Undecided - FM vs EM

[confusedmedstudent1235]

Hey all,

Currently dual applied FM and EM, and still undecisive on which one I'm going to pick. I'm an MDSSP/STRAP Army Reserves student, so I'm committed to working one weekend a month/two weeks a year for the military once I'm done with residency. From what I've heard about EM, the weekends and night shifts really add up (2 weekends a month??) and I really enjoyed continuity clinic, so I'm leaning towards FM right now. My last itch that I can't let go of that I really did love the excitement from high acuity cases/codes/admissions. Because of that, I'm still unsure in my decision. In major Texas cities (Dallas, Austin, Houston, SA) would it be possible to still occasionally get that acuity in FM? I know hospitals favor IM, but would they take FM for per-diem swing/admitting shifts maybe?

Thanks!

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[FrustratedFamDoc]

It's a different way of approaching your answer, but decide which field will have fewer aggravations you'll have to deal with.

Both will have admin to deal with (ED probably more so), and circadian rhythm issues with EM are terrible. Autonomy over your schedule with EM... good luck. Quality standards, non-compliant patients, encroachment with mid-levels which may eventually impact job roles/expectations and salary (true for both fields), endless FMLA requests and tasks, etc. You'll definitely work for "the man" in EM and there is already concern for oversaturation of the field since you're beholden to the hospital and quite a few hospitals are opening new programs. I don't foresee oversaturation with FM, but again, you'll still probably work for "the man."

For this, you will be a top 5% earner and get the satisfaction of helping some/hopefully most patients. Your skills are portable and you can probably find a job anywhere in the country. All medical fields and burdened with monotony. 80-90% of today will be exactly what it was yesterday. Too much interesting will be exhausting, trust me.

In FM, you'll mostly be managing chronic illnesses, acute/subacute problems (some potentially serious), and playing keep away from the reaper as we fight against an inevitable outcome. As long as you're good to people and honest with them, the vast majority will love you. It's very gratifying. There are quite a few things that you can't really help patients with and this can be discouraging (your self pay 300 lb back pain patient that has come back early 3 times in the past 2 months because his pain is no better) or (older people with older people problems seeking the fountain of youth, bring it up EVERY time you see them, leading you to breaking their heart once again). But overall, I leave work gratified and in a good mood each day. I work 4 1/2 days a week and have COMPLETE autonomy over my schedule.

I can't comment much on EM, as I have never work a shift a day in my life, but beware the allure of being purely exciting. It definitely comes at a cost.

 

[dadaddadaBATMAN]

Hey all,

Currently dual applied FM and EM, and still undecisive on which one I'm going to pick. I'm an MDSSP/STRAP Army Reserves student, so I'm committed to working one weekend a month/two weeks a year for the military once I'm done with residency. From what I've heard about EM, the weekends and night shifts really add up (2 weekends a month??) and I really enjoyed continuity clinic, so I'm leaning towards FM right now. My last itch that I can't let go of that I really did love the excitement from high acuity cases/codes/admissions. Because of that, I'm still unsure in my decision. In major Texas cities (Dallas, Austin, Houston, SA) would it be possible to still occasionally get that acuity in FM? I know hospitals favor IM, but would they take FM for per-diem swing/admitting shifts maybe?

Thanks!

As an em guy, if you are feeling indecisive between the two take fm.

Codes, chest tubes and intubations become routine. Circadian disruptions don’t seem like a big deal till you live them. The salary difference isn’t large enough to make up for how much burnout this causes.

Most people in em hate clinic with a fiery burning passion. I’m not saying you can’t be em if you don’t, just that you may be identifying yourself as a poor cultural fit.

Being able to set up your own shop is a nice thing to have in the back pocket.

Being able to not work weekends, holidays is great.

Being able to fire problem patients is incredible.

Being able to change between inpt and outpt is great.

Liability somewhat lower in fm.

Job markets are difficult to predict, but em is looking a bit grim between cmg pressure, increased residency production, and expanded use of mid levels by completely unscrupulous private equity.

 

[confusedmedstudent1235]

Thank you so much for your input. I am definitely leaning towards FM I think at this point given the current job market, circadian rhythm disruption and weekend responsibilities in EM. I'm hearing about FM jobs for around $250k with 5-6 weeks off; given that EM is around $200 per hour I hear in DFW, is salary really that different? Was thinking that if you take the same time off, $200 per hour with 32 hours per week 47 weeks a year is barely higher than the FM salary, so was a little confused where the higher EM pay comes from (unless its just less time off). Thinking about my extra weekend commitment with the army reserves as well, is it correct that EM docs work around 2 weekends a month? Seems like I'd be working 3/4 weekends with the army reserves commitment.

In regards to FM, do y'all know if academic FM in the big cities staffs the hospitalist units for the teaching hospitals as a possible job? Noticed that a lot of the FM curriculum programs have FM specific inpatient units rather than rounding with the general IM floors, so was thinking about that as a possible career path with a mix of inpatient and outpatient.

 

[dadaddadaBATMAN]

Thank you so much for your input. I am definitely leaning towards FM I think at this point given the current job market, circadian rhythm disruption and weekend responsibilities in EM. I'm hearing about FM jobs for around $250k with 5-6 weeks off; given that EM is around $200 per hour I hear in DFW, is salary really that different? Was thinking that if you take the same time off, $200 per hour with 32 hours per week 47 weeks a year is barely higher than the FM salary, so was a little confused where the higher EM pay comes from (unless its just less time off). Thinking about my extra weekend commitment with the army reserves as well, is it correct that EM docs work around 2 weekends a month? Seems like I'd be working 3/4 weekends with the army reserves commitment.

