As a new member of the ALiEM team, I am joining Dr. Salim Rezaie as the second member to be board certified in both Emergency Medicine and Internal Medicine. Since 2006, I have been asked numerous times, “Why EM/IM?” My answer is simple: I like both. But five years of residency and not be a surgeon? What can you do with this type of training?

1. Katz ED, Katz JT. Careers of graduates of combined emergency medicine/internal medicine programs. Acad Emerg Med. 2002 Dec;9(12):1457-9. PMID: 12460856

This was a questionnaire of 28 EM/IM graduates in 1998. While most practiced EM exclusively, 30.4% practiced both EM and IM, and 43.5% worked in administrative positions. Common reasons for doing the combined program included becoming a better physician, practicing in both fields, and becoming better prepared for an academic career.

CONCLUSION: These graduates exhibited high satisfaction with residency and career choice.

2. Kessler CS et al. Combined residency training in emergency medicine and internal medicine: an update on career outcomes and job satisfaction. Acad Emerg Med. 2009 Sep;16(9):894-9. PMID: 19673705

This was another survey of 163 EM/IM graduates from 1998-2008. Similar numbers were found as Katz et al regarding practicing EM or EM/IM. It was noted that 72% practice in an urban environment, 60% in academics. Interestingly, 88% would complete EM/IM training again.

CONCLUSION: Dual training provides opportunities in multiple environments, particularly academics.


Here are my thoughts.


  • Being IM trained, you know what happens in the office setting and upstairs. You understand why a patient is on a particular medication, and what the next step is after admission. This allows easier transition of care and potentially shorter lengths of stay if some things can be started earlier.
  • Being EM trained on the floors, a sick/crashing patient is easy for us to manage. Procedures are our forte.
  • You are open to pursue all of the fellowships available to both EM and IM.


  • It IS five years of training with twice as much material to know and learn. Fortunately much of EM is IM based and so there is overlap.
  • You have to sit and pay for two board certification exams.

Am I happy with my choices? Yes.

Would I choose this path again? Absolutely.

I have been set up to take any path I choose, whether it is academics, community-based, or administrative. Actually, I currently do all three. I am able to communicate with all parts of the hospital. Plus, I rarely get any pushback from a consultant once they know my background. Just something to think over.

Matt Astin, MD

Matt Astin, MD

ALiEM Guest Contributor
Clinical Assistant Professor of Emergency/Internal Medicine
Mercer University School of Medicine
Houston Medical Center (Warner Robins, GA)