Career Longevity as a reason to do IM (Current MS3)

[Doggeronie]

I have been very much undecided between EM and IM. I liked both rotations.
There are things I like about both specialties and things I don't like about both specialties. Neither one is a clear winner and I have thought the pros and cons through very thoroughly. So in terms of differentiating the clinical aspects of the work I am very much deadlocked. I like both acute and chronic care. I dislike difficult/unnecessary patients in EM but I also dislike the tedium of IM. I'm very whatever about the additional peds/OB aspect of EM; I'm just ok with it.

If I did IM, I would like to do fellowship, but understand that it is not a guarantee.

There is a large financial gap between the two specialties. I understand that EM makes much more money, but I feel like no one is given money for free. EM docs must be earning the money through working harder or facing worse conditions. So I don't think finances are a major differentiating factor either.

For me, I value having free time. I would like to have the time to workout, pursue some hobbies, and spend time with family. I believe that this is possible with both EM and IM. EM appears to provide more free time at first glance, but it does come at the cost of losing weekends and nights, when everyone else has free time. So I think overall it's pretty even. Please correct me if I am wrong, though.

However, I also want to practice for a long time. I feel that as an EM doc, it's difficult to practice into your 60s and 70s, whereas it seems relatively easy for an IM doc to be 70 years old and practicing. I understand that EM docs can go part time, or work in urgent care, or do administrative work, but none of this really interests me. I want to be doing clinical work.

So I feel like in the end, the only differentiating factor is career longevity. Is it ill advised to pick IM over EM because I feel that I can practice longer?

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[throwaway1000000]

I think everyone is going to give you different answers because everyone has different priorities.

I liked EM too but ultimately picked IM for the following reasons:

1) Subject matter. EM has a certain set of expertise. But if you are willing to study and work hard in IM, you can learn everything related to EM and then some more especially if you go into pulm-crit. If you work in a rural setting, hospitalists also probably share some skillsets of an EM-doc. Going in-depth matters to me a lot. Currently, I am leaning towards cardiology but if I wanted to specialize in critical care, I would have gone into IM and pulm-crit than EM.
2) You are better off financially in EM if you compare to a hospitalist and PCP. Don't agree with you that they do more work to get paid more than an hospitalist but that's how the pay structure works. Finance was an issue for me and I want to be in a field that pays well. Cards, GI, pulm-crit, Hem/Onc all have potential to be paid more than an EM doc. End of the day, it is how much you are willing to work though. You can get paid more even as a hospitalist than an EM doc if you are willing to work a lot. If you only care about finance, I think EM is the best bet in the current market. You work for 3 yrs and get paid a lot. Have potential to pick more shifts and increase your pay if you can tolerate it.
3) Lifestyle is not something that I really care about considering I want to do cardiology. Lot of EM docs seem to like their lifestyle. For me the changes in sleep schedule would have been more of a hassle than working weekends or holidays. You can be on call on weekends or on holiday in IM too.
4) Being old and working wasn't an issue for me. I have seen plenty of EM docs that are old and still working. I can see myself being practicing both EM/IM/IM subspeciality at an older age if I wanted to do it and I am healthy enough to do it.

TLDR: everyone has different priorities, analyze what your most important priorities and pick accordingly.