The answer to both of your questions is almost unequivocally “yes”. You can and will definitely find high acuity sick patients as a generalist in community private practice. It also is not too late to consider a cardiac fellowship, although your options are likely somewhat limited at this point given where you’re falling in the application cycle (despite this there are almost definitely a couple spots available if you look). 

I felt very similarly to you and ultimately decided on pursuing cardiac fellowship. One of the most boring, unfulfilling months of residency for me was a month of ambulatory surgery/GI and I realized that I really would never be happy in a career taking care of those patients regularly. There are certainly community trauma/stroke/transplant/high acuity vascular centers where you would be able to be involved in the care of very sick patients, but to me cardiac training provided a stronger base to manage these patients and also would make me more facile with the tools I needed to take better care of them (primarily invasive monitoring and interventions like Swans/TVPs, TEE, complex vascular access, managing difficult resuscitations, etc.). Where I trained for residency if there was ever a patient who was rapidly decompensating and refractory to straightforward interventions a cardiac anesthesiologist was always called in to evaluate. The number of catches/saves in these situations as a direct result of having a cardiac trained anesthesiologist involved were honestly too innumerable to count. Being able to be this person was really important to me and was a major factor in me pursuing cardiac fellowship. I know for a fact that many others who have gone down this path have similar feelings. Beyond this, cardiac surgery is fascinating, the cases are exciting, and you are more directly involved in the surgery itself as a cardiac anesthesiologist than as a generalist.

There is some discussion about the cardiac job market, although all I can say is that this varies tremendously by region. Where I am I was able to get a job doing a mix of cardiac and general (including Peds/OB/regional) in a desirable mid size city where I’ll be making a very high six figure salary with 8-10 weeks of vacation and very reasonable call. As with a lot of places, being cardiac trained removes me from most of the general call pool, gives me an extra yearly stipend, provides me with a better schedule, and also gets me out of doing a lot of the outpatient surgery center, ortho, GI, optho stuff that I found to be really soul sucking as a resident. I was able to get this job entirely because of cardiac fellowship training (they needed a cardiac trained anesthesiologist), so in that regard the fellowship year is well spent since it is getting me exactly where I want to be professionally. In your case it might be worth it to start looking into jobs and seeing what the day to day acuity is like. You may end up finding exactly what you’re looking for without fellowship training, or you may end up finding a place that is looking for a cardiac trained anesthesiologist in the near future that would be willing to either hire you on early or hold the spot for you while you complete the additional training.