If you are completely set on Peds EM, I would say go the peds->EM route. Peds is getting more competitive than in the past, but EM is getting way more competitive as well. But both are completely doable with DO. I have no idea how competitive a peds fellowship after EM is, but Peds EM is one of the more competitive peds fellowships, however competitive peds is nothing like competitive IM. I think for peds EM there are like 1.2 applicants for every spot. something like that.
the peds->peds EM path is a year longer (6 years vs. 5 years i believe), but with the EM route, you are primarily adult with some peds rotations. with peds, you are entirely kids. so if you are certain you want to work with kids in peds EM, 3 years of pediatrics residency is better than 4 rotations in EM.
