Lack of options? Au contraire- there are MORE options in EM! Tired of where you are? Do some locums in the Caribbean. Travel! Work on the beach or the mountains. Every group and practice is different, and yes, academics and community practice are very different.

As an EM trained doc, I do not feel that I am equipped to practice primary care. Although much of what I do is primary care, I am certainly not trained to manage outpatient medicine. Drey hit the nail on the head (as usual) in that there is no way I could ever do that. Because I really don't like it.

And yes, so what if you went into anesthesia and hated it? Or orthopedics? EM is a speciality just like they are. As a wise friend says, "You can't be a stem cell forever."

Haha, I am so a stem cell still. Its so scary trying to choose something without really being able to know how well you will like it in the long run! I do know that I would do best in something varied and fast paced that has lots of face to face interaction. Do you feel like there is any time for connection with the patients required in EM since the time you spend with them is so brief? Also, how much intuition is used in the ER? Is it so evidence-based that you feel like a protocol-following machine or is there still some creative thinking that goes on? I am shadowing right now but these aren't really the kinds of things you learn from shadowing. To the EM docs that love what they do, I am curious as to what your meyers-briggs (sp?) result is. I am an ENFJ...
Also, what is it about outpatient medicine that you dislike? Wondering if I would feel the same way.
It also helps that EM residencies are much more humane than other fields, at least where I am. That is a big plus when you have little ones! The EM docs I have seen seem unusually happy, with the exception of one who told me she hated "complainers." Oops, all of medicine is a bad choice for her!
I appreciate the input ladies.

I am interested in EM but I can't move for a residency because of family obligations. How bad is it to only apply to one or two EM spots with another specialty as backup?

I was wondering the exact same thing!