MS3 at a US MD with step >235, few research activities, decent grades, and no red flags. I've done EM and IM rotations and researched the topic extensively. I really like both fields and can certainly see myself doing both. However, I also like cardiology, a lot. As fourth year is approaching, I have to make a decision about which route to take. I need some advice on wheher a combined IM/EM plus fellowship would be a waste of time if I end up not using the "EM" in cardiology. I know most IM/EM physicians end up doing EM, so I'm kind of torn between the two choices. In addition to clinical practice, my goal is be able to coordinate inter-departmental work, especially in relation to things like STEMIs, door-to-balloon policies and procedures, etc.. My options as I think of them for now: -IM-->cardiology 6 years -IM/EM alone 5 years -IM/EM--> cardiology 8 years I know it's a lot of time but I'm willing to put the work if that will serve my future aspirations. Would really appreciate your insight.