The residency experience

[LobotomyPlzThx]

What's the weekly schedule like? How often are you on call? How long are your shifts? How many hours a week? If you don't mind sharing, what's the stipend? Thanks.

[rcdavis]

great job reporting.

 

exciting times

 

keep it up

 

davis

[True Anomaly]

What's the weekly schedule like? How often are you on call? How long are your shifts? How many hours a week? If you don't mind sharing, what's the stipend? Thanks.

 

My months alternate between the ER and off-service rotations, so the schedule is dependent on which service I'm on. In the ER, we generally work 6 days in a row, followed by three days off. The shifts vary from 9A-7P, 7P-7A, 7P-5A, 7A-7P, Noon-Midnight, or 9P-7A...so depending on the shift, it's either 10 or 12 hours. This means I never work more than 80 hours/week, but it comes close. The shifts also alternate between the three different areas of the ER.

 

For the off-service rotations, the hours may be longer or shorter. I am not put on call, but this has mostly been due to circumstance- for instance, the surgery department no longer puts the ER people (whether physician or PA) on call anymore- that's just their way. No complaints from me, though :D. Other rotations have no call anyway- such as during anesthesia where we did our procedures in the morning when most surgeries occured, or during radiology where it's very laid back, or during ortho splint clinic which only happens during business hours. When I do the SICU in a couple months, it'll be just on during the day without being on-call.

 

The stipend is the same for every intern in the hospital, and is no secret as it's listed on the program's homepage- $46,600. Additionally, malpractice, health insurance and CME are included.

[EMEDPA]

sounds like it's going well...still jealous....

[True Anomaly]

sounds like it's going well...still jealous....

 

Well, I'm still not able to go play in Haiti like some other folks...so the feeling is mutual ;)

[LobotomyPlzThx]

Thanks a lot for answering my questions. Are they flexible about accommodating other life responsibilities? For example, if you needed every Sunday morning off for church or something, would they let you consistently get the noon to midnight shift or the late shift on that day?

[True Anomaly]

I have never requested schedule accomodations because I don't have anything that needs accomodating. I schedule my life around my residency schedule. To an extent, you are free to trade shifts with other ER residents so long as it jives with the overall schedule.

 

I also have never heard of anyone, whether physician or PA resident, in any department in the hospital, getting schedule preference for something like church.

[istat2]

As a residency graduate let me explain how it works. Have a life?-you don't. Time off-doesn't exist. Life responsibilities-if it will interfere with your training you probably shouldn't be there. If you are going to take one of the few valuble slots be prepared to dedicate your life for that year to it.

 

Questions?

[True Anomaly]

So I'm a little overdue for an update. Let's see....where I last left off, I was entering my trauma surgery month. Oh, what a joke that turned out to be- there was NOTHING! Gang-related trauma is very dependent on the weather here in North Philly, and since we saw record snowfalls all month long, the trauma numbers went WAY down. You have to REALLY mean it to shoot someone in the middle of a blizzard. I was still able to assist in the very few traumas that came in during the day, including doing a chest tube on a hypothermic code who had a core temp of 25 Celsius. But the rest of the month was spent monitoring old folks who fell down while on Coumadin and ended up with all shapes and sizes of intracranial bleeds. And of course, the very next day after I leave the service, the weather perks up and they get multiple stabbings and shootings on the service. Good or bad luck, depending on your perspective.

 

A snafu also occured during this time, where my surgical ICU fell through through something at the administrative level, so we came up with an impromptu rotation at a community ER to substitute. The idea was to be the "procedure guy" in the ER and learn to manage the critical stuff that came in the door, as there are no residents at this particular hospital during the day. I got my fair share of central lines, LP's, intubations and (chemical) cardioversions. It was really nice to get back to a more community-ER setting that this hospital offered, which helped me to decide the kind of area I want to practice in when I'm done with this program.

