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It's a simple matter of marketing. EM has perfected: "Sell the 'sizzle' not the steak." The specialty has the sizzle factor and always will. Hence, EM, just like a Porsche, will always sell itself. That doesn't mean that it will still have "the thrill" when a person's circumstances change making a minivan much more useful and practical. But, once you've bought the "sizzle" you've still got to chew the steak no matter how tough. The smartest thing EM ever did for recruitment had nothing to do with recruitment. It had everything to do with closing the primary care pathways. Once EM became a single entry, "no exit" specialty, they secured their workforce. If EM was allowed to be primary care with EM as a subspecialty fellowship, there'd be a much greater risk of recruits bailing out to do more lucrative "fellowships" that could increase pay along with lifestyle, such as GI, Cards, etc. By closing that loophole, the specialty tightened its ranks, but doubled down on exit strategies and therefore upped the ante on burnout. (I have tome-like post on this, that was intended for DrWhitecoat.com, but I just never got around to finishing or posting it).
It's terrible. Sure you'll hear anecdotes and adaptations such as "I just work all nights and I see my kids for breakfast after work and for dinner before work, too. It's the best thing ever!" But the reality is, that sleeping all day and being awake all night, and having your body want to do that on all your off days, when your family lives in an alternate universe, is soul crushing for many people. The only thing worse is a constant rotating schedule of random shifts where one feels chronically jet lagged and sleep deprived, even on their days off. That's another EM lie: "When you're off, you're off!" Nuh, uh. When you worked past midnight, until 3 a.m. the morning of your day "off" and your family is up at 7 am in need of a bright-eyed, bushy-tailed daddy (or mommy), you're no more "off" than a surgeon with a pager. The work bleeds into your day off by stealing forward from your circadian rhythms. Also, doing a Peds code and parental death notification or getting assaulted by a patient is had to turn off like a light switch 5 steps out the door.
That's what they'll be told, and that's what they'll think, hope and count on. A few will secure 99th percentile jobs where they can pick whatever amount of hours they want or don't want, but with a critical and nationwide shortage of BC/BE EPs at a time that 40 million uninsured are set to be newly insured and demanding care, with nowhere that'll accept their Medicaid but the ER, there will continue to be an increasing pressure to chronically work a greater and greater number of hours and shifts than desired for most. They'll still have to work 1/2 of all Christmases, New Years Eves, Superbowl Sundays, Easters, Rosh Hoshanas, and weekends. Many will be sold the "sizzle" and a promising contract but once it's signed, the house is bought and the spouse has secured a job in the new locale, it's much easier to just swallow the medicine, work the extra 3-4 shifts per month, and smolder, while the recruiting cycle repeats is promise to finally, once and for all, fill the staffing gap before volume outgrows the new man power.
I can definitely say, that having been down this road in the past, it's feels damn good knowing every day that I can sleep when it's dark, be awake when the sun is out, be off when my family is off and gone when my family is gone.
Regardless, EM has the "sizzle" and there's nothing I can write or say, if the sizzle is that which you seek.
