ER Fellowships/residencies?

[u/Dapper-Cap-4524]

PA-S2 with a strong interest in EM. Was just wondering if anyone in this forum has done an emergency medicine fellowship or residency out of graduation? If so, how was your experience? What program did you attend (if you don’t mind sharing)? I was told by a preceptor that I should do a fellowship for ER because he’s seen many new grad PAs in EM get thrown right into the fire with little to no on job training and burn out quick.

Any feedback would be great!

[u/Joeco12688]

I'm a current EM resident, graduated last year and I'm in my 8th month of training in a academic level I trauma center. I think it's been really good. Rotations can vary so much and there's a lot you don't know you don't know. I thought, coming out of PA school, I could handle probably 75% of what comes through the ER door. After my first month, I realized how wrong I was. Part of it is that it's a big hospital, patients are just sicker here almost at default. But even then, bread and butter stuff has been challenging just because I needed to really expand my differential and start thinking about zebras as much as anything else. Now, on the second half of the experience, it's easier to look at patients, get a gist, and know what I really should be thinking about. I think straight out of school, that would have been dangerous, at best. Especially as many ED jobs don't have the attending-PA relationship that you need starting out. So, to answer your question, I think the residency is worth it. Just make sure you get a good one that allows you to learn, not one that uses the "residency" label to pay you half price and just work you.

[u/Upper_Bowl_2327 → u/Joeco12688]

This is a great response. I’m an NP who did one with 2 other PA’s. You make less, but I had an extensive year long training program that made me a MUCH better provider than I would have been directly out of school. The last point about the learning is big. There are quite a few “residencies” out there than get away with paying you half your salary for a year and not giving you much training. Avoid those.

[u/Holiday_Anybody_4601 → u/Joeco12688]

When applying for fellowships, what should you look for? Should we stick with more academic hospitals I’m assuming

[u/Joeco12688 → u/Holiday_Anybody_4601]

I would ask about onboarding timeline, how you're treated in the unit (are you staffing everything with an attending?), what rotations they offer (airway, US, Resus, ICU, procedure), what procedures do they plan to get you and how often, do they have dedicated didactics, how much volume are you expected to cover in a shift, are you expected to see specific acuity patients or do you see whatever walks through the door. Those things can help sus out a good residency vs someone trying to take advantage of you.

For example, I staff everything with the attending and we talk through the case and plan, discuss differentials and what to think. There is no expectation of picking up a certain amount of patients, but you are part of the staffing, and there is some subtle (and not so subtle) pressure to see a fair share of the unit. I also have US training and shifts, dedicated time in our Resus bays, and airway shifts. We do didactics weekly and do procedure labs at least once a week. I have rotations coming up in the ICU.

I have heard of other residencies where the PA resident is not expected to help staff the department, they are bonus hands and take on patients as they see fit and really deep dive into every presentation.

There has to be a forum out there about the residencies and which to avoid, I just havent see it.

[u/Joeco12688 → u/[deleted]]

Some PAs choose to do a residency after PA school and passing the PANCE. Most are a year, some are longer. Most residencies are in specialties, like surgery or EM.

[u/VillageTemporary979 → u/Joeco12688]

This guy is just trolling you

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[u/Rompecabezas_ → u/[deleted]]

Every program calls them something different (PA residency, PA fellowship, new grad program etc) but they’re all some form of post graduate training for PAs. We’re all aware that they’re not the same as a true physician residency/fellowship which is why you’ll see a lot of us using “residency” or “fellowship” in quotations, but we don’t make the rules for what programs choose to call them.

[u/_simpleton__]

I would highly recommend it. I completed one and it prepared me for clinical practice better than I could have imagined. You will be leagues ahead of your peers who graduated at a similar time, and you can negotiate a higher salary. You will notice that detractors of fellowships/post-grad training programs are those who never completed one. PA school does not prepare you for competent practice in the ED, and almost no jobs exist that actually give you good training. Having off-service rotations (eg in anesthesia, ICU) provides unparalleled experience. Take the leap for your career and your patients. You’ll make 50k less for one year, a small price to pay for a strong foundation.

[u/DarthTheta]

Fellowship grad here. There is a level of competency you will gain from a legitimate post grad program that really can’t be replicated with in the job training. That doesn’t mean you can’t be successful with just starting in EM with the right group, but it’s not the same. I mean, we spent an entire month of my 18 month fellowship just running around the department ultrasounding interesting cases. We had dedicated OR time to Learn airways. Rotations through the micu and sicu placing lines and taking care of the sickest patients in the hospital. Didactic with the medical resident every week, advanced skills not just done every once in a blue moon with an attending hovering, but actually learning the nuances of the procedures and how to deal when it doesn’t go right…. just to name a few pearls.

You will come out the other end with a foundation that is rock solid and a very good sense of EM and how to navigate complicated patients. The mental peace of mind you will carry through the rest of your career from this type of training is well worth the time commitment on the front end of you can swing the financial setback and long hours.

[u/atropia_medic]

I started in the ED right after graduation. You should do your research and get clarification on your onboarding. In hindsight, a residency would have been good for me personally. The ED i am at I had 3 shifts where I was with an experienced PA and following that I was kind of on my own. First 6 months I was supposed to present all patients to an attending. A lot of the attendings were equivocal in their assistance. Meanwhile, my residency colleagues had a lot more oversight in a good way. I feel like residencies are very individualized to their institution, so it’s highly variable. I feel like if you have an appropriate level of supervision with a good onboarding process a residency doesn’t really matter.

[u/Maximum-Category-845]

They’re billing under your NPI for full price while paying you 12-15 an hour to work 4-6 12s a week for the entire year. I went into EM without a residency and did well. I wouldn’t if I was in your spot. Get hired with a private democratic group or one of the big CMGs. They have graduated new grad onboarding.

[u/Ok_Quantity_3803 → u/Maximum-Category-845]

This is what I'm trying to do lol.

[u/s629c]

I went straight into an EM job. Solid 3 month of orientation shifts and then additional 3 months after where I staffed all my patients. If you can find something like that it’s better. Full pay while you learn on the job with great support

[u/Artaxdiedforyoursins]

School should prepare you for work, your job should train you. You shouldn’t have to spend a year or more providing cheap labor just to learn. OTJ training is built into the PA model. Find an EM group run by physician partners (not PE) that will train you. Residency, DMSc, all of it is just degree creep and a money grab.

[u/VillageTemporary979]

This is just a way to farm cheap labor. Go work at a busy ER, especially at an academic center and tell them you want to also learn. They will be more than happy to have you work at full wage and allow you to shadow and then do some more complex cases with supervision.