Clients often ask me if it's safe to apply to more than one specialty, particularly if it's at the same hospital. There are pros and cons to this, so I'll mention right away that I will not be giving you an absolute answer.
1) Officially, programs don't know where else you applied, either in their specialty, or if you applied to any other specialties. ERAS does not release this information to them at all, so typically there's no danger in double-applying, as long as you never lie about it. But you can't control all information; what if you accidentally sent your FM personal statement to an IM program, or one of your letter writers got a follow-up phone call and accidentally mentioned the wrong specialty? So never volunteer the information that you double-applied, but if a program director asks if you applied to any other field besides theirs, assume that somehow they already know. In that specific situation, say something like "My heart belongs to [your specialty], but at the advice of my residency advisor, I applied to a handful of programs in [other specialty] since I have connections there, and I didn't want to risk not matching. But I'm here today to talk about [your specialty]."
2) Unofficially, you have no control of what happens to your application after you transmit it through ERAS. Many years ago, I heard a story about two program directors meeting for lunch, and as one was running late, the other pulled out an application to review. When the late one arrived he recognized the name on the folder as an applicant to his own specialty. I have no idea if this is a true story, but it's believable. But if I go back even further to when I was still at UCSF, I have a real story to share. One of my students double-applied and got interviews in both specialties at the same hospital. During her second hospital tour (remember that pre-pandemic, all interviews were in person), she bumped into a resident she had met during her first interview! Thankfully, she had never lied during either interview; by not claiming that either was the only specialty she had chosen, she didn't feel she had broken her word.
3) Family medicine and internal medicine applications are often intertwined for applicants due to their high interest in primary care, as well as the fact that the specialties are seen as IMG-friendly. Based on what I've seen over the past 15 years, family medicine is the most IMG-friendly specialty, and if it's already your top choice then it's worth considering if you still want to double-apply. But there's little harm in applying to two specialties. Also, personal connections count for a lot, and if you know people who have matched in both specialties then by all means apply to those specific programs, in the hopes that your friends can put in a good word for you.
4) How has the pandemic affected your medical education? Quite a few of my clients have reported that their experience in internal medicine rotations was quite limited due to COVID-19, with most of their patient interactions happening in an outpatient or telemedicine setting. That may not be the best reflection of your experience in that specialty! I would hate for you to spend lots of money applying, only to be ignored during interview season because of a situation that was out of your control.
5) Your personal statement should be customized for each specialty. Again using family medicine and internal medicine as an example, there's going to be a great deal of overlap between them due to the primary care components, but they should not be identical. Of course if the two specialties you've chosen have less overlap, you'll need to write two very different documents; for example your internal medicine essay might focus on your diagnostic skills, but your psychiatry essay would likely have a different story that highlights your ability to build rapport with patients.
6) Some letter writers act like letters of recommendation are a burden, despite the fact that they needed LORs when they applied to residency themselves! So if you're double-applying, you need to find out if they prefer to write and upload a single letter that's good for any specialty ("She would be a superb resident in the field of her choice"), or if they are willing to write and upload two LORs with lots of overlap, but with some unique sentences ("She would be a superb family physician" / "She would be a superb internist"). Keep in mind that as the applicant, you might be asked to draft the letter(s) yourself! That's extra work for you.
7) Though you should use different personal statements and might get different LORs depending on the specialty, there's only one ERAS application. For some applicants, double-applying can "dilute" your application. It's less of an issue with FM and IM, since primary care fields are so interconnected, but years ago I had an applicant who wanted to apply in surgery and psychiatry. Every surgery experience mentioned mental health; every psychiatry reference mentioned similarities between physical and emotional scars. In my opinion, it felt really forced and didn't seem work in his favor, but he didn't listen to my advice about choosing a single specialty; his writing style seemed to hurt him when it came to the number of interviews he received.
8) Many specialties are using the supplemental ERAS application this year (it's optional but recommended). Family medicine is not using it, but if you're also applying in internal medicine, pediatrics, psychiatry, or many other specialties, that's yet another task you need to accomplish. The main ERAS application should optimally be finished by the day before the target application date of September 28, but the supplemental application is due by September 16, so that's yet another task you need to complete.
Best of luck with your application!
