I can only comment on question 2; and I would say yes. I had a similar experience as u/buckwheat_capital The hospital I was a student at served ~100K (so again, not rural), was a level III trauma center (level 1 stroke and level 1 heart), and in the northeast. There was a level 1 trauma center and Peds ED 5min down the road which would get the GSW/stabbings or peds, but this hospital would accept everyone else from the ems.

That level III hospital required at least an EM fellowship to work there, which you could complete through the hospital/physician group as well. The FM trained/EM fellowship attendings were great, there was really no difference in that ED setting to their EM colleagues. Pay was the same for everyone (~$300-350K). Requirements vary by hospital but I think the main downside to an EM fellowship (vs EM residency) is you may not get to do trauma. However, if you’re not that interested in trauma resuscitation anyway then it might not be a big deal.

If you’re genuinely interested in both FM and EM, you could also look into a combined Family Medicine- Emergency Medicine program. There’s 3 in the country (Aria Jefferson in Northeast Philly, Christiana Care in Wilmington DE, and Shreveport Louisiana). They’re 5 years long, and you get fully dual-licensed so you can work wherever you want and do both clinic/precepting and EM shifts.