I am an EM resident and have a good friend that is EM/IM. I can answer a couple of the questions, and like all of these sorts of questions, be prepared to get different answers from different people. I would also recommend that you pop over to the EM forum and use the "search" engine to find this topic discussed numerous times in the past.
General: EMs history (although not very long) is rather convoluted and interesting - thus the present array of 1-3, 2-4, 1-4, EM/IM, EM/peds, etc. From what I am told, there used to be more EM/IM programs around, but many of those have faded away - I am sure other people can have opinions as to why that was. EM/IM programs are 5 year programs. Most of their formats are something along the lines of 3 months EM, 3 months IM, etc.
Competitiveness: These programs are less competitive than the competitive EM programs and more competitive than the less competitive EM programs. Translation: they are somewhere in the middle of the EM spectrum. EM/IM people will talk about how few spots there are to attest to their competitiveness, but you should realize that most people applying in EM simply do not find these programs very desirable. It is very self-selective.
Residency experience: What I have heard from many EM/IM people is that for the first 3 years of their residency, they feel constantly behind their peers both in the ED and on the floors. The changing back and forth is disorienting, and you cannot deeply study both fields at the same rate as either EM or IM residents. As they enter PGY-4, they actually feel like seniors, Then as PGY-5, they are the "studs" in the ER and on the floors, as they have more years of training than any other residents.
Career: My friend who is EM/IM really made the decision based on an enjoyment of internal medicine but with the notion that he would become an emergency physician. He wanted the extra training. Most people do end up becoming emergency physicians (I think it's because medicine is boring
), but there are those rare exceptions that go on to do cardiology fellowships, have their own clinic, or some other random permutation. There have been studies done on the preparation of EM/IM programs vs. EM programs (I don't have a link to it - I read a paper copy in medical school). What I remember it showing was that EM/IM people generally function at the same level as 1-4-trained people (and above 1-3 trained) until about 6-12 months out of residency. After that, it's a level playing field.
Hope this helped.
