I was pretty biased for community EM programs based on my experience in med school. My home University based EM rotation was way too consultant heavy and I rarely saw EM residents doing procedures. There was a subspecialist/fellow for everything. When an eye complaint came in, they just consulted the ophthalmology resident. Every questionable psych patient was seen by psychiatry in the ED. Ortho reset every fracture, etc. When there was a sick resuscitation, the ICU residents came to the ED to do the resuscitation. I once saw both Neurosurgery and Neurology both consulted to try an LP on one patient. It was not at all what practicing real life EM is like based on my experience. My first community EM rotation literally shocked me, I had no idea the amount of responsibility EM residents could be given when compared to my home program. It drastically changed my approach to the match and I cancelled a ton of University based programs interviews eventually. I work in a Community EM program as faculty, and my resume is definitely good enough to get hired at a University based program if I wanted, but I doubt I'd ever go that route unless I was really looking to slow down. The pay in the community is so much better, and I still love the autonomy and procedures working in the community provides.
I very much appreciate how you stated that this is a generalization/n=1, however, as someone training at an academic program I can tell you this experience you are describing is extremely atypical and seems extreme to me, especially as it pertains to ICU teams coming to the ED to do resuscitations. I can promise you that at 99.9% of academic residency programs in the country this is not happening.
My recommendation is to go to an academic program. From the standpoint of prospects down the road, you keep all doors open. I can tell you at our academic shop, the vast majority of new attendings that are hired are academic trained, and they preferentially hire these grads over community grads. That being said, when it comes to getting jobs after graduating from our academic program, 70-80% of graduates go directly into the community without difficulty. Again, all options are available.
If you have a strong interest in EMS, you should strongly consider checking out academic programs that have EMS fellowships, so you can get strong exposure in residency. I thought I wanted to do critical care coming into residency and then changed to EMS after I had lots of EMS exposure at my program with the EMS faculty and other research opportunities. I believe that some of the opportunities I had you would be hard pressed to find at a community program.
There is a very inaccurate representation of academic programs as being "ivory tower" type places that are consultant heavy without much ED involvement in patient care in relatively sterile/ritzy neighborhoods and VIP patients. While there are some academic centers that fit that profile, many "academic" programs such as where I'm at are the primary safety net hospital for the county patient population, have high degrees of trauma with sick patients and more than enough procedures to go around. I have never consulted an ophthalmologist unless I have a specific question for them, and I get first crack at all reductions, airways, chest tubes, central lines etc. I see more penetrating trauma than I could have ever imagined.
Community programs provide good clinical training, and I don't deny the fact that procedural experience is great at these places (although I don't know if I buy into the fact that it's better). I would venture a guess that research, exposure to other more "niche" aspects of the specialty are lacking at these places, but I'm not 100% sure.
If EMS is your jam, you can still explore it AND do well in EMS coming from a community program, however I just think there are more opportunities during residency if you go the academic route.
