Ultimate Guide for DO Graduates: Researching Emergency Medicine-IM Residencies

Understanding the Landscape: EM-IM Combined Programs for DO Graduates

Emergency Medicine–Internal Medicine (EM-IM) combined programs are a small, highly focused niche, which means your program research strategy must be deliberate and organized. As a DO graduate, you have additional considerations: how osteopathic-friendly a program is, how they view COMLEX vs USMLE, and where EM-IM graduates tend to practice afterward.

Before you dive into spreadsheets and websites, clarify three things:

1. Your goals

   • Do you see yourself in academic medicine, community practice, critical care, hospital administration, global health, or rural leadership?
   • Do you want to practice full-time emergency medicine, internal medicine, or truly hybrid roles?

2. Your constraints

   • Geographic preferences (family, partner, cost of living, specific regions).
   • Visa needs (if applicable).
   • Financial realities (moving costs, travel for interviews, rotation access).

3. Your identity as a DO graduate

   • Are you applying with COMLEX only, or COMLEX + USMLE?
   • Do you prefer programs with a strong history of DO graduate residency training and osteopathic residency match success?
   • Are you open to both EM-IM combined and categorical emergency medicine internal medicine tracks separately (EM alone or IM alone) as backup?

Having these answers informs how you evaluate residency programs and what criteria matter most when you begin your research.

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Step 1: Build a Master List of EM-IM Programs and Osteopathic-Friendly Options

Your first task is to know where you can apply. Because EM-IM combined programs are limited in number, every program counts.

1. Use Official Databases and Directories

Start with these sources:

• FREIDA (AMA Residency & Fellowship Database)

  • Filter by:
    • Specialty: “Emergency Medicine–Internal Medicine” or “Combined Specialties”
    • Track: Categorical vs Combined
  • Note:
    • Program name
    • ACGME ID
    • Location and associated hospitals
    • Program length (typically 5 years)
    • Number of categorical positions per year

• ERAS & NRMP Directories

  • ERAS: Check the list of participating EM-IM programs each cycle.
  • NRMP: Use the “Results and Data” reports to see:
    • How many positions each EM-IM program offers
    • Fill rates and whether DOs matched there in recent years

• Program Websites

  • Cross-check information you find in directories:
    • Some combined tracks are housed under EM or IM departments.
    • Some institutions may have both EM-IM and IM-EM designations or additional special tracks (e.g., EM-IM-Critical Care).

2. Identify DO-Friendly Programs

As a DO graduate, you should pay close attention to how programs view osteopathic training.

Look for:

• Historical DO presence

  • Residency class photos: Are DO residents visible in current or past classes?
  • Resident bios: Count DO vs MD degrees across PGY-1 to PGY-5.

• Program statements

  • Phrases like:
    • “We welcome applications from DO graduates.”
    • “We accept COMLEX in lieu of USMLE,” or “USMLE strongly preferred.”
  • Any explicit mention of osteopathic manipulative medicine (OMM) clinics or osteopathic recognition (less common in EM-IM, but relevant if you value it).

• NRMP and individual program data

  • Some NRMP reports will state DO vs MD match statistics by specialty.
  • Program websites or social media may highlight DO success stories.

If a program shows a consistent pattern of DO graduate residency participation, it’s more likely to be supportive of osteopathic backgrounds and may be a stronger target.

3. Include Backup Categorical Programs

Because EM-IM combined spots are limited, create parallel lists:

• List A: EM-IM combined programs
• List B: Categorical EM programs that are DO-friendly
• List C: Categorical IM programs that are DO-friendly

You’re not diluting your focus—you’re protecting your chances in the osteopathic residency match and creating more paths to a career in emergency medicine internal medicine–type practice (e.g., hospitalist + ED moonlighting, EM with strong medical complexity, or IM with critical care).

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Step 2: Define Your Evaluation Framework and Criteria

Now that you have a list, you need a system for evaluating residency programs. Don’t just rely on reputation or hearsay. Create a structured framework to compare programs on what matters to you.

