

That Sept. 15th ERAS date is fast approaching and my dean's office is very kind to remind me via email, etc.

I just wanted to bump the thread. Any of you possibly thinking of applying IM and EM separately? Esp, IM->Pulm/CCM vs. EM->CCM only... Not sure what to do at this point. There are some shifts in the ED where I'm like yes, this is awesome. But then other shifts where you can only give so much droperidol, handle so many belligerent drunk patients, that I think my diagnostic skills are being wasted. Any of you guys feel the same?

It's really too bad that EM/IM isn't more of a popular option like Med/Peds is... 🙁

Ok, so I applied for EM-IM, EM and IM categorical programs. It can be done but you have to play by certain rules to avoid shooting yourself in the foot.

1) Generally you can apply to the categorical EM and categorical IM programs at EM/IM institutions without it biting you in the ass. There are only a few places where I would do that since IM is not always as strong as the EM program at certain places so your fellowship options may be more limited coming out of IM only there. In looking at EM-IM programs you should make sure that if one department appears weaker that the overall training is synergistic and will make the 5 years worth it.

2) Outside of the EM-IM programs I would not apply to the categorical EM and IM programs at the same places. I did this at a few places and I was very nervous that I was going to run into a resident for one program while I was interviewing for another. It did not happen but it was nerve wracking and I did hear about some people getting burned applying to two other specialties with this.

3) I would be very select in the faculty you let know you are applying for both categorical EM and IM. Some faculty will not understand the rationale and question your commitment. You do not want the chair of medicine letter to be lukewarm because they know you are applying for EM as well. I had 8 different LOR (3 EM 3 IM and 2 EM-IM letters) that I had in rotation for different programs. Both EM-IM letter writers knew while only 1 EM letter writer knew I was applying for both and 1 IM letter writer knew. You can send EM and IM letters to EM-IM programs without a problem even if they don't comment on the EM-IM program itself since the EM and IM PD will likely see your entire files as well.

In addition:

4) While the EM to CC option is there now it is not without risks. For one thing there are not many free standing CC fellowships out there and some of them may still be bias against taking EM grads. This should change but it will likely take some time. Another thing is there is a mandate that all IM based CC fellowships take no more than 25% of non-IM trained people (see link on p. 12 III.A.5). This becomes an EM grad's nightmare for getting a CC fellowship when you combine the fact that there are not many IM based critical care fellowships, that they do not generally take that many CC only fellows and that there are, again, not many of them. Also the American College of Surgeons is FOS with their proposal to have EM grads be eligible for cert if they do a 2 year Surg CC fellowship with the 1st year a prelim Surg intern year. Hopefully this changes. Going from EM to CC boarded at this point is still not a walk in the park but its a step in the right direction. Just know this.

5) If you go EM with plan for CC then you should make sure there is a way for you to meet the 6 month Medicine exposure including 3 months MICU experience as mandated in the link p.11 III.A.4. Review the places curriculum to ensure this is doable. Probably easier at a 4 year program or a 3 year with relatively more ICU months than the standard curriculum.

http://www.acgme.org/acwebsite/downloads/RRC_progReq/142_critical_care_int_med_07012012.pdf

Good luck folks.

 

[inspirationmd]

If anyone is interested check out AMA Freida Program Search feature. Evidently Ohio state just started an EM-IM program. No official website on their page though so I would call for more details. Will be headed up by Dr. Atkins (EM/IM/Pulm/CC)

 

[sylvanthus]

Well, who ended up applying EM/IM?

 

[sylvanthus]

Noone?

 

[K31]

Thought about it. Did a medicine sub-I last month and hated it.

 

[sylvanthus]

Thought about it. Did a medicine sub-I last month and hated it.

Going to shoot for EM and then CCM then?

 

[icaruswalks]

I'm actually going the opposite path, IM and then pulm CCM.

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[K31]

Going to shoot for EM and then CCM then?

Yep.

 

[sylvanthus]

Good call, thats my other plan in case EM/IM is a bad idea. Will make that decision after interview season.

 

[icaruswalks]

So are you applying to medicine and EM/IM programs?

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[sylvanthus]

Not sure who you are asking but i am doing EM and EM/IM programs.

 

[Zatanelov]

Not sure who you are asking but i am doing EM and EM/IM programs.

4 years later. Where did you end up matching? Whats your thoughts about EM/IM now?

 

[FutureDO08]

Also interested


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[Zatanelov]

Also interested


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He matched to LIJ. Hes a current 3rd year. Planning on doing the 6 year cc track

 

[YoungDoc25]

Actively applying to medical school right now, so forgive the lack of knowledge on this subject. I work currently as an ER tech and love the atmosphere, but I have shadowed IM docs and really loved the field. Reading through the conversations, I had a couple of questions on how this could work in a rural or suburban setting.

