I'm an M4 at a US allopathic program. I did well on Step 1, waiting on Step 2, and am applying to EM in a week and a half.
After I finished my FM clerkship, I realized that I really enjoy outpatient FM. My concerns are basically whether the bread and butter would get to me before the bread and butter of EM would get to me, the difference in compensation, and whether the difference in occasional acuity would bother me enough to matter.
I've heard the EM side of the argument, but out of curiosity, I'd be interested in hearing from you guys who liked both and chose FM.
I'm in the same exact boat as you. I loved both. I'm probably choosing EM.
Things I don't like about outpatient FM:
1. You will still have call. Imagine working all day and coming home and getting 4 calls during the night. If you are in a group, it will probably only be 1-2x per week and 1 weekend a month.
2. Lower pay: $150,000 vs $240,000 in EM.
3. When you add in all the call, you'll most likely be working more hours in FM (~50 hrs/week compared to 40 in EM).
Things I don't like about EM:
1. Lifestyle- holidays, weekends, nights.
2. I don't really like critical care too much. I prefer healthy patients.
Some Qs to ask yourself:
1. Do you want true emergencies (MVAs, little old lady falls, cardiac arrest, stroke)?
2. Do you want procedures (central lines, intubations, chest tubes, splinting, suturing)? vs. joint injections and derm stuff in FM.
3. Do you want continuity (do you want to help someone manage their diabetes over years? Do you want to do well checks on kids every year?)
4. Do you want more chronic or more acute? Do you want the suicidal patient who comes to the ED for a crisis eval, or do you want the chronically depressed patient who comes in to the office for an antidepressent? Do you want the person with a BP of 220/110 and a headache, or do you want the patient who comes in for a check up with a BP of 160/90 and no symptoms? Do you want the little old lady who falls and breaks a hip, or do you want to help the family decide on whether she needs a nursing home?
5. Do you want immediate and routine CTs, X-rays, labs? Or, would you rather order a CT occasionally and get the result 2 days later?
6. Would you rather multi-task seeing numerous patients at once with a single complaint or manage multiple problems in the same patient?
If you can think of other things to consider, let me know because I still have a degree of uncertainty in the back of my mind.