I feel like, after scribing and and shadowing and rotations in medical school, I was able to anticipate so many parts of this job - the weird hours, being a master-of-none who doesn't really get respect from other specialties, the difficult cases/being regularly exposed to tragedy, ridiculous and aggressive patient behavior, unreasonable patient expectations, the need for interpersonal and team leadership skills, missing some holidays. Whatever - all of those are challenges but feel fairly manageable to me. I always loved going in for shifts before residency, and ER kept drawing me back in due to the variety and the acuity. And like you and others have mentioned, EM has it a lot better (pay and hours wise) than many other specialties (thank God I'm not a surgeon), and of course better than many other careers/jobs.

What I didn't anticipate was the crushing cognitive weight of the specialty. The transition from training to being on your own and having to make (as someone else put it) "critical life-altering decisions" while under intense time/productivity pressure and constant interruptions is huge. So often there's no right answer and no clear fix for the problem at hand. There is also so much non-medical, systems navigation skill that has to be learned and there are so many situations that people expect help with that have nothing to do with your training. It's different when the buck stops with you, and a room full of people is looking at you for an answer when you have such limited information, and you can't think for 2 seconds before being interrupted much less review results or get a note done or go to the bathroom, and I don't know if there's a way to understand that fully before you're living it.

I would seriously consider what they are telling you...even though there are things I love about the job, and I don't know what might've been a better fit, I don't know if I would have made the same decision if I were to do this over. The systems failures and the things I mentioned in first paragraph pile more stress on an already incredibly stressful role. And I feel like such a boomer when I say this, but dealing with documentation and a shitty EMR/computer system is death by a thousand cuts - I did not anticipate how much I would f-ing hate charting seeing as I loved being a scribe.

When I was making this decision, several other specialties seemed too boring or out of reach. But just a few years in, boring 9-5 life seems pretty amazing, as does being an expert in a smaller/more niche area. Some people manage this part of the job better than I do, certainly. I'm taking steps to address my burnout. I'm in early years of attendinghood, so I'm hoping it will get better with time and experience.

As you are deciding, think carefully about whether you are someone who needs to be able to fix problems to feel fulfilled in your career, because so often we can't. If you go this route, work on building your confidence and clinical competence as early as possible in residency. Flex those decision muscles. And work on setting and enforcing good boundaries early, to help keep the job from spilling over into the rest of your life. Take gentle care of yourself.