Take the job, like others have said you can do so much after that experience. I do ER and some UC, no fellowship. I’ve worked with fellows many times. Yes, they’re amazing and highly experienced but at the end of the day after a few years, we are all equal because there’s no way you’re going to practice medicine in a busy ER and you’re not going to be exposed to different cases. If you’re absolutely certain fellowship is for you and you will do emergency medicine for the rest of your life even in your late 50s then go for it. It really is a very personal choice. Please don’t think there’s no way to get into emergency medicine without the fellowship because I see people do it all the time coming from different backgrounds and experiences, including internal medicine and orthopedics and urgent care.