New Grad: ER fellowship or dive right into ER position?

[currentlyaca]

I am a new grad who is trying to decide between accepting an offer for an ER fellowship position and an ER position that offers very little to no training for new graduate. Obviously, the pay difference is substantial: $50,000 (for the first year- going up to 80 something the 2nd year) vs. $98,000 right of the bat. The hours and benefits are similar (the fellowship is unlike many of the typical residency programs- it is only 40 hrs/ wk) but the ER position offers only 1 week of minimal training, whereas the fellowship will be a year long learning experience. I'm assuming the ER position trusts me enough to handle patients on my own (I was a student there for 4 wks--and loved it but was certainly overwhelmed), however ER is not an area of medicine I want to have any doubts in myself as a PA. Thoughts? Advice?

[True Anomaly]

Honestly, depends on the fellowship program

[Guest Paula]

The ER fellowship is 2 years with pay of $50,000 first year and up to $80,000 second year? vs. $98,000 for the job offer with 1 week of training? If it's a good fellowship with intense training ( not just a cheaper way to pay you for services rendered) then I would say take the fellowship, then take the ER CAQ when you are eligible to take it.

[Just Steve]

How do you feel about being responsible for the death of patients?

 

Before anyone gets their undies in a knot, we all have to admit to being unwittingly responsible for the death of some of our patients..it's not a matter of "if" but rather one of "when".

 

Depends on your background/baseline ER knowledge AND the role in the ER. Will you be responsible for solo coverage? Invasive procedures i.e.: central line placement, intubations, chest tubes? Ever done those? How do you feel about pediatrics who are trying their best to die for no obvious reason?

 

If you have little to no background (four weeks as a student is not a background, or even a warm up), don't put yourself and your patients through the stress and torment of learning on the fly. Go to the residency. Please.

[EMEDPA]

agree with Steve and Paula above. do the residency.

[True Anomaly]

Maybe I should clarify- what I'm now seeing is that not all "residencies" have their residents doing advanced invasive procedures or working with critically ill people- in short, preparing someone to be able to function as a (mostly) autonomous provider in an ED. They are "residencies" only in the sense that they pay half of what they could pay a "full" PA. So again, my advice is "it depends on the program".

 

currentlyaca, if you're not comfortable saying which program it is on here and want to send me a private message, I'll be glad to help.

[ventana]

if er is your field do a GREAT fellowship get the procedures and training the 50k loss in salary comes back to you quickly when you make 120-140k per year and you dont (hopefully ) kill anyone

 

sorry but MOST new grads have no right being anywhere near ER few exception with military or prior STRONG hce but in general fellowship way to go (and we are all going there in the future IMHO)

[Houstonian]

Do the residency, so long as it is a true training program and not just "cheap labor". If you take the high-paying ER job, and then cannot handle the responsibility, you will be fired; where will that leave you? On the other hand, if you do the residency, you can truly learn your craft, which will ultimately insure both your success and high potential level of income for the long term, whether you stay in ER or change to any other field.

[skyblu]

Interesting, I was coming in to say "Take the job."

 

My experience was that of learning of the job, which is kind of the point of being a PA. One of the best parts of being a PA, for me, is that I am not locked into a specialty.

 

I started off in E-Med as it is my true love, and yeah, I learned on the job. I didn't staff serious cases on my own at first, I had an attending guide me through the process. I am fortunate that in my job, the attendings are plentiful, approachable, and willing to help. If the chart I picked off the rack was, say a chest pain, or an elderly person with belly pain, or anything that was a bit more involved, I got an HPI (unless patient was critical in which case triage would have given the chart directly to an attending or a senior PA), then presented to my attending before proceeding.

 

Three years into the job and I run codes on my own. While making six figures since I was right out of college. I graduated in 2010 and am in the same job as where I started, and love (almost) every minute of it!

 

Some of my colleagues have the CAQ certification, but in our job, you are paid by seniority, so the certification doesn't really matter in my particular physician group. It might be helpful in other jobs or in standing out as a candidate when applying to jobs (as might be the residency completion), but if you already have a new-grad job offer for 98K, I honestly don't see the point of the residency.

