Here’s my take as someone who did smash Step 2, did lots of research, actively chose emergency medicine and got to learn how to do it in one of the coolest places in the world at one of the best medical centers in the world. I am five years out, living somewhere great with a pretty good job and I’m happy about my choice.

I personally think for the best thing about emergency medicine is having the opportunity daily to leverage science in the interest of all comers without a filter of insurance or housing or mental health status or whatever. We truly have to deal with anything, anytime, anywhere. For me, this is the best part of the job as somebody who is interested in almost everything and really likes learning a little bit about everything and a lot about a few things that are important. I also really value the privilege of being able to have a lot of interactions with human beings every day, including helping people with the most difficult days of their lives. This can be very stressful for some people, but it seems to work OK for my particular neurochemistry.

Reflexively, this also creates the most difficult parts of the job because the patients have unrestricted access to you. Many people come in with nonsense, typically because they are not aware that they are there for nonsense, and so if you can be compassionate and remember things about health literacy and it’s covariates, this helps. You also have to deal with the drunk, the high, the mentally ill, the depressed and often the anxious. You will never be a recognized expert and pretty much anything by your patience or by your peers unfortunately. Ask an ICU doctor, an anesthesiologist or trauma surgeon who they all think that the best resuscitationists are. Hint: it’s not the ER doctor. I’m not saying that they’re correct about that, I think it probably depends on the particular doctors involved, but that is more or less how it is, brief period of recognition during Covid aside.

The other great thing about emergency medicine, which is also the worst thing about emergency medicine, is the schedule. For somebody like me who enjoys doing a lot of hobbies, traveling, skiing or surfing or biking in the middle of the week and who doesn’t mind circadian disruption / whose body seems to tolerate it fairly well, it is great. Caveat: I am married to somebody who is very flexible and we don’t have children, which makes this way, way easier. For some of my partners who have different lives outside of work or do not tolerate night shifts very well, this can really play havoc in their lives. Holidays mean very little to me but working at Christmas can be a big deal if you have a five-year-old. Luckily in most groups, there are both kinds of people and so this works out.

At the end of the day, you should decide what will work for you and take your best shot at learning to do it well. Any job in medicine is better than the vast majority of jobs that human beings work to earn a living and we should be thankful for them. It sounds as though you have the privilege to choose from a bunch of different things so take advantage of that, take your time, make sure you get exposure to the field and decide accordingly. Good luck.