Why should I do IM over EM?

[Doggeronie]

---

Members do not see this ad.

I'm interested in both IM and EM and am having an incredibly difficult time deciding.

IM is great because I like the complexity of the cases we receive, I love the flexibility of the job (can do outpatient or inpatient), and like the opportunities to specialize. And I love that the job is very sustainable and that you can practice into old age.
However IM does not pay even close to as well as EM, which is also a 3 year residency, and works more on average than EM.

EM is great because I like managing acute trauma, and I love the detective process of identifying disease. The pay is amazing in comparison to the length of residency, and the work life balance also seems amazing.
However, I'm not a fan of the circadian disruption of EM. I also don't know if I could keep seeing undifferentiated abdominal pain and generalized fatigue 20 years into my career. I also have heard that EM is not very sustainable as a career, and that physicians burn out early and transition out of their careers by 50. I haven't seen many older ER docs either.

In terms of subject matter and passion for the specialty, I can't decide. There are things I like about each and things I dislike about each.

However, I don't want to burn out and have to stop practicing early. I'd like to practice as long as I can.

I've been persuaded to do IM because I've heard that if I don't plan on retiring early, I shouldn't do EM.

How realistic is this? Can anyone offer any input?

 

[Ho0v-man]

Read what you just wrote: You should do IM bc you actually like IM. You should not do EM bc it seems like money is the most appealing aspect and you don’t like the lifestyle. Yes you do technically put in more hours in IM, but most ER docs say they need the fewer hours because because of the constant circadian disruptions.

 

[Prehealth1011]

I'm interested in both IM and EM and am having an incredibly difficult time deciding.

However, I don't want to burn out and have to stop practicing early. I'd like to practice as long as I can.

I've been persuaded to do IM because I've heard that if I don't plan on retiring early, I shouldn't do EM.

How realistic is this? Can anyone offer any input?

You don't have to stop practicing and retire early. Just go work at an urgent care.

 

[allantois]

There aren’t many old EM docs because it’s a newish specialty

 

[DokterMom]

In addition to what has already been written, I suspect ER pay will also be trending downward. Big dollars for a 3-year residency and low work hours has become a big draw, so, as a specialty, emergency medicine seems to have been in a bit of a hot phase. Consider also that mid-levels seem to be making lots of inroads, and the MDs are liable for their mistakes beyond their ability to actually supervise.

 

[theonlytycrane]

I think you should consider EM if you like acute trauma, but realize that most of your work will not be true EM complaints + ruling out acute processes. Also consider EM if you like shift work and have no interest in fellowship following a 3 yr residency.

I would consider IM if you are interested and committed in doing a fellowship after 3 yrs of IM. EM > IM with no fellowship.

 

[Tenk]

Trauma is like the last reason you should go into EM. For every legit level one trauma you see there are over a hundred old ladies falling, 20 year olds in mvcs who become numb all over, and drunk idiots being drunk idiots.

EM is for doctors who enjoy life outside work more than work. Plain and simple. I just went snowboarding all day on a Tuesday and have the next 8 days off. Wouldn’t trade this specialty for any other.

 

[Doggeronie]

You don't have to stop practicing and retire early. Just go work at an urgent care.

I would prefer not to do that, I'm not a fan of urgent care work for several reasons.

I think you should consider EM if you like acute trauma, but realize that most of your work will not be true EM complaints + ruling out acute processes. Also consider EM if you like shift work and have no interest in fellowship following a 3 yr residency.

I would consider IM if you are interested and committed in doing a fellowship after 3 yrs of IM. EM > IM with no fellowship.

The problem with that is that you aren't guaranteed a fellowship... Doing IM for the sole purpose of obtaining a fellowship seems to be misadvised. Surely there has to be a way to compare EM and IM without assuming that IM docs will specialize.

 

[CherryRedDracul]

I would prefer not to do that, I'm not a fan of urgent care work for several reasons.

The problem with that is that you aren't guaranteed a fellowship... Doing IM for the sole purpose of obtaining a fellowship seems to be misadvised. Surely there has to be a way to compare EM and IM without assuming that IM docs will specialize.

If you're open to it, a few subspecialties like nephrology always have open fellowship spots.

 

[PugsAndHugs]

MS4 applying to IM right now. I was also between IM and EM. The reasons I chose IM:

1. No peds
2. No disruption in circadian rhythm
3. So many options after residency (outpatient/inpatient/fellowships/admin etc)
4. ED deals with alcoholics, drug users, homeless people, and filters patients that are not sick enough to be admitted - which I commend them for greatly, I just couldn't see myself doing this long-term

Most ED residents/attendings I talked to say they love what they do so much that they do not care about these things. A one month rotation in each specialty should help you make your decision.

 

[theonlytycrane]

MS4 applying to IM right now. I was also between IM and EM. The reasons I chose IM:

1. No peds
2. No disruption in circadian rhythm
3. So many options after residency (outpatient/inpatient/fellowships/admin etc)
4. ED deals with alcoholics, drug users, homeless people, and filters patients that are not sick enough to be admitted - which I commend them for greatly, I just couldn't see myself doing this long-term

Most ED residents/attendings I talked to say they love what they do so much that they do not care about these things. A one month rotation in each specialty should help you make your decision.

are you thinking fellowship?

 

[PugsAndHugs]

are you thinking fellowship?

