Divided on taking this fellowship...

[Guest ERCat]

I recently had my ER rotation and loved it. Never felt so on fire and energized and excited! So I applied for an ER fellowship... And got it. The idea of the ER excites me but I am divided on whether or not I should do this fellowship.

 

I graduate in August, was going to take the PANCE September 1... And this fellowship will start in October or November. So it would be two months before I could start working (that's one con). It's 6 month total for the fellowship... and they pay 30.00 an hour the first 3 months and 40.00 the last 3 months, working 40 hours a week. So it is like $25,000 for six months (another con). They say they will let you take things as slow as you want and it's all about a learning experience. Even if it's just one patient per day. Afterwards there's no certificate of completion or official residency completion (another con)... It is more for the experience, and they promise you they do whatever they can do give you whatever job you want (definitely pros).

 

I am divided on whether or not to take this. The pay is definitely not great. But...The fact that I can still be a student appeals to me, and it's a great way to get into the ER without being thrown into something I am not ready for. I would never take an ER job straight out of graduation without experience!

 

I've been told by other PAs that fellowships like these are just slave labor. But I talked to two of the PAs that went through it and loved the experience and got the jobs they wanted at the end of the day.

[cinntsp]

Six months doesn't seem long enough, especially for the ER.

[EMEDPA]

most of the established em pa residencies are 12-18 months. have not heard of this( 6 mo program), sounds like a gimmick to get free scut out of you for 6 months before they hire you.

[Guest ERCat]

Right. But technically, it's not a real residency or fellowship… That's what the guy told me. He says they won't offer you any certificate of completion or anything, that it's just for the experience (getting to be a student while being paid) -- he says they will do whatever they can to make sure that you get whatever job you want upon finishing. I guess the girl who last of the program got hired on at the location, but they can't guarantee that any spots would be available when I finished.

 

The girl who did the program also said they don't pay you beyond your 40 hours a week. She said that most days she worked 1-2, even 3, hours after her shift and didn't get paid for it. They just give you a flat 40 hour week pay at 35/hr.

 

Part of me thinks this sounds fishy… Part of me thinks it would be a lot smarter to just work in urgent care job for a few years to get my experience...that way, at least I would be getting paid decently… Then try to slide on into the ER after I gained experience. I don't have a burning desire to be in the ER right now, just eventually. I feel like urgent care would be a great new grad job. However, I've also been told that fellowships are very prestigious and I would be a fool to not take up the opportunity because it looks great on a resume and sets me apart from everyone else.

[EMEDPA]

but it's not a real fellowship as you said. no cert, etc. It's you working for less than you are worth, and that just isn't right.

there are 27 legitimate em pa postgrad programs now. if you apply to 5 you will get into one. or do UC for a few years, then do a residency. don't do this unless you are desperate for a job....

[Guest ERCat]

I agree and that why this is unsettling to me. So hard to turn down a spot in such a competitive program -- but it didn't feel right from the get go. I don't mind doing scut work a while but the pay seems insulting when you consider it's not a real fellowship.

 

How plausible would it be to do urgent care For a few years, then apply to ER jobs? Would it be possible to get a job or is it only possible with these fellowships? Would urgent even prepare me adequately?

[EMEDPA]

urgent care is a good start. If you are passionate about EM do a postgrad program. If you are just trying it out do UC, then get a job at a community ER doublecoverage with a doc for a few years. If you really want to see super high acuity or work solo you will likely need more training at some point unless you luck into a situation with a group of docs who really like to teach and will walk you through all the major procedures and cases. I didn't do a postgrad program because none existed when I graduated. it took me 15 years on top of my medic background to work myself into my dream job working solo, directing medics, seeing every pt and doing every procedure.

[Guest ERCat]

So I have an update. I was doing my math wrong and the pay is actually 35K for 6 months... Equivalent to a 70K/year salary... Which isn't that bad especially for the cushion of being able to be "training." I also learned that I can forgo benefits (health, 401K etc) to get an extra 10/hr. I would just get private insurance if I did this. This calculated no benefits pay would then be 45K for the six months -- that to me does not seem bad for a new grad. Learning this was a game changer for me. Sure, since it's on the job training it will not be education that is equivalent to a residency. But for the pay, it seems like a good foot in the door option for ER.

 

Any thoughts on this in light of the recent development?

 

And as a side note -- I know there are legitimate residencies out there but I can honestly say I would not do one. I have been in school too long and have too much debt to justify doing the student thing for another 1-2 years. I know of a lot of PAs in the ER who have not done those long term residencies. I am sure the ones that do are thankful for it and probably better off and worth more -- but all I want to do is be in the awesome, stressful, energetic environment of the ER.

[Guest Paula]

Don't turn down a 401 K and the insurance.  Your private insurance plan will cost you a lot of money.  You will not be  a poor student once you graduate, pass PANCE and start working at this Fellowship.  Plus your loans will come due sooner than you realize.  $70,000 a year in EM is extremely low even for a new grad, but I guess it is called Fellowship pay.

