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The residency experience


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#41 bchernock

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Posted 29 October 2009 - 02:18 AM

any updates? Hope the program is going well.

#42 True Anomaly

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Posted 31 October 2009 - 03:57 AM

Time for an update!

I’m now four months into my training; after my first rotation in the ER, I’ve done one rotation in general surgery, followed by another in telemetry. Now I’m back in the ER where I belong, and while it’s really kicking my *** with H1N1 in full effect, it’s still better than being elsewhere in the hospital.


Here’s what I learned first and foremost about my experience on general surgery- it’s very rough to be the very first person to do something- and I had the lucky honor of being the first-ever PA resident to join the surgery team. Please understand, in no way am I trying to compare myself to those PA’s in the past who had to really struggle with trying to establish their foothold in the medical world- but I certainly do appreciate their situation more! There were quite a few kinks to work out, but I tried to make the experience as meaningful as I could- lots of reading on the side about how these surgery cases correlated with what would come into the ER; trying to see as many consults in the ER as I could for the surgery team; taking the time to learn how a surgeon reads a CT scan…or for that matter, having the radiologist show me how they also read emergent surgical CT scans. The nice thing about my struggles in surgery is that there was a change made for the better for my fellow PA resident, who is now on a different surgery team and is having a significantly better experience.

The next month was telemetry- a much different setting and pace from surgery. The difference in teaching between the two services was night and day- whereas little if any teaching went on during surgery, there was ample time and effort made to educate about the world of cardiology. While the attendings in surgery couldn’t be bothered with dealing with an off-service intern, the cardiology attendings were very approachable and enjoyed teaching. There was time to explore every little detail of EKG’s; every other thing that caused a troponin elevation; when a persantine-sestamibi study was actually needed along with a cardiac cath; and probably the most important lesson of all- the small amount of confidence I gained with being able to send a chest pain patient home. During the first couple of weeks on the service I wasn’t able to go down to the ER to admit patients, but was finally allowed to do so after proving myself on the team. I had some big shoes to fill after my other fellow PA resident, who is much sharper at the inpatient side of things than I am and who completed the rotation before me.

The off-service rotations provided several opportunities to educate about what a PA resident really is. More often than not I got the question, “So when you’re done with this, you’re a doctor?” There’s also been other logistical issues raised, but it all comes with educating other people in the hospital about just what our role is.

As I mentioned above, I’m now back in the ED for my second full month, and it really felt like a homecoming- but oh wait, here’s H1N1 to spoil the party! Our ER has been inundated enough to set up our very own “Flu Tent” outside to steer the masses there who clearly need some TLC at home for their illness (the truly sick complications from H1N1 will still get routed through the main ED). The journey through the two off-service rotations has again helped me give just a little bit of confidence when it comes to dealing with those particular types of patients, whether surgery or cardiac (not even the ED physician residents get to do a telemetry rotation- they just do a standard internal medicine inpatient rotation). I’m finally starting to feel confident on the relatively easy stuff, while at the same time being more brave with how far I can go on the more complicated patients. It’s amazing to me how dealing with the nursing home patient who can’t speak no longer brings this overwhelming tide of insecurity through me like it did before. And I’m squeezing myself into enough traumas that I’m trying to get to run either the primary or secondary surveys on the patients (on the minor stuff….but hey, you gotta start somewhere).

In short…..so far, so good. I don’t think I’d be this far along in confidence and ability had I made a go of this on my own without the program.

Next rotation...anesthesia! Nothing but intubating all month long!
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#43 EMEDPA

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Posted 31 October 2009 - 04:08 AM

Next rotation...anesthesia! Nothing but intubating all month long!


MAKE SURE YOU GET ENOUGH "REAL INTUBATIONS"(AS OPPOSED TO LMA'S) AS LAZY ANESTHESIOLOGISTS REALLY LIKE LMA'S FOR SHORT CASES. I'M NOT A BIG FAN OF THE LMA IN EMERGENT PTS AS IT DOESN'T ACTUALLY PROTECT THE AIRWAY...

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#44 bchernock

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Posted 01 November 2009 - 07:26 AM

Glad things are going well.... keep it up.

#45 klb48

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Posted 01 November 2009 - 01:13 PM

Thanks for the update! Hope you enjoy all those intubations!

#46 Stephanie2009

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Posted 05 January 2010 - 03:35 AM

Does anyone have a general idea of the salary a PA would make after a residency such as EM?

#47 EMEDPA

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Posted 05 January 2010 - 03:52 AM

Does anyone have a general idea of the salary a PA would make after a residency such as EM?

>100k to start in the right setting.

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#48 lov2xlr8

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Posted 05 January 2010 - 01:19 PM

Does anyone have a general idea of the salary a PA would make after a residency such as EM?


First year out of EM residency at a large hospital in Miami, my friend started at 120k. More and more, I see the benefits of aresidency. As many have said in other posts, your responsibilities and autonomy is greater (i.e the procedures you can do) and it seems the starting out money is worth the year of lost pay as a resident.

