Dually trained EM/IM residents are able to confidently face acute illness and injury as well as chronic disease in the ED, the ICU, on the wards and in the clinic. EM/IM residents have the unique opportunity to integrate the knowledge base and skill sets of both specialties into their daily practice. Many “combined” residents feel that their internal medicine exposure helps them to better understand the pathophysiology of medical patients seen in the ED. EM/IM doctors can confidently manage emergency situations in internal medicine settings and are able to take care of the minor surgical problems of their medical patients as they would in an acute setting like the ED.
Critical care medicine is a popular field for EM/IM physicians and is the most common IM fellowship pursued by EM/IM residents. The high acuity care provided in the ED and in the ICU is complementary and a career working in both settings can provide many challenges and rewards. Additionally, EM/IM trained physicians with board certification in both IM and EM are ideal candidates for leadership roles in the growing field of observation medicine where efficiency and continuity of care must be balanced.
Dually trained physicians are uniquely equipped to be systemic problem solvers and leaders in managing administrative issues because they have trained in almost every hospital setting and have worked with nearly every specialty. Dual board certification highlights commitment and EM/IM training enhances leadership abilities – both essential elements of a successful career in academic medicine and the key to successful administration. Collaborating with residents in different programs and learning how to share the knowledge of both specialties are important experiences which help to become a successful educator and mediator.
EM/IM training also leads to a unique understanding of the particularities of the patient population typically seen at Veterans’ Affairs medical centers. These patients often suffer from acute exacerbations of their multiple and chronic medical issues, and the emergency care therefore benefits from the knowledge of both specialties. Working with emergency patients in this setting means less exposure to trauma or pediatric cases. But the integration of internal medicine considerations into the clinical management of these patients is a very demanding task for which dual training offers excellent preparation.
Dually trained physicians are also well suited for work in international medicine. In areas with few resources, the ability to manage both acute and chronic problems is essential. The adaptive and innovative skills enhanced by five-years of combined training are particularly useful in the often difficult or make-shift conditions faced in international and disaster medicine.