Just some questions for the thread.
1) What do most people with EM/IM do after residency?
2) Could I be a part time hospitalist and part time EM doc? Is that a smart path to take?
3) Is EM/IM something people should go into if they are unsure what they want or if they just cannot choose EM over IM or vice versa.
Any EM/IM that could talk about their experience and what they are doing now?
A few thoughts:
1) As was mentioned, historically most people did EM with a tendency to end up in an academic setting. The Hospitalist movement was not as prominent back then so from a monetary and scheduling standpoint EM was more desirable. You now have more people opting for fellowship, administrative leadership opportunities, or varied practice patterns integrated into EM (ie. Observation Medicine).
2) Yes, you can do this however as was pointed out again you would have to take a pay cut unless you were smart about it. For example, in a smaller hospital your skill set could be shopped at a premium. A lot of Hospitalists do not like critically ill patients or procedures. My former chief resident is in a medium sized hospital in rural America and gets almost his ED hourly rate as a "Critical Care Hospitalist" in an open ICU model. His partners are happy to just do the lower acuity non-ICU stuff when he's on and he gets to bypass the Grandma has a CURB 65 of 1 but "I am not comfortable discharging" admits. I have another former chief who does 70% EM and 30% Observation Medicine for a private EM group to keep up both of her skills and her salary is almost the same as if she did just EM since a lot of her partners hate covering the Obs unit. You need a niche or you are going to lose money and after 5 years I think that would be unacceptable.
3) Bad idea. You need a plan - whether thats to do Admin, get a letup to break into a competitive academic market, as a precursor to a fellowship. Eventually we all skew more one way vs another (usually EM) and if you don't have your eye on a long game you are going to be very bitter come Year 3 when your co-residents are starting to get jobs and you're only 1/2 way done. Or when you have to present to people you started intern year with or who were your interns/visiting medical students when your started. Either pick one or have a way that you plan to integrate it. When I interview candidates they have to make me believe or I push for a do not rank designation.
Personally, I am doing EM/IM/CC and am building a substantial profile in academics/administration to augment myself clinically. I am going to focus on passing my IM boards and EM written QE exam this summer/fall before I start entertaining full offers but the preliminary scouting I have done indicates substantial interest from private and academic organizations even unsolicited once they hear my background.
As I see it, about the only thing someone with EM/IM/CC can't do is cut them in the OR which in my preliminary job searches has translated into real value for organizations. EM and CC are both red hot specialties in demand right now and there are shortages as well. As one of my mentors says - "Punch as many tickets as you can while you are young to create options later on". Obviously you must eventually say enough is enough. We have an attending who is a bad ass - EM/IM/Cardiology/Advanced Heart Failure but thats 9-10 years of training and far more than I would be willing to do.
Models I am personally aware of:
Program Director of prominent EM programs
Advanced Heart Failure Cardiologist
EM/IM Pulm CCM
Private EM/Obs Medicine
Private EM/Hospitalist Medicine
Proceduralist (walks in drops lines, tubes, intubates, etc for Hospitalist and then walks out)
EM/IM Program Directors - EM and academic hospitalist ward weeks
Deputy Chief of Staff
Academic Chairs
Read this paper for more insight:
http://www.ncbi.nlm.nih.gov/pubmed/19673705
I know a new one is being worked on and should be out at some point in the near future.
Lastly, and a major caveat:
We take a substantial financial hit with the prolonged training which unless you have no debt/independently wealthy is a real issue. This much be strategized or you stand to lose in excess of >$400,000 just with two extra years as a resident. Most EM/IM places let you moonlight in the later years. I can tell you that I now make more than quite a few of my academic EM and IM attendings moonlighting as both a ED doc and Hospitalist in community hospitals. If done right you can come out at the end a real boss from a training and still in a financial situation that is not much different than if you graduated in just 3 years.