What are the benefits and drawbacks of a combined internal medicine (IM) and emergency medicine (EM) residency program?

Combined Internal Medicine and Emergency Medicine Residency Programs

Overview and Career Outcomes

Combined EM-IM residency programs offer excellent career satisfaction and diverse practice opportunities, with 88-95% of graduates reporting they would choose this training path again. 1, 2

These ACGME-accredited programs typically span 5 years and prepare physicians for dual board certification in both emergency medicine and internal medicine. 3, 4 The American College of Emergency Physicians recognizes that emergency medicine residency programs provide the best method of training future emergency physicians, and combined programs extend this principle to dual specialty training. 5

Key Benefits

Career Flexibility and Practice Patterns

• 37-51% of graduates practice both EM and IM clinically, while 51-55% focus primarily on emergency medicine practice. 1, 2
• The majority (72%) work in urban settings with strong academic affiliations (60-71% practice in academic centers). 1, 2
• 69-87% spend at least 10% of their time in academic roles, with many holding leadership positions in education, research, and hospital administration. 1, 2

Fellowship and Advanced Training

• 31% of graduates pursue formal fellowship training, with critical care medicine being the most popular choice—a proportion that has increased significantly over time. 1, 2
• The establishment of the EM/IM/CCM (critical care medicine) pathway has expanded training options for those interested in intensive care. 2

Professional Satisfaction

• 87-88% of graduates report being "extremely satisfied" with their training choice. 1, 2
• 95% would choose this path again despite the additional years of training required. 2
• Most graduates (64%) believe it is practical to maintain clinical practice in both specialties. 1

Essential Training Components

Technical Skills Integration

• Emergency ultrasound training is mandatory, requiring at least 25 documented and reviewed cases in each core application during the 3-4 year emergency medicine component. 5
• Programs must include both didactic lessons and hands-on skill sessions with quality assurance programs. 5

Educational Infrastructure Requirements

• Structured curricula with both didactic and bedside teaching are essential, along with formal evaluation methods for residents and faculty. 3
• Training must ensure comprehensive diagnostic and procedural skills across all age groups and clinical settings. 3
• Programs should utilize collaborative team structures where experienced physicians supervise developing residents, similar to critical care training models. 3

Potential Drawbacks and Considerations

Time Commitment

• 5-year training duration represents 1-2 additional years compared to categorical programs in either specialty alone. 3, 4
• The extended training period delays independent practice and income generation, though graduates report this is worthwhile. 2

Practice Pattern Realities

• Despite dual training, over half of graduates ultimately practice primarily or exclusively in emergency medicine, suggesting some may not fully utilize their internal medicine training clinically. 1, 2
• Only 7% practice internal medicine or IM subspecialties exclusively, indicating EM tends to dominate career trajectories. 1

Program Availability

• Limited number of combined programs exist (currently 5 types of combined EM programs), restricting geographic options for training. 4
• Programs require adequate, predictable, and stable funding sources, which may limit expansion. 5

Scope Considerations

• While 64% believe dual practice is practical, this means over one-third find it challenging to maintain competency in both specialties simultaneously. 1
• The changing healthcare landscape and increasing subspecialization may make it difficult to maintain expertise in both broad fields over time. 2

Common Pitfalls to Avoid

• Don't assume dual training guarantees dual practice: Many graduates ultimately focus on one specialty, so applicants should carefully consider their long-term career goals. 1, 2
• Avoid underestimating the academic commitment: The majority of graduates work in academic settings, so those seeking purely clinical community practice may find fewer role models or opportunities. 1, 2
• Don't neglect fellowship planning: With 31% pursuing fellowships, applicants should consider whether additional subspecialty training aligns with their goals before committing to 5 years of residency. 2