Emergency Medicine/Internal Medicine

Combined training in internal medicine (IM) and emergency medicine (EM) is currently offered at eleven institutions for graduate medical education in the U.S. After completing the five-year integrated training, graduates are board-eligible in both internal medicine (ABIM) and emergency medicine (ABEM). An optional six-year EM/IM critical-care track is available at a few of the EM/IM training sites (those with ** below), which residents may opt into later in their training.

Many exciting career opportunities are available to graduates of these combined residency programs. Most graduates pursue careers in academic medicine, international medicine, rural medicine, or take on a variety of leadership roles. Some graduates complete fellowship training in either IM or EM sub-specialties. Although many early EM/IM graduates practice primarily one of the two specialties, EM/IM graduates now are increasingly able to practice both specialties in some capacity. Some work as hospitalists, splitting their time between the wards and the ED. Some run observation units adjacent to the ED, while others pursue careers in critical care. It is important to get an idea of what your career goals are to know which programs would best align with your goals. You will see that certain programs have better exposure to outpatient medicine or observation medicine while others have great exposure to critical care. Knowing what your goals are will help you ask the right questions along the interview trail to ensure a specific program is going to be a good fit.

The most important initial questions to ask when considering a combined program are, “How would this type of program help me achieve my career goals? Why is it worth five years of training?” Realize that it is generally not advisable to pursue EM/IM training only to be a “better” emergency physician or internist. It is highly recommended to get advice from EM/IM residents and our own program director, Dr. Michael Winters  , as well as EM Program Director Dr. Michael Bond .

Each EM/IM program has its own strengths and weaknesses. Some important considerations for you may include: How balanced are the EM and IM departments and training? Are EM/IM grads able to practice both specialties at this institution? How much focus is placed on outpatient internal medicine? How much experience do I get with observation medicine? How good is the critical care training (patient acuity, how many months spent in an ICU, etc.)? How is the relationship between the departments? As with any residency, personal fit, location, university vs. community hospital, patient acuity/diversity, and research or international opportunities should also be evaluated closely.

Letters of Recommendation: Typically most programs require two EM letters and two IM letters. This can vary depending on the program so please check each programs website for specific requirements. The EM letters should be a SLOE and if you did an EM rotation at another institution you should get a SLOE from there. One of the IM letters should be a letter from the Internal Medicine Department Chair. Usually if you are applying for categorical EM or categorical IM you can use the same letters for those programs as well. However, if you do this you may want to ask your letter writers to write two separate letters. One that describes your interest in the combined program and one that expresses your interest in the categorical program you are applying to. This can be helpful for your categorical program interviews so it isn’t obvious that you are applying to categorical programs as a back-up. Interviews: One quick note about interviewing. Going on interviews for combined programs and categorical programs can be challenging when trying to switch over your mindset so you can express interest in the specific program. It is often an uneasy feeling on categorical interviews if they know you are only applying to their program as a back-up. That being said, it is absolutely essential to be honest with your categorical programs if they ask you. Tell them your interest in the combined programs and that your passion/interest sways toward whichever categorical program you are applying. As long as you are honest and explain your reasoning and career goals I don’t think categorical programs will count this against you if they know. So I will say this again, be completely honest with them if they ask you.

Away Rotations: Several of the combined programs offer a medical student combined (EM/IM) away rotation. This is not required but can be helpful for meeting the leadership faculty and getting your foot in the door to a place you are interested in. However, if you are applying to EM categorical programs you will still need to do an EM away rotation separate from this. Please read the EM section for more information on the EM application if you are applying to EM categorical programs.

Personal Statement: You will have to write two personal statements. One for the combined programs and one for the categorical programs that you are applying to. These should be different, although, they can overlap a little bit in their content.

With only 11 active programs in the country that typically have 2 spots per program (a few have 3 or 4), matching in EM/IM remains competitive. You must have a backup plan, be it EM, IM, or another specialty. Most EM/IM programs will only require you to come for one interview day and will count that interview for categorical EM at their institution as well. Be sure to read through the EM section in this handbook for good advice on planning away rotations and the importance of the SLOE in EM. You will want to plan ahead to the extent possible in order to fit everything you need into those key early months of fourth-year. In the meantime, work hard, determine what you want, and sell your vision of an EM/IM career.

• University of Maryland**
• Christiana Care Health System
• Vidant/East Carolina University/Pitt Co. Memorial**
• LSU Health Sciences Center
• SUNY Downstate-Kings County
• Hofstra/Long Island Jewish Medical Center**
• Henry Ford Hospital**
• University of Illinois Chicago
• Hennepin County Medical Center**
• Virginia Commonwealth University Medical Center
• Ohio State University

For more information or questions contact Jordan Parker.

Last Revision: February 21, 2019