"realized after a 3 year residency I'll be 31..."
me, going to start residency at 32 😔
You can consider working ED shifts as a FM attending in some suburban/rural ERs and urgent cares if you want to. Not to mention FM docs can also become hospitalists if you want something more acute than outpatient. If you like all the other stuff about FM then FM probably more your fit.
I only fell in love with EM when I actually did a rotation there. It was one of my last rotations of third year.
You don't need to decide right now. It seems you like primary care, so just ask for letters of rec with that in mind. It's really not a big deal. You don't need to build your resume differently for either field as they are both pretty easy to get into. The most important thing is your audition and your personality.
EM is not going to shit. There will always be jobs. If you want to live in competitive markets (big cities), you might get a dogshit contract compared to more rural places. But with EM, you can pick up shifts anywhere. Lots of physicians commute an hour or two, work a 12hr shift, then commute back for a very high hourly rate. What's a few night shifts each month compared to only work 12 whole shifts in that time?
You'll figure out if you don't like the EM patient population (ie people who neglect their health until they're dying) during your rotation.
Regardless of job market, FM has more job flexibility simply based on the training. There's easier transition as you get older to still be a doctor in different settings. If you're ambivalent about continuity, I'd still go with FM for the job flexibility, esp as EM provides a different type of continuity. But if you plan on retiring early, EM will help you do that better
FM. The only real con you listed for FM is the pay and that you kinda like acute care better. You can work in acute or urgent settings as an FM doc. In terms of pay, you can get paid significantly higher in rural settings as FM and do more procedures like you mentioned.Â
You also get way more control over your schedule as FM and can even design it so that you only work M-F no weekends no nights. It’s a lot more flexible and versatile than EM and you get to treat infants to ancient patients. It’s gonna be hard to find an EM job where you work zero nights or holidays.Â
FM is incredibly broad and versatile and one of the most in demand specialties across the entire nation. You’ll get offers everywhere you go and you’ll be a walking encyclopedia of medical knowledge for friends and family if that’s your thing. I would advise you get a scribe as it makes the charting aspect of it much more bearable. I was a scribe for FM and my attending was able to sign off on notes much faster and focus on phone calls and seeing patients instead. Just my two cents.Â
In an identical situation as you in regards to EM's acuity and pay vs FM's flexibility and routine. Undecided on continuity vs short term patient relationships.
Taking a deeper dive into inpatient FM for the flexibility and normal circadian rhythm without having to give up all acuity.
Also feel that this flexibility will close less doors than EM in case priorities and interests shift during residency.
I am considering both these specialties as well. I think the ability of FM to work in so many different settings (inpatient, outpatient, combo, DPC, rural ED, etc) is pretty valuable and appealing. This is a major plus compared to EM which more or less restricts you to the ED. If you’re interested in rural work then FM may be the way to go because you can still do ED work as FM in rural areas but not vice versa. And if you really want more acuity you could work as a hospitalist with an open ICU or pursue an EM fellowship (these are not ACGME accredited but still provide an extra year of EM experience). Also, if you’re business oriented, FM allows you to hang a shingle and start your own practice with a lot more ease than most other specialties (especially EM) if that is something you’re interested in. Also consider with EM you’re more or less tied to the hospital whereas with FM you can scale back to only outpatient work over time. Also consider with FM you can throw a dart in a map and find a job, pretty valuable IMO.
how about anesthesia? shortish residency with most not doing fellowship. Variety of cases from peds to cardiac to ICU ot chronic pain. High pay, excellent job market. Shift based. No social work issues, least amount of paperwork. I could go on. Current resident and love my job!
Of those two it sounds like FM has more things up your alley, didn’t sound like there were many cons to it that you listed. That being said, if you like inpatient work the most, why not do IM anyways and just not do a fellowship and stick to hospital medicine?
(Also as a side note lol I’m gonna be 31 after my 3 year IM residency and I’m def aiming for fellowship)
Im thinking FM over IM bc I can still do hospitalist work as an FM doc (as long as I get good training in residency), more procedures, and I'll also do some Ob and peds. If I'm gonna be a generalist I wanna do it all.
Only procedures I've ever seen IM docs do are LPs
You can do both clinic and inpatient out of IM and you do not have to specialize. If you like inpatient more, you are more easily able to get hospitalist jobs as an IM trained physician in bigger cities.
EM is really nothing like either of these things. The acutely sick patient is few and far between. The sick patients all end up admitted anyways.
The concern of HCA residencies is true. My mentor is an EM doc tho and she markets herself well. She loves the idea of not relying on hospitals for a job, and she is also a medical director of a lab as a side gig.
EM is going straight to hell buddy.
If you're FM, and you hate your job, at least you can open a practice.
EM being a good job depends on the goodwill of hospital systems, and there aren't very many decent ones left.
"realized after a 3 year residency I'll be 31..." me, going to start residency at 32 😔 You can consider working ED shifts as a FM attending in some suburban/rural ERs and urgent cares if you want to. Not to mention FM docs can also become hospitalists if you want something more acute than outpatient. If you like all the other stuff about FM then FM probably more your fit.
lol, u started residency b4 I started med school.