Core Categories to Compare

Use a spreadsheet or note-taking app with columns for each of these categories:

1. Program Structure & Curriculum

   • Number of months in EM vs IM over 5 years
   • Unique rotations (e.g., ultrasound, critical care, toxicology, EMS, global health, hospitalist tracks)
   • EM-IM–specific features:
     • Dedicated EM-IM conferences or retreats
     • EM-IM faculty advisors
     • EM-IM continuity clinic model (how they integrate both disciplines)

2. Clinical Training Environment

   • Emergency Medicine side:
     • ED volume (annual visits) and acuity (trauma level, tertiary vs community)
     • Patient mix (urban, suburban, rural; underserved; diversity)
     • Number and type of ED sites (main academic ED, community affiliates, VA, etc.)
   • Internal Medicine side:
     • Inpatient vs outpatient balance
     • Exposure to subspecialties (cards, pulm/crit, neph, ID, heme/onc)
     • ICU exposure and autonomy

3. Culture & Support for EM-IM Residents

   • Are EM-IM residents fully integrated or treated as “in-between”?
   • Do they have mentorship specifically for dual-training career paths?
   • Is there protection from over-service or schedule conflicts between EM and IM rotations?

4. Osteopathic Friendliness

   • Historical DO match rate
   • Faculty with DO backgrounds
   • Explicit acceptance of COMLEX-only applicants (if relevant)
   • General attitude toward osteopathic training (gleaned from website, open houses, and resident conversations)

5. Outcomes & Career Paths

   • Fellowship match (critical care, cardiology, ultrasound, toxicology, administration, etc.)
   • Graduates in:
     • Academic EM or IM
     • Combined hybrid roles (e.g., 50% ED / 50% inpatient or ICU)
     • Community practice vs tertiary centers
   • Leadership positions (ED director, Chief medical officer, Program leadership)

6. Logistics & Lifestyle

   • Geographic location, cost of living, commute
   • Schedule structure (block vs X+Y models on IM side; EM shifts and shift length)
   • Wellness resources and support (especially crucial in a 5-year, high-intensity combined program)
   • Moonlighting policies for EM-IM residents and when allowed

7. Competitiveness & Fit

   • Typical board scores and academic profiles of current residents
   • Number of applicants per spot (if shared)
   • Whether they prioritize research, leadership, community service, or prior clinical experience

Weighting Your Priorities

Not all factors matter equally. To create an effective program research strategy:

1. Rank each category from 1 (low importance) to 5 (high importance).
2. For each program, score them (1–5) on each category based on your research.
3. Multiply category weight × program score to generate a rough “fit score.”

This is not a strict formula but forces you to clarify your values and see patterns, especially when comparing dozens of programs.

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Step 3: Deep-Dive Research: How to Research Residency Programs Effectively

Once your framework is set, it’s time to engage in detailed, targeted research.

1. Program Websites: What to Look For (and What’s Missing)

Most applicants skim; you should read critically:

• Curriculum pages

  • Detailed rotation schedules for each PGY year
  • How EM and IM rotations alternate or integrate
  • Required versus elective rotations
  • Unique EM-IM tracks (e.g., combined critical care pathway, ultrasound emphasis)

• Resident rosters and bios

  • Count DO residents and note their prior schools.
  • See what residents highlight: research, global health, teaching, advocacy.
  • Look for EM-IM alum pages showing current jobs and fellowships.

• Program director messages

  • Tone and priorities: Are they emphasizing education, service, research, wellness, or numbers (RVUs, volume)?
  • Mentions of EM-IM specifically: Is it an afterthought or a proud highlight?

Remember: websites are marketing tools, often out of date. Use them as a starting point, not your final source of truth.

2. Virtual Open Houses, Webinars, and Q&A Sessions

Nearly every EM-IM program now runs:

• Pre-application webinars
• Specialty interest nights
• Combined program info sessions

Use these sessions to:

• Ask DO-specific questions, such as:
  • “How have DO graduates performed in your program?”
  • “Do you accept COMLEX-only scores for EM-IM applicants?”
• Clarify combined-training logistics:
  • “How do you coordinate EM and IM schedules to minimize burnout?”
  • “Do EM-IM residents feel fully supported by both departments?”

Take notes immediately after each event and record impressions of culture:

• Did residents seem tired, supported, enthusiastic, or neutral?
• Did EM-IM residents speak up, or only categorical EM/IM residents?

3. Social Media and Online Presence

Programs use:

• Twitter/X
• Instagram
• YouTube
• Occasionally podcasts or blogs

Look for:

• Day-in-the-life posts featuring EM-IM residents
• Educational content: journal clubs, ultrasound teaching, case conferences
• Diversity and inclusion efforts
• Resident camaraderie and wellness events

Treat social media as anecdotal, but useful for sensing culture and energy.