 

This past weekend was exactly one year since I graduated PA school, which gave me some time to reflect on where I"m at now with my career. One year later....absolutely no regrets about doing this program. I really don't know where I am in relation to a PA who just got hired on with an ER straight out of school without any prior experience....all I know is that compared to some of my physician resident colleagues, I'm doing well. I definitely feel the confidence that should come with that first year under your belt, but seeing how much more there is to master as the years go by. I honestly couldn't imagine having done this past year without the support I've had at the program, so my hat's off to all of you who just jump into a job straight out of school and try to make it work.

 

On a personal note, I'm taking a damn sabbatical when I'm done with this thing! Two or three months to travel the world, race on my bike, play music....SOMETHING ELSE!

[rcdavis]

you are getting very very studly.

 

and the next ED you walk into you will find that:

 

- 1. you walk much less urgently around, ans you know there are truely less things that you cannot handle (performance / ability anxiety leads to anxiety)

 

2. you will be much more efficient than you were before.

 

take that sabattical, enjoy yourself and re-read house of god.. which of course starts with a sabattical..

 

davis

[EMEDPA]

agree with davis. you are learning a lot and are way ahead of most em pa's out there and definitely at the 99% vs ANY 1st yr em pa without residency.

[mahnken]

I have really enjoyed reading about your residency. I have always been interested in EM, and just recently decided on PA school versus going back to med school. I didn't even know PA's could do a residency. I am very excited to hear more!

[narcan]

TA,

 

Any update on the EMS fellowship? How is that going to be structured and what is the PA's role going to be? Very interested to find out. Any EMS research opportunities for you there?

 

Thanks for all the updates. It's been really informative to read your posts.

[True Anomaly]

Hey gang!

 

So uh....once again, it's been a while! I'm still around...life has just taken over, and I'm letting it wash over me. So while I've been buried up to my neck with both the residency and personal life, the forum's gotta take a back seat :xD:

 

Where I left off, I think I was wrapping up another month in the ER, and was (still) awaiting what the EMS fellowship was going to look like. I finally have some good idea of how it will go down. Basically, I will be put in charge of one of the EMS organizations we picked up in our medical direction group recently (with the appropriate physician oversight, of course). This EMS group runs 1-2 calls per day on average, and it's felt that this will be an excellent training ground for this program to get started due to the low call volume and the ability to be as hands-on as we want to be. It should involve at least 8 hours of in-station time (riding out with crews, QA/QI of reports, teaching topics to the medics), and possibly more if I choose. And while that would be my main responsibility with the fellowship...when it comes to actually doing advanced skills in the field, I'll ride out with busier services that are overseen by others in the medical direction group. I've been told by the "godfather" (my term) that "You're not gonna want to leave...you're gonna have too much fun". :=D::=D: This is all still theoretical....but at least I now have some idea of what's gonna go down. It's equally nerve-racking and exciting....so we'll see what happens come January!

 

As for the residency....during June I did two weeks of radiology and two weeks of OB. Radiology consisted mostly of doing bedside ultrasounds in the ER- mostly FAST scans (with the extended pneumothorax views) and OB scans to rule in IUP's, but also got to practice doing aortic scans, gross evaluation of cardiac status with bedside echo's, searching for DVT's and gallbladder scans. I really only feel proficient in FAST scans now, but at least I got good looks at everything, so it won't be the first time attempting this stuff in the future if/when I need it. Oh yeah, and a few ultrasound-guided central lines to round it out. :wink: The OB rotation had me bouncing from L&D to OB Triage...and I found OB Triage the most helpful since, of course, it's the OB ER. Not that most ER's have the stuff needed to evaluate pre-term labor and other such specific etiologies, but at least I've got some grasp of the stuff.

 

July was orthopedics, in which I primarily did consults in-hospital and also in the ER....which means lots and lots of reductions! We reduced quite a lot of wrists, but also a couple shoulders, ankles and such. Doing clinic once a week helped to see the other side of when I send people to ortho from the ER with splints on....and just how shoddy of splints I used to do ;) I feel like I should be doing plaster for EVERYTHING, although I know how impractical that can be. Loved the ortho guys...one of the best training programs in our hospital- they knew their stuff.

