@chocomorsel
I agree with you and hope we will be morphing toward more departments of multidisiciplinary critical care. there are a few caveats I'd add to the EM/CCM side of things though:
1. Certain things are definitely easier if you do IM or Anesthesia CCM compared to EM/CCM. With regards to training, I think acquiring an CCM fellowship in general is probably more competitive if you're coming out of EM/CCM (re IM: some very good programs prioritize EM fellows, most don't give a ****; same with anesthesia. The other issue you have to deal with anesthesia is going through the hassle to see if they even fund the second year of training).
2. There are some shenanigans with some of the EM/CCM training tracks from the anesthesia side - anesthesia-CCM programs are 1 year in length, but it is two years for EM/CCM fellows. Some programs "fund" the second year by having you Ed shifts. Even BWH's IM-CCM program does this, but in general it'll be more rare on the IM side of things as most of those programs are funded for two years.
3. There is no credit towards a CCM fellowship if you end up doing a 4-year EM residency. So the 4th year, while being a good year to hone up your skills and lose $200k in earnings, is essentially a waste unless you're going to continue practicing EM.
4. EM and CCM - as I mentioned above, integrating the two fields is harder than I expected or was sold to me. Getting a split FTE where you aren't overburdened with nights and holidays is logistically tricky because both your departments probably won't speak to one another and they will prioritize their 1.0 FTE players. Many people I know just do CCM and work some extra EM shifts here and there. What I've heard that in general it's the rare person that practices both specialties after 5 years due to the above issues. I've seen this happen in the vast majority of cases with most of the attendings I worked with as a trainee.
5. Skill Overlap - I think there is less overlap between the two fields than I thought. A small fraction of EM involves the care of the critically ill. You aren't going to be doing orthopedic reductions, taking care of children, doing complex laceration repairs, etc. as an intensivist. It's not to say the broad skillset isn't useful to have going into CCM, but going back to EM after you've been an intensivist and being able to wield those skills at a high level is a very difficult thing (unless you're an attending and can punt all of this to residents or if you don't need to see kids, for instance).
A question for the anesthesia/EM intensivists here - do any of you guys split your time or do you work 100% CCM?