4. Objective Data Sources

To avoid reliance solely on impressions:

• NRMP “Charting Outcomes” & “Program Director Surveys”

  • Gauge competitiveness in EM, IM, and combined specialties.
  • Learn how PDs weigh COMLEX, USMLE, SLOEs, research, and communications skills.

• Hospital Quality & Volume Metrics

  • Trauma level, magnet status, tertiary/quaternary referrals.
  • Community vs academic mix—this shapes your clinical exposure.

• Fellowship Match Lists

  • Ask or look for EM-IM–specific outcomes:
    • “Where did our EM-IM graduates match for fellowship?”
    • “How many went into critical care, cardiology, ultrasound, administration, etc.?”

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Step 4: Networking and First-Hand Intel: Beyond the Website

Some of the most valuable information comes from people actually in those programs.

1. Talk to Current EM-IM Residents

Current EM-IM residents are your best resource. When possible:

• Find them via:
  • Program website bios
  • LinkedIn or Doximity
  • Social media (Twitter/X, Instagram)

Politely message them with specific questions, for example:

• “As a DO graduate, did you feel fully integrated into both departments?”
• “How well is the EM-IM schedule structured to avoid conflict and burnout?”
• “Do you feel the program genuinely supports dual-career goals, or do you feel pulled more toward EM or IM?”
• “What surprised you about the program after you arrived?”
• “What would you change if you could?”

Respect their time: keep messages concise and focused, and thank them.

2. Seek Input from EM and IM Faculty Mentors

Even if your school doesn’t have an EM-IM program, you likely have:

• EM faculty who know the EM landscape and combined training’s reputation
• IM faculty who can speak to the quality of internal medicine departments at those institutions

Ask:

• “Which EM-IM programs have strong internal medicine and emergency medicine reputations?”
• “Have you worked with or trained any EM-IM graduates from X program?”
• “From your perspective, how does this program treat DO graduates?”

Their perspective can help refine your program research strategy and highlight hidden gems.

3. Use Away Rotations Strategically

If you have the chance to complete an away rotation:

• Prioritize EM-IM institutions if possible, even in categorical EM or IM settings.
• Goals of an away rotation:
  • Get a sense of ED culture and IM culture at that institution.
  • Understand how learners are treated at different levels of training.
  • Earn strong SLOEs (Standardized Letters of Evaluation) in EM settings.

During rotations, silently evaluate:

• Are residents and attendings teaching-oriented?
• Are EM and IM departments collaborative?
• Do they speak positively about EM-IM residents and graduates?

Away rotations also help you answer the question of “Can I see myself living and training here for five intense years?”

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Step 5: Synthesizing Information and Building Your Program Strategy

By now, you’ll have lots of data. The key is turning it into a clear application plan.

1. Tier Your Programs

Based on your evaluation framework, categorize programs into:

• Tier 1: Ideal EM-IM programs

  • Strong EM and IM departments
  • EM-IM culture is robust and supportive
  • DO-friendly with history of osteopathic residency match success
  • Outcomes align with your career goals

• Tier 2: Solid programs / geographic or lifestyle fits

  • Good training with some trade-offs (e.g., location, slightly less DO representation, fewer fellowships)
  • You would still be happy training there

• Tier 3: Reach or safety programs

  • Reach: Highly competitive, fewer DOs historically, but dream environments
  • Safety: Slightly less ideal clinically or geographically, but higher likelihood of interview/offers

Aim for a mix of all three tiers, balanced with your categorical EM and IM lists.

2. Identify Red Flags Early

When evaluating residency programs, particularly as a DO graduate pursuing a demanding combined specialty, note these warning signs:

• No or almost no DO representation, especially over many years
• Vague responses about support for EM-IM residents or how conflicts are resolved between departments
• High resident attrition or EM-IM residents switching out of the combined track
• Minimal or no EM-IM–specific mentorship
• Culture of overwork without support:
  • Residents discourage you informally
  • Frequent mention of burnout or toxic dynamics

Red flags don’t always mean you should not apply—but they should be weighed heavily in your decision.

3. Plan for Both EM-IM and Categorical Pathways

Because EM-IM is competitive and limited:

• Apply to a reasonable number of EM-IM combined programs (often all that align with your geographic and career constraints).
• Simultaneously apply to:
  • DO-friendly EM programs with strong internal medicine exposure and critical care opportunities
  • DO-friendly IM programs with strong critical care, ED interactions, or hospitalist tracks

This diversified strategy gives you multiple pathways to a career that resembles emergency medicine internal medicine practice, even if you don’t train in a formal EM-IM combined program.

