Thinking about a residency but.......

[paraguru]

I have been thinking about attending an EM residency but I am hesitant for several reasons.

 

1. I have been practicing rural primary care/EM for just over two years and have about 1.5 years left on my current contract. How did anyone else in the same boat cope with the huge pay cut when you went to your residency? Was it worth the huge cut in pay?

 

2. How hard is it to just find an EM job and simply go to work? I know a residency would be awesome because of the immersive environment but is it worth it in the long run? What value is added at the negotiating table? I have EM experience (granted not the massive level one trauma, 80-thousand-visits-a-year, running-your-butt-off-for-12-hours kind) but still it is better than the nothing kind.

 

Any thoughts would be greatly appreciated. Thanks in advance. - Sonny

[KMD16]

It doesn't make sense given the loss of income & the fact that you've being a PA for 2 years. If you need to add to your skills set. Here is what I would do. Attend every EM cme/bootcamp, EM pod cast/cme etc. You could go to PA EM residency program, review the program outline and use it as your study guide. Pick up hour at busy ED start as a per diem and later convert to PT or FT. I must admit, when I was two years in practice, I felt like doing an EM residency. I will end here and would let others like E chip in.

[True Anomaly]

KMD makes good points- there are several ways to get education and experience that don't involve doing a residency. I've never felt that residencies were the "end-all, be-all" of getting ER experience- I fully support additional programs, seminars and self-directed learning to keep yourself a competent provider. Particularly with the education portion- you can certainly read the same texts and studies that I read and draw the same conclusions. There IS something you lose by not being in that "immersive environment" that was alluded to above- and for me that was one of the things that was worth it- but that doesn't work for everyone. We all learn differently, and thankfully there are several ways to go about obtaining the knowledge and skill set needed to function.

 

As far as transitioning from a job into residency and pay-cut....I went straight from school into a residency, but about half the residents in my program did come from other jobs- for the most part, they were single with no kids, so their expenses were minimal. They just sucked it up and dealt with it- Im not aware of any of them taking out any loans. You don't make peanuts, but youre certainly on the bottom rung of the PA world, salary-wise.

[paraguru]

Thanks to both of you, I really appreciate the insights. I have been attending the EM CME courses when available. As for getting a PT gig in an ER, I am about 40 miles from the nearest "large" ER and have thought about trying to get on there. It is really hard because I already take 10 days of ER call per month where I am currently working. It doesn't leave a lot of wiggle room for family and other stuff.

 

Thanks again for the feedback. - Sonny

[KMD16]

You're welcomed! You're building a good experience for when you decided to do EM full-time.

[EMEDPA]

2. How hard is it to just find an EM job and simply go to work? I know a residency would be awesome because of the immersive environment but is it worth it in the long run? What value is added at the negotiating table? I have EM experience (granted not the massive level one trauma, 80-thousand-visits-a-year, running-your-butt-off-for-12-hours kind) but still it is better than the nothing kind.

 

it's easy to find an em pa job. it just isn't easy to find a GOOD em pa job without significant experience.

you need to start somewhere. you can suck it up and do 12-18 mo of intensive training now or work your way up the experience ladder by working a series of not so great jobs, each slightly better than the last.

it's not about the didactic exposure, it's about the hands on. you need to actually DO the procedures and SEE the really sick folks yourself live and in person.

[Maverick87]

Bump.

 

Emedpa, do you think doing a residency 3 years into practicing makes sense?

 

Based on your response here, the answer appears to be yes?

[EMEDPA]

Bump.

 

Emedpa, do you think doing a residency 3 years into practicing makes sense?

 

Based on your response here, the answer appears to be yes?

yup. I'm still considering one 20 years into practice...

[andersenpa]

There were PAs in my residency class (Surgery) who came from established clinical practice, for the reasons mentioned above- wanting to build skill set and competency

Having seen what it offers, I would say that it will accelerate your learning curve faster than a standard PA position- BUT- this depends on the quality of the program. Postgrad programs are growing now so (just like with PA programs) the younger residencies may still be oiling the machine.

 

The only person who can determine the relative value of gained experience and skill over income lost is you. My guess is that you will be glad you did a residency when you're done.

[gbrothers98]

I think a residency makes sense unless you cant relocate or the hit to income is insurmountable for the year.

On the other hand, could save up prior to the residency so you dont come out as a pauper.

The real question is, is a residency or fellowship worth it?

What determines worth though? A very individual thing. For some obviously money. Would they get the same job if they did or did not attend the fellowship? No double blind, RCT to prove that.

Instead, read the entries from some of the fellowships on this forum.

When you go to that full time job instead of doing the fellowship, no one is going to let you wander around an ED for 2 weeks, doing an ultrasound on every patient nor will there be an attending there to teach you this skill and discuss technique and cases with.

Same with ophthalmology and eye exams. And tubes and the OR. The EMPA fellows at Albany Med describe a pretty rich environment for learning. With a few years of PC and some EM under one's belt, hitting the ground running in that situation would be likely.

Last, if 2-4 years into a career, this is the start of a marathon not a sprint. Put in the miles and the training now.

GB PA-C

[ventana]

13 years out

 

created my own "residency" of sorts having worked

5 years urgent care, occ health, PCP

2 years IR

1 yr Chronic Pain

1 yr ER - main side

2 years office based urgent care

 

now in my own practice and guess what - there I times I really wished I had done a residency and knew more..... there is just nothing like trying to drink from the knowledge fire hose in a formal training environment - it works!  

 

I considered going back to the new VA Geriatrics/IM residency that is developing just a few years back

 

I honestly don't think there is much to be lost by doing this - 

 

If you can make your ER pay 130k after residency that instead of muddling along at 80-100k for a number of years, well it doesn't take long to make up for the $50k loss for one year.....

[SoCalPA]

Is the pay difference for residency trained really that large?

[EMEDPA]

Is the pay difference for residency trained really that large?

yup. probably 30k/yr as residency grads can ask to start near the top or at the top of pay scales while new grads by definition start at the bottom. we just hired a residency grad with 1 yr experience after her residency. she will probably make 130k+ her first yr working for us.

[gbrothers98]

Is the pay difference for residency trained really that large?

 

With so few PAs attending a residency in comparison to the yearly release of new grads, likely a hard thing to get a handle on. 

Part is assumption that a residency completion will equal better pay.

Maybe it just translates into better opportunities?

 

Anecdotally, I was discussing this with a colleague recently. His SO graduated from a fellowship sponsored by a well known academic medical center last year. She got guidance from the fellowship director about salaries when job searching because she truly could not determine what her value was post fellowship. They took a local survey of PA salaries in the specialty to establish a range. Then they added 25-35k to make a range that reflected the worth of the residency. 

 

Since she had flexibility in where she lived, she could readily turn down places that didnt land in that range and accepted a position that did. 

 

I imagine the same thing occurred during the period of time that residencies and specialties were developed in this country. For example, decades ago many EDs were staffed with physicians that had completed residencies in other specialties including surgery and IM/FP. As EM residencies gained traction, savvy graduates of those started to market themselves and also established salary ranges regionally. I could see grads of PA residencies and fellowships doing this across the country and I hope they do. It is a wave that will raise all ships to a certain extent.

GB PA-C

[EMEDPA]

Agree with above-

there are really 2 issues; getting the job and getting the salary you want.

we occasionally hire new grads, but they work fast track/urgent care for 1-2 years before they see sicker pts. In those areas they make 20 dollars/hr less than the pas working in higher acuity areas.

the residency grad we just hired went to work right away in the high acuity areas and also covered solo night shifts her 1st month there.