EM/IM + Fellowship

[gxb]

MS3 at a US MD with step >235, few research activities, decent grades, and no red flags. I've done EM and IM rotations and researched the topic extensively. I really like both fields and can certainly see myself doing both. However, I also like cardiology, a lot. As fourth year is approaching, I have to make a decision about which route to take. I need some advice on wheher a combined IM/EM plus fellowship would be a waste of time if I end up not using the "EM" in cardiology. I know most IM/EM physicians end up doing EM, so I'm kind of torn between the two choices. In addition to clinical practice, my goal is be able to coordinate inter-departmental work, especially in relation to things like STEMIs, door-to-balloon policies and procedures, etc..

My options as I think of them for now:

-IM-->cardiology 6 years
-IM/EM alone 5 years
-IM/EM--> cardiology 8 years

I know it's a lot of time but I'm willing to put the work if that will serve my future aspirations. Would really appreciate your insight.

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[megawhizz]

Most people do not pursue IM fellowships after an EMIM residency. EMIM programs are generally leadership tracks, so cases may exist, for example I know of one person who wanted to do an ID fellowship with a career goal of leadership positions within the CDC. If your goal was, say, to become a major researcher/influencer in emergency cardiac care, then EMIM-->cardiology may be the way to go.

Doing EMIM alone will give you sufficient clout within a department of IM to help achieve the goals you list above. You will be "one of us" when speaking to the IM doctors and the EM doctors, which is key to the success of any inter-departmental work. The IM-->cardiology route does not necessarily give you that, and does not distinguish you from any other cardiologist who is "telling the EM people how to do their jobs."

The key question is what kind of clinical practice you enjoy; do you want to work in a cath lab/stress lab, primarily manage cardiac issues for your patients. This you can only do after you do a cardiology fellowship. If you are okay working clinically as an Emergency Physician and an Internist (perhaps academic internist, hospitalist, short stay/stress test unit), then EMIM would be a good choice.

 

[engineeredout]

Not sure I understand the point in EM/IM followed by cardiology. I believe EM and IM augment each other and improve you as a physician in either one. I don't really see how being an EM doc will help you be a better cardiologist, and being a cardiologist is not likely to impact that much of what you do in the ED. if all you want to be is a cardiologist, then do Medicine and get yourself into a cards fellowship.

One other thing I'd throw in there - if you do not love Emergency Medicine, don't do EM/IM. Burn out is high enough in emergency medicine, without being committed to it you're setting yourself up to be miserable, or in the best case waste a few extra years. In addition I think you also find that the combined residents tend to be more of an EM mentality then an IM mentality

 

[gxb]

Thank you for the replies. Definitely gave me a lot to think about.

 

[sacksfan2011]

My program has an EM/IM program (and an EM/IM/CC program), the EM/IM seniors are pretty baller, but most of them say the jobs are usually one or the other.
One senior did the whole EM/IM/CC route and went on to do locums CC in the midwest
We have one EM/IM graduate in our research/admin

I suppose the main benefit would be the flexibility, its a long ride tho

 

[aafisahar]

The mentality is extremely different in EM than in IM. IM is slower, methodical, usually deeper thinking about fewer patients. EM is more heuristic, working up an undifferentiated patient giving a **** history, along with trauma, procedures, and generally more chaos (eg 20 in the triage area, three level 1 ambulances just rolled in, and bed 14 is now vomiting blood).

In the abstract, people think they like both. Speaking from an IM perspective, I couldn't stand the pace of EM and the complaints I saw in the ED (URI, sprains, random abdominal pain x4 hours, fender-bender housewives coming "just to make sure").

Finally, 5 years of training is a long time. People will be finishing up their fellowship when you start thinking about fellowship (if at all). You will likely end up doing one or the other for your ultimate career. In general, I advise anyone thinking about dual-residencies to reconsider. You don't know what your future career will be like and very likely a dual-residency does nothing for you.

 

[megawhizz]

You will likely end up doing one or the other for your ultimate career. In general, I advise anyone thinking about dual-residencies to reconsider. You don't know what your future career will be like and very likely a dual-residency does nothing for you.

Most EMIM programs today help their residents achieve a specific leadership goal, rather than just become "a better clinician thanks to the combination of EM and IM." Easiest to think of it as a separate specialty distinct from EM or IM, almost like residency in Ophthalmology vs residency in Urology. All the EMIM graduates that I know (including myself) would credit this training for much of what they have achieved in their careers, and strongly recommended it to others with similar goals.

 

[PossibleEMapplicant]

Most EMIM programs today help their residents achieve a specific leadership goal, rather than just become "a better clinician thanks to the combination of EM and IM." Easiest to think of it as a separate specialty distinct from EM or IM, almost like residency in Ophthalmology vs residency in Urology. All the EMIM graduates that I know (including myself) would credit this training for much of what they have achieved in their careers, and strongly recommended it to others with similar goals.

What types of leadership positions would that be?

 

[megawhizz]

What types of leadership positions would that be?

Examples may be residency or hospital administration, research, quality improvement (e.g. interdepartmental STEMI, stroke, sepsis care), global health, public health.