Since 1991, these 5-year combined programs have prepared medical students for a career in both acute and chronic medicine. Training lasts for 30 months in each area and includes the minimum requirements for that specialty. Internal medicine-emergency medicine (IM-EM) specialists can treat a broad spectrum of disease and injury that range widely in presentation-acute, nonurgent, emergent, and chronic. They are experts in the diagnosis, treatment, and rehabilitation of all kinds of patients.
Is it possible for internist-emergency medicine physicians to practice both fields? After all, their work schedules are rather different. Internists typically spend their days in a clinic and on-call overnight, whereas emergency doctors work varying shifts — whether days, afternoons, or nights. A recent survey of graduates found that most (65%) are active in emergency medicine only, and 30% still practice both fields.9 They are all highly satisfied with their careers. Those who do integrate both specialties well balance a part-time emergency department schedule with shifts on the wards as hospitalists. Instead of spending time in clinic, hospitalists are internists that work 12 to 24 hour shifts as inpatient physicians. In the same survey, most IM-EM specialists identified the academic teaching hospital as their primary clinical setting. Here, several are directors of observation units for patients under consideration for admission to the wards from the emergency room.
Although most graduates believe that their combined training provided excellent preparation for the clinical practice of emergency medicine, most (93%) felt it was only marginal training for the practice of internal medicine.10 These results perhaps indicate that most students entering this combined program are more motivated to become emergency medicine physicians than internists.
In the 2002 National Resident Matching Program, 81% of the 21 IM-EM positions were filled.
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