Pro and Cons of a combined EM/IM residency

If I had the chance to get into such a program I'd borrow a couple of extra hands so that I could grab this chance with 4 hands. Get it?

I can't think of anything more interesting. EM/IM is definitely the most challenging residency I can think of.

Speaking as one who hasn't yet started his EM residency, and one who will never do an IM residency, my advice is worth a little less then it costs, but here goes:

EM/IM folks really seem to know their stuff through & through. They cover the two opposite ends of the continuity spectrum, and occasionally are able to apply knowledge from each end to the other. Good for them.

I considered doing the combined residency thing until I realized a few things:

1a-I want to be an EM Doc.
1b-I do NOT want to be an Internist.
1c-One can be a great EM Doc without ever doing an IM residency.
Taking these together I realized that a combined EM/IM residency would equate to little more than two years of mental masturbation for me. I aint knockin IM here - it's just not for me. And I aint knockin mental masturbation either, I'd just rather ruminate on Relativity, Wittgenstein, or Punctuated Equilibrium than IM.

2-Those who are great at what they do are usually, if not always, focused on it.
The day of the Renisance Man is behind us. Our body of knowledge is simply too large for any person to master it all. As such, I think that, while an EM/IM person is likely to be quite able to flex his/her knowledge on rounds & really impress those M3's, one who practices two fields will be less strong in either than he or she would be if his or her efforts were focused on a single field.

3-One of the main benefits of EM/IM is the academic doors that it opens. I don't want to do academics (thank goodness there are others who do!), so the pay-off just wasn't there for me.

4-EM/IM residencies include about two extra years of rounding - 'nuff said.

But if you feel differently about IM than I do, then your views might be in stark contrast to mine. In fact, they almost certainly are.

I don't understand EM/IM. I mean, I understand what it is, but I don't really get why it exists. For me, many of the reasons I want to do EM are the same reasons that I don't want to do IM. In fact, with few exceptions, I don't understand combined programs at all, because I don't know of many people that actually use the training they receive from BOTH fields. Now, if there were a Med-Surg combined program, I'd be all for it, but only because I could refer pts to myself and then charge for an initial visit and a consult, as well as the procedure 😉

Being 50-60 years old and working 5 shifts a month will be fine with me...vs being 50-60 years old and working 5 days a week in a god-forsaken clinic doesn't sound all that appealing. And unless you plan on practicing IM to some extent during your youthful years, good luck keeping your board certification up to date.

Several of the EM attendings I've talked to here say this: Those who do EM/IM generally end up doing either one or the other. So while there may be a lot of cross-knowledge, at least some portion of that training will end up being wasted.

Also, with regard to burnout: These same very reputable attendings tell me that this phenomenon was much more common before there were a significant number of EP's around. It stands to reason that the FP/IM/moonlighter person covering the ED would burn out doing something they weren't trained to do. Among residency-trained EP's, though, I'm told that the burnout rate is not signficantly different from other fields.

I also considered this and went with IM. In the end I think I want to be an intensivist when I grow up, I dislike doing women's medicine, and I really don't like peds. So if I don't want to deal with gyn stuff and I really don't to deal with sick children and I want to be "board certified" in cc, why would I want to do EM?

One of the renal fellows where went to school is a graduate of LSU's combined program. His goal is to get critical care certification after nephrology. So then he would be EM/CC with nephrology -- a pretty potent combo and fairly unique to aid in getting jobs. On the other hand he is bitter and does not seem to like the ED, maybe too many nights at Charity, maybe just his personality? But a couple of weekend shifts in the ED moonlighting at the VA pays more than he makes in a month as a renal fellow.