The one thing I have considered is that being older, I feel like I don't have as much time to go on and on in an extended residency and fellowship. Maybe I will. I guess I'll see. I have thought a lot about combined residencies (such as IM and Med Gen for instance), but that is 5 years and if I want to add a fellowship it is yet another 2. I contrast this with just picking another area of interest, such as Neurology, where I would just have a 3 year residency (or is it PG1 + 3?). I guess i'll have to see how things evolve.
I have a strong background in genetics so I feel like I want to continue it in something like Med Gen, but I still don't want to give up the broader clinical practice of other specialties, like IM, EM, or something like that. Path would be an option too, but I feel like i'm already off-gasing all kinds of lab chemicals from my previous experiences. We'll see how it plays out.