Emergency medicine/internal medicine (EM/IM) residency programs are an emerging option that allows residents to become dually board-certified after 5 years of training. Since the approval of EM/IM in 1989, 12 EM/IM programs have been founded in the United States. EMRA Immediate Past President Ricky Dhaliwal, MD, JD, former EM/IM Chief Resident at Hennepin County Medical Center in Minneapolis, was kind enough to speak with me about his experience in residency.
When did you decide you were interested in emergency medicine?
I knew by middle of third year. I enjoyed everything, but after one EM rotation, realized it was the right choice. I like to have a lot of different things going on and to see the patient first - when their history is a blank slate.
What has been one of your favorite aspects of your residency program?
I have been amazed by the amount the faculty teach and how much knowledge they have. Also the opportunities we have at our hospital: managing airways, managing trauma, and being autonomous. Combining the faculty and autonomy makes for an amazing resident experience.
What kind of applicant may want to consider a dual residency in EM/IM?
There are the people who have an interest in the ICU. There are EM tracks to critical care, but your basis for understanding the discipline is stronger when you have an IM background.
If you're interested in rural settings, there are many opportunities for you to work as an IM physician, but also in the ED. In a lot of small towns, that background is exactly what would benefit their communities.
In international medicine, going abroad and being able to understand the complicated medical problems you see while actively managing procedures allows for opportunities to help people on a wider scale.
Finally, [EM/IM might be right for someone] interested in an administrative position - being able to understand the hospital in a way that an EM person in their silo or an IM person in their silo wouldn't.
Those are just a few; the opportunities are endless.
What advice would you give to medical students interested in EM/IM combined residency programs?
First, have a clear understanding of why you want to do it; you have to be comfortable with the fact that you're going to be in training for longer than your colleagues, and it's important to consider the trajectory of your career. I also recommend reaching out to EM/IM folks at conferences to ask questions, or rotating in a setting where you can see how the combination works.
Is there anything else you would like to add about EM/IM programs?
If you look at the way the hospital systems are working, everything is becoming less of a silo. There is an acute care continuum with EDs, hospitals, and ICUs so the skill set of an EM/IM physician is going to be very useful to a health care organization now, and even more so moving forward with increased efforts to streamline and improve quality of care.