 

Currently, I'm wrapping up my pediatric ER rotation at one of the two local pediatric hospitals...and it's been one of the best rotations I've had. While I haven't had great exposure to true pediatric resuscitation (the ER has a LOT of residents...and unfortunately, we kinda take a backseat to that), there's still plenty of sick kids to go around, so I'm admitting neutropenic fevers and random thrombocytopenia and doing LP's on neonates....and trying to do it while handling 5-6 patients at a time. And this is a good marker I'm using, as the ER there also uses staff NP's to see kids...and while I'm seeing 4-5-6 patients at a time, they're seeing 1-2 mostly. Not to brag....but it does make me feel pretty damn good :D

 

In between the work and the readings I've been imposing on myself, I've found time to really enjoy life. Honestly, I've enjoyed this past year more than any other time of my life. Philly's pretty awesome, if you know how to work it ;) Getting into cycling the past couple of months has been a nice physical diversion away from the residency, but I'm always guilty of tackling more hobbies than I have time for. But a life not advanced gets too stagnant!

 

And in the past couple of months I've been to both St. Thomas and London for vacation....both awesome!!

[elmostoy]

where are the post?

[True Anomaly]

"Where are the post?" Explain, please?

[True Anomaly]

Hello all!!

 

I think this is the longest I've gone in between posts. Blame it on life going well. I haven't found the best way to integrate constructive Internet time with a quality life, like others seem to have.

 

I'm here to tell you, though, that I'm DONE with the residency! I've actually been done for about three weeks now, but haven't gotten around to discussing it until now. Let's swing through the last few months and what was involved with each rotation.

 

After my pediatric ER rotation, I did my last full month in the regular ER. I felt myself starting to stretch out my wings and try flying solo...but everytime that would happen, some case would come up that would ground me, or an attending would remind me of how much I still needed to learn. I was still feeling the constraints of being a resident - I had my own idea of how I wanted to proceed with a patient, and I really did want to go around the senior resident to the attending simply to expedite the process. Plus, having been my first time back in that ER in a few months made it a bit more of a challenge to get back up on the saddle and ride. The best part was working with newer interns, and watching them trying to learn to stand up and crawl made me feel better about really stretching my legs and running.

 

After that was an interesting mix of two rotations- two weeks in the CCU, and two weeks of nights in the MICU. My first time to be in a critical care unit- I used it mostly to focus on ventilator management and hemodynamic support (ie, "What drug do you want the MOST, because you have 4 access points and 5 IV drugs ordered??"). I was scared ****less to be in the units, to be honest...but it wasn't as scary as I thought it would be once I started doing it and learning the reasoning behind it all. There was a nighttime ICU attending who was excellent with teaching, and the senior resident would go over topics every night. Knowing the ins and outs of ventilator management was invaluable. Getting to do some arterial lines was a nice benefit. No intubations, codes or central lines, but that didn't bother me (I was a freakin' white cloud with absolutely NO codes on a unit month!). This was another rotation I truly benefitted from by doing a residency.

 

Next up was two weeks in ophthalmology, and two weeks in ENT. The Ophtho rotation was simply about getting to look at as many eyes as possible. No paperwork, and I didn't have to see my own patients. I could bounce from room to room and look at all the dilated eyes I wanted. This was the point where I finally said, "So THAT'S what an optic disc looks like!". Using cycloplegics wasn't as scary as I had initially thought, and certainly made me think I was UNDERutilizing them in the ED. By the end of the two weeks, one of the optometrists thought I could drive a slit lamp like a Porsche. ENT wasn't as great, but I did get to do as much nasopharyngeal-laryngoscopy that I could handle. There were some dreadedly long stretches in the OR where I did nothing, but I took it all in stride.

