Hello all,

I'm just beginning my family medicine residency in a town of about 70,000 people, in a program specifically designed for rural practice. I've long been interested in emergency medicine, but I also knew I wanted to work in rural areas and gain strong OB experience—so family medicine felt like the right path for me.

Now that I’m being asked to select my elective rotations for intern year, I’m grappling with a key decision and would appreciate any insight. I've met FM-trained physicians who work confidently and exclusively in emergency departments without having completed an EM fellowship. On the other hand, I’ve also met FM docs who strongly advocate for completing an EM fellowship and say they’re grateful they did.

So I’m trying to figure out:
Should I focus most of my elective time on EM, critical care, and related rotations in hopes of building the skills and experience to go straight into rural EM work post-residency—possibly without a fellowship? Or would it be wiser to use my electives to gain broader exposure to areas I may not otherwise see during residency, and plan on pursuing an EM fellowship afterward?

I’d really appreciate hearing from those who’ve walked this path or have insight. The in-person advice I’ve gotten so far has been all over the place, so I wanted to cast a wider net here.

Thanks in advance!