Question #1: I did an EM/Ped combined residency. Regarding potential redundancy in EM/IM, I will defer to another who went through that training track. I will mention thought that it appears a higher percentage of EM/IM go into academics (Acad Emerg Med Volume 9, Number 12 1457-1459). I am not sure if this is due to the training itself or whether it is due to the masochistic nature of a person who chooses a five year residency.

I trained via the EM/Ped residency that is also five years (equally masochistic). My argument for this training is simple. I prefer to care for kids but don’t mind caring for adults, I prefer to work in an emergency setting and I didn’t want to give up either. I also wanted the lifestyle, job opportunity and academic opportunity that EM allows. Currently I am a faculty member in a Dept of EM but I also have a joint appointment in a Dept of Peds. I am one of the PedEM specialists of my group and organize the pediatric emergency curriculum.

So, you ask, would I have gone through the combined program if I had it to do over again? Heck yes! It got me were I am now. I will refer you to an article just out in JEM, Feb 2007: this article shows that graduates of EM/Ped combined programs are actively practicing in both fields. This opposed to EM/IM and IM/Ped who tend to chose one specialty over the other. (for full disclosure sake, I wrote this article).

How combined EM/Ped training compares to the fellowship of Pediatric Emergency Medicine is another very long topic that I will not belabor now.

Question #2: I am not familiar with the Internist/surgeon models since I have never worked in a facility of such. Suffice it to say, my understanding is that these are diminishing fast. My personal opinion is that this type of model would not work in our department (or ED’s that I have worked in the past). Not to toot my own horn but I do not know of another specialty who is as broadly trained as EM (save Family Medicine: note that it is FM, not FP -just keeping you up to speed on the jargon). EM is truly a “Jack of all Trades”. IM-great training and excellent for the adult medical emergency but what are they going to do with the Pediatric case? OB case? Gyn case? Difficult airway? You can make a similar arguement with surgery.

To be fair though, along with the Jack of all trades comes the “master of none.” I am fine with that-hence why I am happy with my specialty. I would argue a rebuttal though (this will be my last personal opinion), I do have a specialty! My specialty is Emergency Medical Care: I am specifically trained to take care of emergencies of ALL KINDS which is what IM and Surgery does not universally have.

How much of an advantage do you see in doing an EM/IM double residency for someone who wants to be an ER doctor? It seems that the added profundity in medicine could only be helpful, but perhaps that can be had on the job without dragging out residency to five years.

Also, what do you think of ERs that are run on the Internist/Surgeon staffing model rather than the ER-doc staffing model? What about a hybrid of the two?

Regarding moving to a larger city… Simple salary alone would not drag me to a larger city. You not only have to be happy where you work but also where you live. I am not a big city kinda guy.

Regarding benefits/disadvantages… I don’t see there would be much of a difference. I currently work at a Level 1 trauma center which is the tertiary care center for our area.