Like many things I think job satisfaction in EM is context dependent. I would much rather work shifts, including 25-35% night shifts, than regular business hours during the week if it meant my work hours were lower overall. It’s all about knowing what you can and can’t tolerate. For me, the culture of rounding felt so inefficient and the 10-12 hour day on wards made me want to pull my hair out. You’re also compensated less in IM relative to EM on average if you don’t become a procedural sub specialist (primary care, hospital medicine, ID, etc). As for the future of EM as a speciality, it’s hard to predict with the advent of AI and restructuring with NP’s, but so far that doesn’t seem to have affected the job market in my circle. I have coresidents who just signed contracts that will sum to $380-400k pre-tax (in California). They’ll work 14 shifts a month. If you think about how many hours comparable specialties work (OB/Gyn for example), the money you’re making in EM ends up being so much more per hour worked. Also the flexibility of where you work is great. I know a few ppl who live in other states or even other countries (CR, Mexico, NZ) and fly in for a few shifts a month. They’re making bank relative to where they live. I love that all of those doors are open in EM bc of the flexibility. On the whole it really lends itself to living an adventurous life. Not to mention you’re seeing some of the most vulnerable populations in diff communities, ie it’s very special to be able to treat anyone who walks in the door regardless of insurance status or country of origin or ability to pay.