 

6 more months of education like this might be a key to help you.  Remember that the legitimate EM residencies are paid positions, too. 

[gbrothers98]

Only forgo benefits if you can get those through significant other or spouse.

If you make 35k in 6 months, save 10% of that pretax in a 401k, $3500, in 35 yrs at 5% annum return, you would have $20k in your 401k. That may not seem like much but the bottom line is that you will have to save early and often.

Also, your plan to obtain health insurance cheaper on your own is not valid. You likely will make too much money throughout the year to be eligible for subsidies through your state health exchange. So you will pay full price which likely is more expensive than what the employer can provide you.

A few things about this fellowship.

First it isnt.

This is a way for this employer to check out new grads in their ED with minimal risk financially.

The evidence is in the last 'grad' that got hired there. She was kept on but there is no guarantee you can. And the promise of help with a job elsewhere is just that, it is not a contractual requirement for them. I would only count on something in a contract.

The fact that you dont get a certificate or something that signifies your completion means that it is not a residency or fellowship, just something dreamed up locally to entice new grads to work on the cheap. A real residency or fellowship has specific clerkships and objectives, not something vague such as see as many patients as you are comfortable seeing in a day even if it is one.

Better to search out a real job, get paid a real salary (75k is not a real salary) with benefits rather than be taken advantage of.

Or seek out a real residency or fellowship that provides you with objective goals and bonafide completion credentials.

Good luck.

G Brothers PA-C

[ajnelson]

Only forgo benefits if you can get those through significant other or spouse.

If you make 35k in 6 months, save 10% of that pretax in a 401k, $3500, in 35 yrs at 5% annum return, you would have $20k in your 401k. That may not seem like much but the bottom line is that you will have to save early and often.

Also, your plan to obtain health insurance cheaper on your own is not valid. You likely will make too much money throughout the year to be eligible for subsidies through your state health exchange. So you will pay full price which likely is more expensive than what the employer can provide you.

A few things about this fellowship.

First it isnt.

This is a way for this employer to check out new grads in their ED with minimal risk financially.

The evidence is in the last 'grad' that got hired there. She was kept on but there is no guarantee you can. And the promise of help with a job elsewhere is just that, it is not a contractual requirement for them. I would only count on something in a contract.

The fact that you dont get a certificate or something that signifies your completion means that it is not a residency or fellowship, just something dreamed up locally to entice new grads to work on the cheap. A real residency or fellowship has specific clerkships and objectives, not something vague such as see as many patients as you are comfortable seeing in a day even if it is one.

Better to search out a real job, get paid a real salary (75k is not a real salary) with benefits rather than be taken advantage of.

Or seek out a real residency or fellowship that provides you with objective goals and bonafide completion credentials.

Good luck.

G Brothers PA-C

 

drross....This is exactly what I was trying to say in my PM....but this is much more eloquent than I could ever be!  

[RetNavyPAC]

Arrrghh.  HCA does this crap.  Enticing new-grads with an impressive-sounding name when it's really just a cheap onboarding scheme.  Reminds me of the scene at the end of Caddyshack when Carl Spackler is setting up his gopher traps: "Hello, Mr. Gopher! It's me, Mr. Squirrel. Just a harmless squirrel. Not a plastic explosive or anything. Nothing to be worried about."

[Guest ERCat]

OK, I think I've arrived at my decision. I finally feel a little calmer and more at ease with it. I've decided that you guys are right and I should not take this opportunity.

 

I still think that for those students who are absolutely desperate to get their foot into the ED in any capacity and feel their knowledge base is adequate this is an option. Especially if they have had solid prior healthcare experience and ER experience but I haven't. This whole time I've been feeling in my gut that it just isn't a good idea for ME...The truth is I am too unprepared and too insecure in my capabilities at this point to think about living and breathing the ER without adequate supervision AND training. I personally feel like I would be a risk for patients going into the ER without this. I realize everyone has fears when they graduate school, but I really do feel like a risk and that's why I wanted to be certain that this program would really offer me some solid training. And if this experience won't REALLY prepare me and give me the confidence I need then it isn't worth it, especially when I consider the low low pay. How can it be worth it when there is no didactic portion, no specific doctor(s) who are responsible for teaching and leading me on the job, no procedure experience... And then no guaranteed job at the end?

 

Last night for a few hours when I posted my last comments I had a change of heart when I heard about forgoing benefits for a more decent pay. I also had a few people (mostly non-PAs but only one PA) telling me that it is only six months and I might as well do it because I will never get this opportunity again (which is true). So for a little bit I was convinced it could be worth it for the "experience." But sure enough, the feeling in my gut came back and I've officially decided I'm not going to take up this opportunity. When I talked to the guy on the phone today about my concerns about not learning procedures like lumbar punctures and intubations and central lines, he sort of laughed and told me that reality the PAs don't do major procedures and that the six month program he was offering would prepare me everything I actually needed to know. Something about that didn't sit right with me. Not only was it sort of a deprecating and false statement about PAs, and a "shut down" to me for wanting to know those procedures... I got the feeling he felt I was demanding. Although he was very nice, I got the feeling that he was sort of acting like I should be nothing but totally thankful that he picked me for his program. Even if PAs don't do any procedures in his ER, it sure doesn't work that way in all ERs and it would suck to go into an emergency job totally unprepared because I didn't learn things I needed to in my "fellowship." So as hard as it is for me to turn down a post grad program, I feel like it is what I need to do.

