The consensus model in many hospitals IS being followed, most notably in the eastern states. I am finding it becoming more important to have a career direction (as you do) prior to going to NP school, if possible. Within the hospital in general (not necessarily ED), acute care NP is important for credentialing. For example, I was still a RN in NP school when a co-worker a semester ahead of me was hired for a hospitalist role at our hospital. She was family. She actually started training, was well-established and respected by the docs, all that...well horrible here she ended up not being credentialed by the hospital. I get goosebumps still thinking about this. She ended up working getting a job in outpatient setting, but it was months waiting for credentialing and turning down job interviews, etc., thinking she had a job. Anyway, if you want to work primary with all ages then family is the way to go in urgent care or family, in general. Ob then the midwife etc. ED, find an ED program. Peds, either acute pediatric program or family. Hospitalist or ICU acute adult. Outpatient specialty or adult/geriatric, adult/gero primary. Psych, of course psych. You will find there are a lot of post-graduate programs, and this will be your answer if you want to cover a spectrum of, say, completing an adult program but then doing a year of post-grad family to capture pediatrics for kids. Or working in a hospital and needing acute, do an acute post-grad, as my friend was considering.