Thanks for the reply. Hospital medicine comes with enormous, heaping mounds of bullish*t and that is why I want to stay away from it if I can too. I never really bought into the 7 on 7 off schedule as any kind of great bargain either. I really don't want to devote an extra second to training more than I have to. Even the extra year in if I switch to EM makes be cringe but I am trying to think long-term. I am going to be in my late 30s by the time I graduate. I have a young family. I feel like I am economically pigeonholed into hospital medicine (if I stay in IM) because it pays so much more than outpatient (even outpatient subspecialties.) Even if I wanted to subspecialize, I feel I cannot sacrifice the extra 2-3 years for less or the same pay as PCP internal medicine. Let's face it cards, GI, pulm/crit are not exactly there for the taking. So when people tell me "why not do GI or pull/crit" a) I am really not that enthusiastic about those fields and b)they are a reach considering I am a DO with no research training at a small community program. It seems if this ER thing doesn't work out then hospital medicine is my only choice at least for the first several years out of training.
Being that you mention you are a DO at a small community program with no research, I agree that matching into an IM subspecialty will be an uphill battle and possibly just out of the question for some fields. If you take that off the table and are just comparing IM vs EM, I still think sticking with IM is the better choice.
For one thing, there isn't any PCP/outpatient option for EM. As many have said, the pay for a busy PCP is not that different than an EM doc and the ceiling on PCP work is higher if you are business savvy. Private equity is coming hard for PCPs but they pretty much own most of EM already. You can always choose outpatient work, albeit you probably forget alot of what it takes to be a PCP if you've been a hospitalist for a few years...but you can relearn it.
Hospitalist jobs and EM jobs vary in work flow and hour-to-hour flexibility. My wife's previous jobs was crazy busy and she was essentially unreachable while in the ED. Hospitalists generally have more flexibility and some have jobs where they can round and go. EM does have the luxury of random weekdays off and the ability to trade shifts around with colleagues if certain days off are needed. This is kind of a toss up and very much dependent on the job. I remember being an IM resident and thinking my wife had the better gig, even kind of thought about switching to EM. Very happy I chose to specialize instead. I wouldn't want to be a PCP, hospitalist, or EM doc -- not even sure which I would choose if those were my options. The idea of an extra year of training would be enough to keep me in IM. On a side note, it reminded me of people in med school who chose EM/IM combined residency. What a nightmare choice. I wonder what those people ended up doing career wise. With that said, my wife now has a job in the suburb area of a desirable metro where she works for a large hospital system and has a pretty good gig. She almost always finishes her notes at work and they have dedicated nocturnists in the ED so she has only worked one true overnight shift in the last 8 months. Her shifts now are some sort of day shift (6a-2p, 8a-5p, 2p-10p, etc.) and the latest she is ever home is probably 11p. Work flow is reasonable and she has decent support staff. I do echo what's been said above regarding the job market. No one has a crystal ball and the sky is always falling but it does look pretty grim for EM. They have rapidly expanded EM residencies and many are at community hospitals without true faculty. They are actually launching one at my wife's hospital and the doctors aren't asking for it so there isn't a ton of buy-in. Ie you don't have a bunch of attendings interested in medical education, rather you have a bunch of attendings who are employees being told they will soon have residents. I'm sure this reflects on training since I imagine many of these attendings are just going to want to get through the work day and probably aren't super keen on getting behind on their workflow so they can take a bunch of time to walk you through procedures and all that. Also, traditional "good" EM programs (like most other training programs) are at large academic centers tied to county hospitals that see super sick patients with untreated pathology. You are less likely to see that level of pathology at a suburban community hospital even if it is a level 1 trauma. Also, without all the other residents and fellows typically present at a large teaching center, the educational experience likely isn't the same. Now, I'm sure all the same can be said for these random community hospital IM programs as well.
Good luck and wish you the best with whatever the outcome. I can empathize with being an IM intern and thinking I totally screwed up and that there had to be a better choice. Definitely know people who left IM, either during residency or after completing the IM residency, for PM&R, anesth, rads, EM, gen surg, and even derm. The grass is always greener and that doesn't stop. I love my field and job and I still sometimes find myself envious of my buddies with little to no college education who are making good money in sales, real estate, and business.