In regards to FM, do y'all know if academic FM in the big cities staffs the hospitalist units for the teaching hospitals as a possible job? Noticed that a lot of the FM curriculum programs have FM specific inpatient units rather than rounding with the general IM floors, so was thinking about that as a possible career path with a mix of inpatient and outpatient.

Depending on region you may get anywhere from 180-250/hr in em, +/- night differential. Most jobs don’t have any actual paid vacation, so the 32/week is for all 52 weeks. My current pretax salary is somewhere from 350-370k with good benefits. If I stayed 3 more years would end around 400

2 weekends is standard.

 

[bronx43]

In regards to FM, do y'all know if academic FM in the big cities staffs the hospitalist units for the teaching hospitals as a possible job? Noticed that a lot of the FM curriculum programs have FM specific inpatient units rather than rounding with the general IM floors, so was thinking about that as a possible career path with a mix of inpatient and outpatient.

My academic institution in a big city has FM inpatient services, where the attendings rotate on coverage. I don't know that there is an actual "hospitalist" service where it's only staffed by family medicine. Academic hospitals would rather just hire IM hospitalists and have FM see patients in clinic.
I don't know that big city hospitals would have a need for someone who is a mix of inpatient and outpatient, since that causes inefficiencies on both sides. In a rural area, it may be more likely.

 

[confusedmedstudent1235]

My academic institution in a big city has FM inpatient services, where the attendings rotate on coverage. I don't know that there is an actual "hospitalist" service where it's only staffed by family medicine. Academic hospitals would rather just hire IM hospitalists and have FM see patients in clinic.
I don't know that big city hospitals would have a need for someone who is a mix of inpatient and outpatient, since that causes inefficiencies on both sides. In a rural area, it may be more likely.

That's actually what I was thinking of! So these attendings would essentially function as a hospitalist for these weeks that they rotate on coverage right? It seems like it would be a good way to get some of the variety that I want/not lose inpatient/higher acuity skills from doing outpatient only.

 

[confusedmedstudent1235]

Other than that, I really enjoy the diagnostic processes of admitting patients from ED to the floor. From speaking to internists, the ability to pickup swing admitting shifts (especially on the weekends) doesn't seem to be hard since need is always greater than people wanting to take those shifts. Are FM trained physicians able to do these per-diem shifts in the big cities, or is the IM bias too strong in areas such as DFW?

 

[AMEHigh]

Thank you so much for your input. I am definitely leaning towards FM I think at this point given the current job market, circadian rhythm disruption and weekend responsibilities in EM. I'm hearing about FM jobs for around $250k with 5-6 weeks off; given that EM is around $200 per hour I hear in DFW, is salary really that different? Was thinking that if you take the same time off, $200 per hour with 32 hours per week 47 weeks a year is barely higher than the FM salary, so was a little confused where the higher EM pay comes from (unless its just less time off). Thinking about my extra weekend commitment with the army reserves as well, is it correct that EM docs work around 2 weekends a month? Seems like I'd be working 3/4 weekends with the army reserves commitment.

In regards to FM, do y'all know if academic FM in the big cities staffs the hospitalist units for the teaching hospitals as a possible job? Noticed that a lot of the FM curriculum programs have FM specific inpatient units rather than rounding with the general IM floors, so was thinking about that as a possible career path with a mix of inpatient and outpatient.

Yes. At tons and tons of family medicine residency programs the attendings cover inpatient, outpatient and OB.
Although many people seem to think it’s a dying breed to be a full-spectrum FM doc that truly is not the case and is definitely truly not the case if you work at a residency. I can think of at least 10 people off the top of my head that do all 3 as mentioned above and they’re all on either coasts in large-ish cities. And I know the same is true for the Midwest and South but since I didn’t train there I don’t know as many people from those regions.

 

[Splenda88]

Other than that, I really enjoy the diagnostic processes of admitting patients from ED to the floor. From speaking to internists, the ability to pickup swing admitting shifts (especially on the weekends) doesn't seem to be hard since need is always greater than people wanting to take those shifts. Are FM trained physicians able to do these per-diem shifts in the big cities, or is the IM bias too strong in areas such as DFW?

I think IM bias are strong in probably most big cities... Also, you will find hospitals in suburbia (30-40 miles radius from big cities) that are open to FM docs working these shifts.

 

[VA Hopeful Dr]

I think IM bias are strong in probably most big cities... Also, you will find hospitals in suburbia (30-40 miles radius from big cities) that are open to FM docs working these shifts.

Yep.

If you really want to be able to pick up some hospital work you're better of doing IM. Plenty of places are fine with FM hospitalists but plenty are also IM only.

And IM can do outpatient clinic, just minus kids and with arguably less GYN and office procedures.

 

[FrustratedFamDoc]

If you find a hospital cool with you managing inpatient, they will give you ANY and ALL the extra shifts you want. If your extra work can make it so they can hire fewer hospitalists, you will be their best friend. You'll probably make physician of the month within the first 3 months of employment. Just realize that they may/probably will ask you to fill in for a night shift "here and there," while they're "trying to find another nocturnist" so be sure to protect your turf.

 

[ciestar]

The job market for EM is also bad, so take that into consideration