I really enjoy this thread TA. Thanks and keep it coming!

#49 True Anomaly

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Posted 03 February 2010 - 02:54 PM

When I started this thing, I had anticipated not posting regularly, but at least I had envisioned a post at least once a month. I’ve just been busy enjoying not only my residency but also the life I now find myself in. So I’ll spend this post catching y’all up on what’s been up with my experience as a resident.

As of my last post, I was finishing up another month of the ER and excited to start anesthesia. This turned out to not be as wonderful as I had anticipated, but at least I was able to get some experience at intubations through various means- not just direct laryngoscopy, but also with the “light wand” and the new toy in the hospital, our own glidescope with LCD monitor. What was equally important to me was getting down the proper method of bag-valve-mask ventilation; I didn’t realize all the errors I had ingrained in myself with BVM’s when I was an EMT. Yes, I did a few LMA’s as well, which was fine since I hadn’t played with those much prior to PA school- and hey, at least it’s a temporizing measure. The frustrating part was fighting with the CRNA students at the hospital for procedures; this has been an ongoing problem at our facility for the physician ER residents for quite a while, and a fundamental overhaul of the anesthesia rotation is likely. So what I got out of the rotation was truly a matter of how aggressive I chose to be. I could’ve gotten a couple more intubations, but overall I felt I did enough to at least get comfortable with the action.

At the end of the month I finally had a week of vacation; I chose to travel to Boston, which was the last major Northeast city I had yet to see. Boston in December probably wasn’t the smartest idea for a vacation, but it was quick, easy and something new to see.

Upon return, all the ER residents (physicians and us three PA’s) split up into two groups- one half was going to work over Christmas, and the other over New Years. I chose to work the two weeks over New Years, which meant that I started LAB WEEK- a week devoted to procedure practice and lectures about those procedures, as well as refreshers in ACLS, PALS and ATLS procedures. The first day of lab week involved ENT procedures- this was the day where we performed nasopharyngeal laryngoscopy on each other with the video fiberoptic scopes. I really wanted to be the guinea pig so I knew exactly what this felt like, so after a lidocaine neb treatment and Cetacaine spray in the throat (sour bananas!), up went the tube….and oh man, is that ever uncomfortable. But once it was in I got to see my vocal cords and use my iPhone to take a picture- how cool is that??? The rest of the week involved running multiple megacodes, chest tubes, cricothyrotomies, peritoneal lavage (yeah, it ain’t used much anymore, but they still wanted us to know how), slit lamp examinations and some minor stuff.

After a week spent back home in Texas for Christmas, I returned for six straight weeks in the ER, which I’m now wrapping up. This recent stretch of ER work has been a real turning point- thanks to one of our attendings (who used to run the physician EM residency and is now the chief academic guy at the hospital), I’ve learned the proper perspective of how to approach any ER patient. And I’ve seemed to arrive at some level of respect among the nursing staff (especially with the tough-as-nails night crew). It makes work so much more bearable, and is starting to feel like “home”, even if I end up leaving here at the end of my residency. I also like to think that myself and my two fellow PA residents have come to some level of respect among the physician residents; they've certainly been nothing but accomodating and helpful to me. One of them was kind enough to give me all her stuff from EMRAP that's available only to Emergency Medicine Residency Association members...an organization we're not quite able to join ;)

Next week, I’ll be finding out exactly what the potential EMS fellowship will entail, and will choose to extend my contract for it or not. It’s also almost time for the next round of interviews for potential PA residents to start, and I’m quite excited to meet those folks who were in my shoes at this time last year.
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#50 bchernock

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Posted 08 February 2010 - 08:12 PM

Thanks for the update. That residency really sounds like a truly amazing experience. Make sure you let us know what they have in store for the EMS fellowship. Koodos to them for getting PAs more involved in EMS!

#51 LobotomyPlzThx

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Posted 11 February 2010 - 09:45 PM

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.
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#52 rcdavis

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Posted 12 February 2010 - 08:42 AM

great job reporting.

exciting times

keep it up

davis
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#53 True Anomaly

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Posted 13 February 2010 - 09:06 PM

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.
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#54 EMEDPA

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Posted 13 February 2010 - 09:11 PM

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

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#55 True Anomaly

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Posted 13 February 2010 - 09:50 PM

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 ;)
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#56 LobotomyPlzThx

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Posted 15 February 2010 - 03:29 PM

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?
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#57 True Anomaly

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Posted 15 February 2010 - 09:10 PM

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.
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#58 istat2

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Posted 04 April 2010 - 06:04 AM

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?
Just an old broke down medic living in Anchorage-which is only 20 minutes from Alaska :D

#59 True Anomaly

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Posted 18 May 2010 - 03:02 AM

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!
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#60 rcdavis

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Posted 19 May 2010 - 08:36 PM

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
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