 

I am now seeing all of my options clearly. 1) If I did a real ER residency or fellowship, I would learn a lot and I would feel prepared, and I would probably have a guaranteed emergency job at the end. I would have an unparalleled level of experience. 2) If I put my ER dreams on hold for a while and instead did a first job in family medicine and/or urgent care, I would gain a solid foundation as a PA. This would allow me to jump headfirst into the profession without taking on the crazy high acuity patients of the ER. Then as I gain confidence I could consider ER. 3) I could do this program. I would for sure be unemployed for a few months before the fellowship began, as there is a 3.5 month gap between my graduation and the start date. Throughout my six-months I would probably feel a lot of pressure and a lot of stress, and I might feel frustrated that I wasn't learning the things I need to learn. Every day I would be working for very little money and I would be trying to balance the pressure of learning everything I could while trying to squeeze in enough patients to "impress" the program directors in the hopes that they would hire me. And then there's the possibility of finishing the program and not being offered a job, either because I wasn't up to par or because there isn't a job available. Then I would basically be at square one and would be trying to find a freaking job. And by what you're all telling me, and a six-month "internship" would not be sufficiently impressive experience for most emergency departments.

 

My goal is now this -- family med for a few years with a little urgent care on the side, and then I will revisit the ER idea when I have built up my confidence as a PA. Or, somehow miraculously land a job in the ER that's willing to train me and pay me a decent pay.

[Guest ERCat]

Just a question -- if a PA doesn't do a specific residency for emergency (which you hear of all the time) what DO they do to feel okay in ER especially new grads? I know some PAs who literally went straight into the ER after graduation at a normal pay, but how? Are there jobs out there that are willing to train you and teach procedures while paying a normal wage?

[EMEDPA]

Just a question -- if a PA doesn't do a specific residency for emergency (which you hear of all the time) what DO they do to feel okay in ER especially new grads? I know some PAs who literally went straight into the ER after graduation at a normal pay, but how? Are there jobs out there that are willing to train you and teach procedures while paying a normal wage?

most of the new grads jobs are fast track. it is rare that a new grad gets a full scope er job at graduation unless they had significant prior experience and lots of quality rotations in er, trauma, peds er, etc.

[Guest ERCat]

Interesting. So what you're saying is, I could go into the ER as a new grad and do fast track? Which is really what this program would be having me do anyway. Except not paying me a real wage for it.

[Guest Paula]

Yup, sounds about right.  I got a part-time job in the ER and it was the fast track, my first job out of school.  It was interesting and I learned a few new things, did some locums at area hospitals in the ER, mostly fast track, and then worked up to sick medical patients.  I did not do trauma, nor run a code but was part of codes, or if the whole staff ran into the cardiac room and there was no more room for one more body, I just kept seeing the fast track and getting the curious on-lookers with snotty noses the heck out of the ER.  

 

I got frustrated and asked to get more training but no one had time or interest to really mentor in any of the stuff you want and need to know if you do the REAL ER/EM type of work.

 

So ultimately, as they wanted me to do more and see more really sick or injured, (without adequate training), I decided I was more of a liability than an asset.  So now I am in family medicine with urgent care mix.....loving it for the most part.  I do miss suturing and I&Ds and some procedures I did get good at, including splinting fractures,  but the stress got to me.

 

So if  you want to do EM with high acuity and procedure stuff you need to apply for a really good residency.  

[EMEDPA]

Yup, sounds about right.  I got a part-time job in the ER and it was the fast track, my first job out of school.  It was interesting and I learned a few new things, did some locums at area hospitals in the ER, mostly fast track, and then worked up to sick medical patients.  I did not do trauma, nor run a code but was part of codes, or if the whole staff ran into the cardiac room and there was no more room for one more body, I just kept seeing the fast track and getting the curious on-lookers with snotty noses the heck out of the ER.  

 

I got frustrated and asked to get more training but no one had time or interest to really mentor in any of the stuff you want and need to know if you do the REAL ER/EM type of work.

 

So ultimately, as they wanted me to do more and see more really sick or injured, (without adequate training), I decided I was more of a liability than an asset.  So now I am in family medicine with urgent care mix.....loving it for the most part.  I do miss suturing and I&Ds and some procedures I did get good at, including splinting fractures,  but the stress got to me.

 

So if  you want to do EM with high acuity and procedure stuff you need to apply for a really good residency.  

pretty typical

[True Anomaly]

Interesting. So what you're saying is, I could go into the ER as a new grad and do fast track? Which is really what this program would be having me do anyway. Except not paying me a real wage for it.

 

Exactly.  

 

Residencies will also take PA's who have been out of school for a while- they don't just take new grads.  Another option to consider down the road if you choose.