why not do both EM/IM?

[BMW19]

So I want to be hospital based and I am torn between hospitalist and EM. I love my EM rotation but the idea of hospitalist also seems very appealing ( a little more stable in my mind). I want to have a normal lifestyle and not deal with practice nightmares (insurance companies, hiring and firing etc.).

So the obvious answer is to just do EM/IM but everyone I bring this up to says it is crazy. That you should just choose one because everyone that does this combined program eventually chooses one and you will be wasting 2 years of your life that you could be earning an attending's salary by choosing one or the other.

Can anyone comment on this. I am really torn. Granted I just started my 3rd year but I know the decision will be here before I know it.

Thanks,

BMW-

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[yaah]

Sounds to me like you want to be a Hospitalist. So you should do IM. EM wouldn't have very much relevance. You won't gain much by doing both other than the option of doing one of the other. You can't really do both realistically.

 

[KGUNNER1]

So I want to be hospital based and I am torn between hospitalist and EM. I love my EM rotation but the idea of hospitalist also seems very appealing ( a little more stable in my mind). I want to have a normal lifestyle and not deal with practice nightmares (insurance companies, hiring and firing etc.).

So the obvious answer is to just do EM/IM but everyone I bring this up to says it is crazy. That you should just choose one because everyone that does this combined program eventually chooses one and you will be wasting 2 years of your life that you could be earning an attending's salary by choosing one or the other.

Can anyone comment on this. I am really torn. Granted I just started my 3rd year but I know the decision will be here before I know it.

Thanks,

BMW-

Even though the majority practices only one, it is not uncommon to find people doing both. It is actually very practical in today's world of hospitalists and shift work.

U of M in Flint used to have an entire inpatient service run by EM/IM grads. They also worked in the ED.

There are two in my ED that practice both inpatient IM and EM. I practice EM and Critical Care (a little different but still inpatient medicine).

So if you end up liking both you can, rather easily, practice both. "Realistically" you will end up only wanting to practice one.

kg

 

[Hard24Get]

Bah. I think my medicine team brainwashed me during my sub-I and now I don't remember why not EM/IM (except the extra 1-2 yrs). Can't someone generate a "Is EM/IM for you?" post, like this one. Although, I disagree with some of it and still think it's ok to see EM as a calling.

 

[sistermike]

Kind of trolling here... but I had a professor a few semesters ago whose husband is a practicing EM physician. I discovered that he was board certified in IM and EM, and he told me he did a combined residency back in the day (he is in his late 50's now). He told me he has been practicing EM and has never really practiced IM. The only time his IM certification has come in handy was when he decided to do a little per-diem work for a IM practice. He told me that the extra few years of residency was not worth it... but he had to do it because it was the only EM residency he was accepted to and that is what he wanted to specialize in.

 

[heartdoc345]

It all depends on time-economics and your practice goals.

If you want to finish residency and make money, do one or the other, get done in 3 years.

IM residency leads to a very flexible career and probably more options than EM training if you finish and decide you hate shift-work. If you want to be a hospitalist who works in an ER, you can do that through IM without any EM training, but only if you want to work in a small community ER. You won't get to work in a major trauma center ED without EM training.

If you want to be able to take care of very critical patients, then IM/EM training may be a good idea, since it would give you some extra ICU time. An alternative would be to do EM training followed by a critical care fellowship.

If you want to do academic emergency medicine, you may want to do a four-year EM program such as Cincinnati, so an IM/EM program wouldn't be much longer. But that doesn't sound like your goal.

 

[BMW19]

Thanks heartdoc. I have heard that you can work in small community hospitals in the ER as an IM or FP doc but then you are taking a big risk if you screw up. "So dr. _________ you were never formally trained in EM but you missed my clients diagnosis.....etc. etc." So if I did hospitalist I would prob. just stick with admitting pts. from the ER which still kind of gives you the EM atmosphere. I am leaning toward IM but I just don't want to admit a pt. to the floors and look back with regret saying I could have been an EM doc.

BMW-

It all depends on time-economics and your practice goals.

If you want to finish residency and make money, do one or the other, get done in 3 years.

IM residency leads to a very flexible career and probably more options than EM training if you finish and decide you hate shift-work. If you want to be a hospitalist who works in an ER, you can do that through IM without any EM training, but only if you want to work in a small community ER. You won't get to work in a major trauma center ED without EM training.

If you want to be able to take care of very critical patients, then IM/EM training may be a good idea, since it would give you some extra ICU time. An alternative would be to do EM training followed by a critical care fellowship.

If you want to do academic emergency medicine, you may want to do a four-year EM program such as Cincinnati, so an IM/EM program wouldn't be much longer. But that doesn't sound like your goal.

 

[methadonian]

I have often regretted doing just EM and not a combined residency. I definitely enjoy ER the most because of the excitement and the challenge of it, but I miss internal medicine and being able to slow down, think carefully about what you are doing, and develop real relationships with patients. If I could have a career where I could split time between the two, I think I would be less likely to burn out in the long run.

As far as the above arguments, you can do EM followed by a critical care fellowship but as of now you still cant sit for the ICU boards after an ER residency. Some people say it's inevitable, some say it will never happen. But you cant get board certfication right now. And you can practice in ERs as an IM doc or an FP, but those jobs are becoming fewer and farther between, and you're absolutely right about not being protected if you have a suit brought against you. ER trained docs in the ER is now the standard of care and there are many many expert witnesses who will testify as such.

 

[BMW19]

So at the hospital I was just at for a rotation, the Hospitalists respond to every code that is not in the ER. i.e. on the floors, ICU, there was even a code in the laundry room! Not sure what the details were. So it appears you at least have to keep your ACLS skills current even as a Hospitalist....

I have often regretted doing just EM and not a combined residency. I definitely enjoy ER the most because of the excitement and the challenge of it, but I miss internal medicine and being able to slow down, think carefully about what you are doing, and develop real relationships with patients. If I could have a career where I could split time between the two, I think I would be less likely to burn out in the long run.

As far as the above arguments, you can do EM followed by a critical care fellowship but as of now you still cant sit for the ICU boards after an ER residency. Some people say it's inevitable, some say it will never happen. But you cant get board certfication right now. And you can practice in ERs as an IM doc or an FP, but those jobs are becoming fewer and farther between, and you're absolutely right about not being protected if you have a suit brought against you. ER trained docs in the ER is now the standard of care and there are many many expert witnesses who will testify as such.