There are a number of different types of combined residencies. For example: EM/IM, EM/IM/CC, EM/FM, Med/Peds, Med/Psych. In general, each combined program fulfills all the requirements of each individual specialty by integrating all essential components into one longer residency.

 

EM/IM – Emergency/Internal Medicine

Internal Medicine residency programs generally last 3 years. Emergency Medicine programs come in two flavors – 4 years and 3 years (the majority of US programs are 3 year residencies). Adding the two together you would expect to end up with a 6 year program. However, due to some overlap between the requirements for these two specialties (think ICU time, some ER time, some electives) EM/IM residency programs take only 5 years.

EMIM residencies all handle scheduling somewhat differently. In general, we  strive to minimize abrupt jumps from EM rotations to IM rotations. Some programs switch every 3 months, others do it differently. At the Zucker/Northwell Health EMIM Program we recently converted to an 8+2 cycle for the PGY 2, 3, and 4 years. PGY1 and PGY5 are scheduled on a usual 4 week block schedule, with the aim of batching IM time and EM time as much as possible. We also allow residents flexibility to modify their schedules as needed to accommodate projects, research, etc. During the middle years (PGY 2 – 4 ) our residents are scheduled for 2 weeks of clinic every 8 weeks. This means that, if the first hemiblock of the year is 2 weeks of clinic, it will be followed by 8 weeks of other stuff. For example: 2 weeks vacation, 4 weeks floors, 2 weeks Ultrasound (Total = 8 weeks). Then the resident would have 2 weeks of clinic, followed by 8 more weeks of other rotations.

This novel scheduling solution allows for some predictability and regularity, ensures that we meet all training requirements including ambulatory medicine, and eliminated the need for EMIM residents to attend to clinic while also covering inpatients on the wards.

 

EM/IM+Critical Care

All of our residents have the option of transferring to the 6 year, triple board, EM/IM/CC residency program as long as they meet academic requirements. The transfer occurs at the end of PGY3 and all residents must commit by December of their PGY3 year.

This integrated residency allows physicians to meet all the requirements for the EM, IM, and Critical Care specialty boards. Graduates generally take (and pass) all 3 board exams. Our EM/IM program is weighted towards critical care and thus our CC residents are able to complete the additional required ICU training in their PGY5 and 6 years primarily. Critical Care training takes place primarily at our main training sites, but our CC residents also rotate through our community based ICU’s and Northwell’s eICU (telemetry ICU).

 

Combined Training IRL

Many EMIM graduates end up practicing EM only. There are also those who find split positions combining both EM and IM. Others have gone in to Observation Medicine, a natural fit for EMIM docs. Over the last 10 years most of our residents have chosen to pursue the EM/IM+CC program. Those grads have mostly found split positions so that they spend half of their time working in the ICU and half of their time working as an ER doc. Some EM/IM grads pursue fellowships (Dr. Allison Walker is now starting her Palliative Care fellowship, one of our grads went on to Allergy and Immunology). Many end up in leadership positions.