Discussion on Combined Emergency and Internal Medicine Residency and Critical Care Fellowship

Dr. Brad Langston is a practicing physician with triple board-certification in Emergency Medicine, Internal Medicine, and Critical Care gives his advice to students interested in pursuing combined Emergency/Internal medicine residency and working as a critical care physician.
0:00 Introduction and path of emergency medicine, internal medicine, and critical care medicine
2:25 Is the extra 2 years of training for EM/IM program worth it?
3:29 Do people do EM only, IM only, or both, or something else after graduating combined EM/IM residency?
6:12 Multiple paths to being critical care physician
7:16 The reasons of choosing combined EM/IM program then critical care fellowship
8:33 Any changes he would make along his path?
9:17 Qualities to make a successful critical care physician
11:23 Satisfying aspect of being a critical care physician
12:26 The not so satisfying aspect of working as critical care physician
13:45 Myths about critical care physicians that aren't true
14:47 Work-Life balance as a critical care physician
16:25 Changes in critical care medicine including during covid19
20:53 Working with midlevels as a critical care physician
21:47 Future job market for critical care physicians
22:15 Additional resources to learn if EM/IM or critical care is right for you
23:17 Top tips to students

[@orlandoalessandrini2505]

This is something I was actually looking for. Subbed.

[@khanhcaomd5838]

Cool thanks, feel free to share my channel with your classmates as I'm sure they're in the similar situation as you. th-cam.com/channels/c6gs_5VVWvfZuQ5mqc0l8Q.html

[@joshcrane4107]

MS4 currently applying to EM/IM programs. Loved this interview. Thanks! Resonated with so many of the motivations he talked about. I have a question! There are currently only six programs that offer a combined EM/IM/CC residency which increases the duration of the program by a year and 7 other programs that only offer EM/IM. IF you complete an EM/IM residency but would like to do CC after finishing, are there fellowships in CC that are only a year long that work for an EM/IM trained doctor? OR do you have to go through one of the EM/IM/CC programs?

[@khanhcaomd5838]

I believe the built in EM/IM/CC is 6 years and if you go to other critical care fellowships that don't have this, it would be 2 years. You can always apply to one of the CC fellowships in the EM/IM/CC after you finish at the EM/IM program as they'll most likely take you although more advantageous and easier to get in if you're already at an EM/IM/CC place.

[@chetmcmasterson]

Man, I miss hanging out with both of you guys. Gimme a call if you ever make it back to ENC.

[@FS-td3og]

You are doing great interviews! Just subbed! Very informative and genuine interviews for medical students deciding on a specialty. Keep em coming!!

[@khanhcaomd5838]

Thanks, I try to put myself into a medical students' shoes to figure out what could be helpful to know. Good luck.

[@brennengodeen3796]

I’m a 3rd DO student and I’m currently torn on FM or EM. I feel like I am someone that performs at my best when I’m under pressure or stress. Id say that I also have a lot of emotional discipline which seems like a characteristic that would also serve me well in EM. Being able to go from the trauma room and code a patient and then go into the next room that is a child with an ear infection. I don’t allow any prior emotions conflict my experience with a different patient. Is it safe to say that most ER docs function well under pressure and almost embrace it? I have some serious concerns about how heavily abused ER services are (I understand there is a lack of PCP’s). My wife is an ER nurse and we often discuss the poor patient behavior that makes her exhausted. She always says she wouldn’t want to do any other specialty. She either loves it or hates it. It seems like a pretty toxic relationship😂 I’d like to observe how the attending are treated by the uncooperative, demanding and abusive patients she often talks about.
Also the most recent match results is alarming in addition to the employment outlook having a “surplus”. If I do EM, I would really like to do a combined program or another fellowship like sports medicine. Variety is extremely important to me. I would like to believe that doing a fellowship is another area of medicine that I really enjoy may save me from potential burnout. I understand that FM can also do a variety of fellowships as well. In this situation I’d either do a fellowship in EM or sports medicine. I am under the impression that a FM doc can moonlight or work in an ER. But it’s usually in rural locations (we plan on living rural anyways). I feel like the ability to do this would scratch that itch for some adrenaline pumping emergency care.
I always hear how FM is poorly compensated in comparison to other specialties but I believe pursuing your passion will result in financial stability. There are so many ways to supplement your income that this is hardly an issue in my decision making process. My priorities and goals in life are to be a good doctor, father and husband. Lifestyle is important to me. I didn’t particularly like surgery that much and I certainly don’t have the scores for derm.
I think if I only did EM I would become shaded quickly since I have already seen the abuse when I worked as an EMT in the ER. It appears that EM lacks strong leadership from hospital administrators. They seem to be far more concerned with budgets and profits than actually providing excellent evidence based care. I’m fearful that I would be very enthusiastic working in the ER early in my career. However, I’m concerned that later into my career I may become shaded and resentful.
At least I know what specialties are an absolute no for me. I have an elective rotation at the ER my wife works at which will allow me to ask my preceptor some difficult questions about the specialty. He is relatively young so it will be nice to hear his perspective and outlook of the specialty. It always seem like the older attendings are already burnt out regardless of specialty. They just want to retire haha. I often take what they say lightly and often ask someone else for their opinion too. I think observing the role of the physician within the department will help solidify my decision. The nursing staff often deals with the majority of the abuse, assault and harassment. They work incredibly hard and are often treated poorly by rude patients. I understand this but I really need to see how my prior negative experiences would affect me as an attending. It seems like the rude and disrespectful patients respect and respond to doctors much differently than nurses.

[@strongDr]

So, being board certified in both IM/EM ,can one go for competitive fellowships in IM like Cardiology?

[@khanhcaomd5838]

Not many people that I know take the cardiology route through EM/IM only because that would be 8 years vs 6 years in IM route. If you truly want to do cardiology, go through IM. If you see yourself working in the emergency department and want flexibility in the future, then do EM/IM. I do not believe EM/IM makes one any more competitive for cardiology than IM.

[@strongDr]

@@khanhcaomd5838 Thanks so much for replying Dr.Cao! I think then being more interested in Cardiovascular sciences, IM is the best fit.
Really appreciate the interview series!

[@SS-nt6jn]

Hello! Any way we can reach out to this doctor to get more info? His email or something

[@khanhcaomd5838]

Here's Dr. Langston email address [e-mail]. Good luck.