How does this differ from being an IM guy that picks up shifts in the ED for a hospital? Where I live (granted, it's a trauma III center), we have physicians from all primary care areas working the ED. I love both sides of IM and EM so far, but the extra 2 years of residency are tough for me to grasp, and I'm 99% sure it's due to a lack of understanding. Would love for someone to clear this up for me if possible!

 

[megawhizz]

Actively applying to medical school right now, so forgive the lack of knowledge on this subject. I work currently as an ER tech and love the atmosphere, but I have shadowed IM docs and really loved the field. Reading through the conversations, I had a couple of questions on how this could work in a rural or suburban setting.

How does this differ from being an IM guy that picks up shifts in the ED for a hospital? Where I live (granted, it's a trauma III center), we have physicians from all primary care areas working the ED. I love both sides of IM and EM so far, but the extra 2 years of residency are tough for me to grasp, and I'm 99% sure it's due to a lack of understanding. Would love for someone to clear this up for me if possible!

In most urban and suburban settings, it would be unusual for non-EM trained people to work in an ED. As we continue to produce more EM physicians, this will continue to improve. I think non-EM people will eventually only work in urgent care type settings. If your goal is to work in an ED, you should train in EM (not necessarily EMIM).

The extra two years of residency can be thought of as a leadership track, something that gives you increased exposure and a head start towards a career that specializes in a particular aspect of administration, education or research.

 

[YoungDoc25]

In most urban and suburban settings, it would be unusual for non-EM trained people to work in an ED. As we continue to produce more EM physicians, this will continue to improve. I think non-EM people will eventually only work in urgent care type settings. If your goal is to work in an ED, you should train in EM (not necessarily EMIM).

The extra two years of residency can be thought of as a leadership track, something that gives you increased exposure and a head start towards a career that specializes in a particular aspect of administration, education or research.

Awesome info! Thank you!

 

[StrongIslandDoc]

My general understanding is that IM/EM is suited for those who want to pursue something academic; that being said I could also see IM/EM combined training lending itself to someone who is going in the direction of a concierge medical practice. It's 3am and your daughter has a broken arm - but you're too rich and entitled to go to an urgent care center or emergency room while your child is in agony so you'd rather pay $60k to have a physician on retainer...enter the IM/EM dual-boarded concierge physician.

 

[wholeheartedly]

My general understanding is that IM/EM is suited for those who want to pursue something academic; that being said I could also see IM/EM combined training lending itself to someone who is going in the direction of a concierge medical practice. It's 3am and your daughter has a broken arm - but you're too rich and entitled to go to an urgent care center or emergency room while your child is in agony so you'd rather pay $60k to have a physiciant on retainer...enter the IM/EM dual-boarded concierge physician.

Hmm, that's not one I've heard before. Usually things like critical care, rural med, and global heath seem to be big ones.

 

[StrongIslandDoc]

Hmm, that's not one I've heard before. Usually things like critical care, rural med, and global heath seem to be big ones.

Its something I've thought about quite a bit since beginning medical school actually - private practice and making boatloads of cash is not the reason I got into this game, but where I attend medical school is, erm, lets call it "Lavish" and its something I am really quite fond of and would like to be able to afford that kind of lifestyle as promptly in my life as possible. That said, I imagine that path would require considerable business savvy, which I don't particularly regard myself as having - at leasts not at this moment in time. That being said, if the dream doesn't play out that way, at the very least its made for some fantastic wedding fodder whenever I haven't checked that [+1] box on the RSVP 😉

 

[wholeheartedly]

Its something I've thought about quite a bit since beginning medical school actually - private practice and making boatloads of cash is not the reason I got into this game, but where I attend medical school is, erm, lets call it "Lavish" and its something I am really quite fond of and would like to be able to afford that kind of lifestyle as promptly in my life as possible. That said, I imagine that path would require considerable business savvy, which I don't particularly regard myself as having - at leasts not at this moment in time. That being said, if the dream doesn't play out that way, at the very least its made for some fantastic wedding fodder whenever I haven't checked that [+1] box on the RSVP 😉

Oh, def heard of variations on concierge or cash only, just not the suggestion that EM/IM might be a good fit for it. It's an intriguing thought. I would think high overhead for the caring for emergencies side, and also the need to really always be on and accessible would likely be hard.

 

[Bojack Horseman]

Oh, def heard of variations on concierge or cash only, just not the suggestion that EM/IM might be a good fit for it. It's an intriguing thought. I would think high overhead for the caring for emergencies side, and also the need to really always be on and accessible would likely be hard.

I guess the beauty is that you can set up a concierge practice however you want. I would imagine making yourself readily available is part of that, but that doesn't necessarily mean you would have to be on call 24/7. You could potentially work a shift in the ED once a week or so to supplement a concierge practice and keep your emergentologist skills fresh.


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