Background: Critical care medicine (CCM) specialists' shortage is a well-known problem.In the past decade, emergency medicine (EM) physicians became trained in CCM through the internal medicine pathway.Objective: We point out the competence acquired by EM trainees, which makes them qualified to complete a CCM fellowship and the hurdles they faced to achieve it.Methods: This study reviews the Accreditation Council for Graduate Medical Education (ACGME) EM residency requisites and how they prepare for a CCM fellowship, discusses the requisites for the EM/CCM pathway, and reviews a recent retrospective analysis by comparing the scores obtained by EM/CCM on the Multidisciplinary Critical Care Knowledge Assessment Program (MCCKAP) as well as the American Board of Internal Medicine (ABIM) examination with Surgical Critical Care Medicine SCCM and Anesthesiology Critical Care Medicine (ACCM) fellows over a 10-year period.Results: During training, EM residents become proficient in the daily management of critically ill patients.They become certified in many procedures performed by CCM physicians.Despite this, pre-requisites of certain number of clinical rotations are required when they apply.A recent study compared scores obtained by EM/CCM on the MCCKAP examination with SCCM and ACCM over a 10-year period.EM/CCM fellows obtained higher scores (562.4,SD: 67.4 vs. 505.3,SD: 87.5; p < 0.001).ABIM board certification rate was similar between EM and IM candidates (91.2 vs. 93.2%;p = 0.22).Conclusions: The higher exposure and treatment of critically ill patients experienced by EM trainees and the procedural skills they acquired made them more than qualified for an IM-CCM fellowship.Acknowledging this, VA-Caribbean Healthcare System CCM department has become the main source of EM/CCM-IM pathway physicians in Puerto Rico.