 

The only thing is the new grad job should be in a busy ED where you will be able to hone your skills in procedures and your eye for sick vs non sick people, and you can't do that if you're in certain Urgent Care-type settings. And it should be somewhere where you have lots of available senior residents or attendings to staff cases with. A rural ED where it's just you and a doc might be super scary as a new grad!

 

Take my advice with a grain of salt, as I was very, very lucky to get a job where I was both training and earning at the same time. And my hospital doesn't have an emergency medicine residency program for PA's or MD's, so I never have to fight residents to get a good case or to throw in an ET tube or perform a cool procedure. Also, I had done 3 ED rotations in my clinical year in PA school. One was my assigned, one was my elective, and one was something I begged for during our break from school. All were at the same Level I trauma center where they love to teach, so I got 15 weeks of amazing training side by side with the MD residents (they normally don't take PA students there or employ PA's, but I somehow got in!)

 

So yeah, your mileage may vary. I got pretty lucky with my situation!

[cbrsmurf]

Interesting, I was coming in to say "Take the job."

 

My experience was that of learning of the job, which is kind of the point of being a PA. One of the best parts of being a PA, for me, is that I am not locked into a specialty.

 

I started off in E-Med as it is my true love, and yeah, I learned on the job. I didn't staff serious cases on my own at first, I had an attending guide me through the process. I am fortunate that in my job, the attendings are plentiful, approachable, and willing to help. If the chart I picked off the rack was, say a chest pain, or an elderly person with belly pain, or anything that was a bit more involved, I got an HPI (unless patient was critical in which case triage would have given the chart directly to an attending or a senior PA), then presented to my attending before proceeding.

 

Three years into the job and I run codes on my own. While making six figures since I was right out of college. I graduated in 2010 and am in the same job as where I started, and love (almost) every minute of it!

 

Some of my colleagues have the CAQ certification, but in our job, you are paid by seniority, so the certification doesn't really matter in my particular physician group. It might be helpful in other jobs or in standing out as a candidate when applying to jobs (as might be the residency completion), but if you already have a new-grad job offer for 98K, I honestly don't see the point of the residency.

 

The only thing is the new grad job should be in a busy ED where you will be able to hone your skills in procedures and your eye for sick vs non sick people, and you can't do that if you're in certain Urgent Care-type settings. And it should be somewhere where you have lots of available senior residents or attendings to staff cases with. A rural ED where it's just you and a doc might be super scary as a new grad!

 

Take my advice with a grain of salt, as I was very, very lucky to get a job where I was both training and earning at the same time. And my hospital doesn't have an emergency medicine residency program for PA's or MD's, so I never have to fight residents to get a good case or to throw in an ET tube or perform a cool procedure. Also, I had done 3 ED rotations in my clinical year in PA school. One was my assigned, one was my elective, and one was something I begged for during our break from school. All were at the same Level I trauma center where they love to teach, so I got 15 weeks of amazing training side by side with the MD residents (they normally don't take PA students there or employ PA's, but I somehow got in!)

 

So yeah, your mileage may vary. I got pretty lucky with my situation!

 

where do you work? :)

[skyblu]

Busy non-academic hospital in MA with a good affiliation to an excellent level I where we transfer big trauma cases. Best of both worlds. And the nurses are outstanding. They got me through the first 6 months of practice. Rely on your nurses! The older and more crotchety, the better! Those old ER nurses know more than a lot of docs.

[Devlinblue]

Have to agree with skyblu.

 

I started in a busy ER right out of my program without any major issues. Again the key is having good attendings and nurses who will tell you if you are doing something wrong or just being stupid in general. I had the luxury of having done 8 weeks of rotations in the ED that I started in, plus 4 weeks elsewhere, and actually spoke with the RN's and told them I knew that I didn't know everything and to keep an eye out for mistakes.

 

If the ED that you're considering is not one to help out new grads or is not a busy ED then it is probably not the best place to cut your teeth. In that case I would find a good residency (get procedures, see critical patients) not just one that is looking for someone to take on the lower acuity cases for less pay.

 

Just as skyblu said, i got lucky with my first job in that it had almost everything a new grad trying to get into EM could ask for. The only downside is that my starting pay was terrible. The upside was that my pay made exponential jumps every 3 months for the first year until at a year I was earning similar to what the senior PA's were making. I started at a single provider Critical Access hospital 5 years out of school and love my job.