Not sure yet. I have done several subspecialty rotations in med school, plan to do more during residency. The problem is I despise research. If I fall in love with a field, I will definitely do the research, if not I can see myself being happy as a hospitalist.

 

[OnePunchBiopsy]

My thought would be that IM allows for more fellowship opportunities resulting in higher pay and a better lifestyle than EM.

GI, ID, Oncology, and Allergy come to mind.

 

[Frazier]

OP, from your opener, the answer in my mind is 100% IM.

EM sounds to be a less ideal match for you.
The pay is going to be heading downward.
Circadian disruption is near guaranteed.
Most docs don't practice into old age, if that is a goal.

That said, for the right people, EM is an excellent choice.
But, it sounds like the IM pathway will match your interests better longterm.

 

[pillowsnice]

I also don't know if I could keep seeing undifferentiated abdominal pain and generalized fatigue 20 years into my career.

I think that only you can decide whether you like IM or EM, but it does seem like there are more pros to IM in your mind than EM. To contrast your views, I would like to do EM and generally don't care about the 'cons' that you mentioned above. However, when I think about IM, I absolutely dread the rounding, and other aspects of IM that I won't get into. If your only con about IM is the pay, then I don't believe that is a strong enough con to not do the field.

 

[ace_inhibitor111]

I don’t get the feeling that you’re particularly passionate about IM. Sounds to me like you like IM because of the flexibility and stability, which is a smart thing to think about. If EM weren’t under fire by literally everything right now, I would probably suggest that. But for now, Cards/GI > EM > General IM

 

[hello1234!]

I find it interesting that someone can be interested in both. I hate EM (but of course I have great respect for EM docs) and love IM. I always kinda felt like you can like one or the other but not both.

 

[Chemist0157]

IM based on your post. I tend to think of EM more as a "calling" so if you are not 100% committed to EM, I would not pursue it.

 

[CyrilFiggis]

I hate call. I hate 7 on 7 off. I hate clinic. I love knowing how to treat RSV and COPD, priapism and AUB, reduce a fracture and place a central line. I also like the idea of spending time with my wife and kid, maybe coach tee ball. As someone else said, EM was a calling for me since a premed.

 

[nimbus]

I hate call. I hate 7 on 7 off. I hate clinic. I love knowing how to treat RSV and COPD, priapism and AUB, reduce a fracture and place a central line. I also like the idea of spending time with my wife and kid, maybe coach tee ball. As someone else said, EM was a calling for me since a premed.

How do you treat priapism? Asking for a friend.....

 

[MerYangBey]

I find it interesting that someone can be interested in both. I hate EM (but of course I have great respect for EM docs) and love IM. I always kinda felt like you can like one or the other but not both.

I was thinking the same thing. I’m doing an EM rotation currently, and I feel like it’s one of those things you either really like or kinda hate. I don’t see how anyone would genuinely be torn between IM and EM.

 

[whoknows2012]

I don’t think doing IM with the pure intention of pursuing a fellowship is misadvised. I’ve wanted to be a leukemia doc since med school and there remains only one way that I was able to achieve that goal...(I start my leukemia position in July)

That’s obviously anecdotal and highly specific to my situation but these occurrences are common in IM. Certainly you have to realize nothing Is guaranteed, and thus be ok in a worst case scenario practicing general IM (hospitalist isn’t a terrible gig and pays well). It too is flexible as you can do outpatient, inpatient, a mix and/or be faculty at an academic institution involved with an IM residency program.

That all being said, EM and IM don’t share a lot of similarities and so instead of focusing on compensation and what you may perceive as good work life balance (this totally exists in IM and IM specialties) focus on what you could see yourself doing and being happy for the next 40 years.

 

[gyngyn]

IM.

 

[chromaticscale]

You should choose the specialty that you would enjoy the most regardless of length of time or other factors that are minimal because it wouldn't feel like a job to you if you love what you are doing. However, if you feel you would enjoy each specialty equally, then I would look at the practical aspects. Since IM offers more options such as outpatient and inpatient as you mentioned as well as many opportunities to sub-specialize, you should do IM (which is also why I chose this field).

 

[Splenda88]

If you want to be rich quick and have time to spend with love ones, EM.

 

[shouldigomd]

I hate call. I hate 7 on 7 off. I hate clinic. I love knowing how to treat RSV and COPD, priapism and AUB, reduce a fracture and place a central line. I also like the idea of spending time with my wife and kid, maybe coach tee ball. As someone else said, EM was a calling for me since a premed.

You could treat all those things, place a central line and spend time with your wife / kid as either IM or EM. You also don't have to do 7 on 7 off. Clinic would be only during residency (and honestly a great change of pace from inpatient months).

Not saying EM isn't right for you ... just not a very convincing argument.

 

[Pepe18]

.

 

[Doctor Strange]

JOIN US IN INTERNAL MEDICINE!
Kool Aid aside, it sounds like what you're looking for in a career is more based in IM. While EM does do their fair share of "detective work," most of it is centered around stabilizing the patient enough to either discharge with outpatient follow-up or admit to whatever service. If you're looking to go zebra hunting, IM lends itself more to that since you might be sold a "COPD exacerbation" by the ED but actually end up diagnosing something like interstitial lung disease.

IM is also incredibly versatile. You have the option of specializing as well as going right into practice either in the inpatient or outpatient realm.