4. Keep Updating Your Spreadsheet

As interview invitations and rejections come in, adjust your assessments:

• Mark programs that showed strong interest versus no response.
• After interviews, record:
  • Your gut impression
  • Resident morale
  • Clarity of expectations for EM-IM residents
  • How they spoke about DO graduates

By the time you create your rank list, your organized notes will be more reliable than vague memories.

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Practical Example: Applying the Strategy

Imagine you are a DO graduate with:

• COMLEX Level 1 and 2, plus USMLE Step 1
• One EM away rotation with a strong SLOE
• Interest in critical care and academic teaching

Your program research and selection might look like:

1. Build lists:

   • Identify all EM-IM programs in FREIDA and verify via ERAS/NRMP.
   • Cross-check which have DO residents and DO faculty.
   • Create parallel lists of 15–25 EM programs and 10–15 IM programs that are DO-friendly.

2. Review curriculum:

   • Highlight programs that:
     • Offer multiple ICU rotations
     • Have EM ultrasound and critical care electives
     • Show EM-IM graduates matching into critical care or cardiology

3. Engage with programs:

   • Attend EM-IM virtual open houses for each program on your Tier 1 and Tier 2 lists.
   • Ask specifically about:
     • Dual-board preparation support
     • DO performance and support
     • EM-IM–specific mentorship structure

4. Network:

   • Email 2–3 EM-IM residents per region (e.g., Northeast, Midwest, South, West) with concise questions.
   • Consult your home EM and IM advisors about the reputations of these programs.

5. Finalize application plan:

   • Apply to all aligned EM-IM programs (for example, 8–12).
   • Apply to ~20–30 EM programs and ~10–15 IM programs that fit your goals and scores.
   • Tailor your personal statement to emphasize why EM-IM suits you and how your osteopathic training prepares you for dual practice.

By taking this structured, data-informed approach, you’re not simply “hoping” the osteopathic residency match works out—you are strategically positioning yourself for multiple paths to an emergency medicine internal medicine career.

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Frequently Asked Questions (FAQ)

1. As a DO graduate, do I need USMLE scores to be competitive for EM-IM programs?

Not universally, but USMLE scores can help. Many EM-IM programs accept COMLEX alone, especially those with a history of DO graduate residency training. However:

• Some programs strongly prefer or require USMLE.
• If you already have USMLE Step 1 or 2, it may broaden your options.
• If you do not have USMLE, focus more on:
  • Strong COMLEX performance
  • Excellent SLOEs and clinical evaluations
  • Programs that explicitly welcome COMLEX-only applicants

Always confirm each program’s policy on COMLEX vs USMLE via their website or by emailing the coordinator.

2. How many EM-IM programs should I apply to?

Because EM-IM combined spots are limited, most applicants apply to all EM-IM programs that:

• Match their geographic constraints
• Are reasonably DO-friendly
• Fit their competitiveness profile

You should not rely solely on EM-IM programs. Complement them with a robust list of categorical EM and/or IM programs to build a safe and realistic match strategy.

3. How can I tell if a program is truly DO-friendly?

Look for multiple indicators:

• Visible DO residents across multiple classes
• DOs among faculty and leadership
• Clear website language welcoming DO applicants and acknowledging COMLEX
• Current or recent DO residents confirming positive experiences during your conversations
• Reasonable match history of DO applicants into that program or institution

No single data point is definitive, but consistent patterns across these areas signal a DO-friendly environment.

4. What if I don’t match into an EM-IM combined program?

You still have multiple routes to a career combining emergency medicine internal medicine–type practice:

• Matching into EM and seeking:
  • Critical care or ultrasound fellowship
  • Hospital administration or academic roles with strong medicine overlap
• Matching into IM and pursuing:
  • Critical care, hospitalist tracks, or ED-adjacent leadership roles
  • Moonlighting in EDs (where allowed after board eligibility)
• Reassessing and, in some cases, reapplying with enhanced clinical experience or additional research

A well-executed program research strategy, with both combined and categorical options, ensures you maintain strong pathways to your long-term goals even if the EM-IM match itself doesn’t go as planned.

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By approaching program research with structure, intentionality, and a DO-specific lens, you can confidently navigate the osteopathic residency match, identify the EM-IM programs that align with your goals, and position yourself for a fulfilling, dual-trained career.