 

The next month was fast track at another hospital in our system. Overall...excellent experience. I truly picked up my pace in how many patients I was seeing while trying not to sacrifice quality of care. But, the absolute biggest beatdown was the amount of drug-seekers who came into that particular fast track. I was blown away. I had heard they had a huge problem with it, but I had somehow minimized it to "It can't be that bad". Well, it WAS that bad. It did lead to some interesting moments however. One of my PA resident colleagues had seen a patient there the previous month for dental pain, had given her a dental block and 30 percocet. A month later, she sees me, gives the exact same story of how she can't get into her dentist for a week, was referred to an oral surgeon who couldn't see her for two weeks....and when I confronted her about what we did for her before (and how she lied about not coming there before), her attitude predictably turned sour. And I quote, "I didn't know you guys actually kept records of that stuff".

 

My last month of residency was the holiday block- you spend two weeks working in the ER, and two weeks on vacation and doing lab week skills. It was quite a little swan song to being a resident. My last shift as a resident was Xmas Eve overnight, and the ER did a very nice potluck, which helped give it a finality of sorts. As I walked out, a lot of the residents gave me a little ovation, which felt pretty nice.

 

So now it's the end. After all this....what is there to reflect on? The complexity of patients who constantly gave me mental and logistical fits? The difficult residents from other services who treated you like dirt because you were an intern? The baffling nature of attendings who do things contradictory to each other, but yet can both quote studies that say the exact opposite? Or maybe....the kindness of the residents, nurses, techs and other staff who welcomed me and never made me feel inadequate because I was a PA? Maybe the resident who gave me access to EMRAP and the wonderful resources available only to physician residents, but who realized I was learning just as well as he was? Maybe the camraderie we all experienced when we rented limos and drove all around the city findings props in order to put on a skit about...anything? The countless nights spent out with not just the ER residents, but other residents in the hospital who realized we're all in this together? Maybe the respect I gained from other physician residents who treated me as an equal and not as a subordinate?

 

The best question to ask- "Am I glad I did this, and did I learn anything?" A resounding YES.

 

Would I choose to go through this again? Umm.......would any of you go through PA school again?? :D

 

So what am I up to now?? I am now hired as a staff PA through the same hospital. No more running through attendings and senior residents if I choose not to, and the schedule is WAY less brutal....along with actually making SOME money! I still see mostly the same kinds of patients, but since we also cover a community ER I get a breath of fresh air from the inner city on a regular basis.

 

Oh yeah.....and I am right in the middle of our brand-new, never-before-seen EMS fellowship for PA's. But that's gonna have to be covered another time, because I'm tired of watching myself type!

[chiaroscuro27]

Amazing, TrueAnomaly! I'm so happy for you.

[klb48]

Congrats!!! And thanks for sharing your experiences along the way!

[zzz]

I see you have been working 24 yrs in Emergency Medicine. I bet you have tons of experience. Do you ever consider going to med school because you pretty much can pass step 1, 2, 3 easily?

[homecow2000]

Hi All! I am a second year PA student and I just received the good news that I will be interviewing for a surgical residency slot soon. Any advice that current or previous residents have regarding the interview process would be greatly appreciated. Thanks!

[HersheyKisses]

True Anomaly congrats on your success!!!! And thank you for sharing it with us!

Can you lend any advice on how to make your residency application competitive? I will be starting school this summer and want to make sure I make decisions that will eventually build a competitive residency application, but besides good grades I am not sure where to begin. Any thoughts?

Thanks!!!

[dukefan]

Thanks TrueAnomaly! This really reaffirmed my desire to follow your path. I will be graduating in August and just wanted to echo the last two posts and see if you had any tips on landing a residency. I hope to be able to get into one of the limited EM spots.

[mshells90]

Reading this has definitely motivated my to attend a residency in the future. Your experience sounds amazing.

[Focused7285]

Hey!

 

I have been following your posts.......thank you so much for keeping us up to date on the experience! Do you have any suggestions for making a good impression during the interview process?