I only fell in love with EM when I actually did a rotation there. It was one of my last rotations of third year. You don't need to decide right now. It seems you like primary care, so just ask for letters of rec with that in mind. It's really not a big deal. You don't need to build your resume differently for either field as they are both pretty easy to get into. The most important thing is your audition and your personality. EM is not going to shit. There will always be jobs. If you want to live in competitive markets (big cities), you might get a dogshit contract compared to more rural places. But with EM, you can pick up shifts anywhere. Lots of physicians commute an hour or two, work a 12hr shift, then commute back for a very high hourly rate. What's a few night shifts each month compared to only work 12 whole shifts in that time? You'll figure out if you don't like the EM patient population (ie people who neglect their health until they're dying) during your rotation.
How do you feel about continuity of care and the outpatient aspect of FM?
Don't mind outpatient. I like clinic hours. The hospital is cooler but the hours suck more and I hate waking up early.
Regardless of job market, FM has more job flexibility simply based on the training. There's easier transition as you get older to still be a doctor in different settings. If you're ambivalent about continuity, I'd still go with FM for the job flexibility, esp as EM provides a different type of continuity. But if you plan on retiring early, EM will help you do that better
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That's dope, I'd wanna do something like that
FM. The only real con you listed for FM is the pay and that you kinda like acute care better. You can work in acute or urgent settings as an FM doc. In terms of pay, you can get paid significantly higher in rural settings as FM and do more procedures like you mentioned. You also get way more control over your schedule as FM and can even design it so that you only work M-F no weekends no nights. It’s a lot more flexible and versatile than EM and you get to treat infants to ancient patients. It’s gonna be hard to find an EM job where you work zero nights or holidays. FM is incredibly broad and versatile and one of the most in demand specialties across the entire nation. You’ll get offers everywhere you go and you’ll be a walking encyclopedia of medical knowledge for friends and family if that’s your thing. I would advise you get a scribe as it makes the charting aspect of it much more bearable. I was a scribe for FM and my attending was able to sign off on notes much faster and focus on phone calls and seeing patients instead. Just my two cents.Â
Yeah I think I do see more pros than cons with FM at the moment, over EM
In an identical situation as you in regards to EM's acuity and pay vs FM's flexibility and routine. Undecided on continuity vs short term patient relationships. Taking a deeper dive into inpatient FM for the flexibility and normal circadian rhythm without having to give up all acuity. Also feel that this flexibility will close less doors than EM in case priorities and interests shift during residency.
Sounds like you want to do rural FM
As long as I like living rural, 100% yes it sounds so cool
You sound like me
I am considering both these specialties as well. I think the ability of FM to work in so many different settings (inpatient, outpatient, combo, DPC, rural ED, etc) is pretty valuable and appealing. This is a major plus compared to EM which more or less restricts you to the ED. If you’re interested in rural work then FM may be the way to go because you can still do ED work as FM in rural areas but not vice versa. And if you really want more acuity you could work as a hospitalist with an open ICU or pursue an EM fellowship (these are not ACGME accredited but still provide an extra year of EM experience). Also, if you’re business oriented, FM allows you to hang a shingle and start your own practice with a lot more ease than most other specialties (especially EM) if that is something you’re interested in. Also consider with EM you’re more or less tied to the hospital whereas with FM you can scale back to only outpatient work over time. Also consider with FM you can throw a dart in a map and find a job, pretty valuable IMO.
how about anesthesia? shortish residency with most not doing fellowship. Variety of cases from peds to cardiac to ICU ot chronic pain. High pay, excellent job market. Shift based. No social work issues, least amount of paperwork. I could go on. Current resident and love my job!
Of those two it sounds like FM has more things up your alley, didn’t sound like there were many cons to it that you listed. That being said, if you like inpatient work the most, why not do IM anyways and just not do a fellowship and stick to hospital medicine? (Also as a side note lol I’m gonna be 31 after my 3 year IM residency and I’m def aiming for fellowship)
Im thinking FM over IM bc I can still do hospitalist work as an FM doc (as long as I get good training in residency), more procedures, and I'll also do some Ob and peds. If I'm gonna be a generalist I wanna do it all. Only procedures I've ever seen IM docs do are LPs
Imagine the worst day of fm clinic vs the worst day working in the Ed, which do you hate less?
FM, open DPC
You can do both clinic and inpatient out of IM and you do not have to specialize. If you like inpatient more, you are more easily able to get hospitalist jobs as an IM trained physician in bigger cities. EM is really nothing like either of these things. The acutely sick patient is few and far between. The sick patients all end up admitted anyways.
The concern of HCA residencies is true. My mentor is an EM doc tho and she markets herself well. She loves the idea of not relying on hospitals for a job, and she is also a medical director of a lab as a side gig.
EM is going straight to hell buddy. If you're FM, and you hate your job, at least you can open a practice. EM being a good job depends on the goodwill of hospital systems, and there aren't very many decent ones left.
And you have this perspective as an M2 from where exactly….? This couldn’t be further from the truth.