New EM residency in NYC

[foley08]

There's a new EM residency at New York Presbyterian-Weill Cornell, info is at APPAP and also here:

http://web.me.com/brooks16pa/Cornell_EMPA/Home.html

 

So, I'm in the clinical year at a program in NYC and the EM residency idea is intriguing. I know there are some big residency supporters on the forum but I have a few questions.

 

Here is the curriculum:

Adult Emergency Department (5 Months)

Pediatric Emergency Department (1 month)

Internal Medicine (1 month)

Cardiothoracic ICU (1 Month)

Orthopedics (1 Month)

General Surgery (1 Month)

Anesthesia (2 weeks)

Ultrasound (2 weeks)

Ophthalmology (1 week)

Vacation (3 weeks)

 

Total : 12 months

 

This gives you 6 months of ER and then you don't make it back to the ER for the rest of the residency!? I understand that off service rotations are a part of MD residencies but those are in the context of 4 or more years. In this case, with only a year, it actually seems somewhat odd to say I completed a year long EM residency and spent only half the year in the ED.

 

The thing that is drawing my to residency is the formal, structured learning environment and the chance to see a lot and do a lot within that context. But the curriculum seems weird and the pay is $45,000 in an extremely expensive city.

 

What if this hospital ED or another teaching hospital was hiring and would hire a new grad. The pay would be almost double and I would spend all my time in the ED...any thoughts?

[EMEDPA]

off service rotations are very important in a residency. em physician interns spend a lot of their yr outside the er.

I think 6 months off service is ok.

this is a very strong dept.

I have been there and worked with a few of thier docs.

[andersenpa]

This is a great curriculum. I would do it in a heartbeat except for the ortho.

 

This looks like EMEDPAs dream PA School 2nd yr rotation schedule .......

[EMEDPA]

This is a great curriculum. I would do it in a heartbeat except for the ortho.

 

This looks like EMEDPAs dream PA School 2nd yr rotation schedule .......

close but maybe more like this:

Adult Emergency Department (5 Months)

Pediatric Emergency Department (1 month)

Internal Medicine ( 2 weeks changed from 4)

***(medical) ICU (6 weeks changed from 4)

Orthopedics (2 weeks-changed from 4)

***(trauma) Surgery (1 Month)

Anesthesia (4 weeks) changed from 2

Ultrasound (2 weeks)

***neurology/stroke team (1 week)

Vacation (3 weeks)

 

I think trauma surgery would be higher yield than general surgery and neurology/stroke team> ophtho. a month of anesthesiology would be better than 2 weeks.

also medical icu would probably have more bearing on em practice than ct surg icu.

but overall a nice program and one I would consider. I think an elective would be nice as well so if someone wanted to do aeromedical ems, vascular access team, or rural em they could do that for 2-4 weeks.

[foley08]

Thanks for the input guys.

 

I agree that off service rotations are important so that is maybe why many EM PA residencies are 18 months? It really seems odd to me that your not in the ED for the last 6 months of the residency and then your essentially cut loose. You make it through that intern year and then you'd really be ready to start honing your skills in the ED but your done and the learning environment of your next job is potentially very variable. Not to mention that these off service rotations are potentially very variable, I didn't like gen surg the first time around, wouldn't really look forward to doing it again.

 

Beyond that I agree with EMEDPA, if the off service portion was as he described I would be more into this program. Not to mention that this one requires "ACLS , PALS, and BLS certification prior to starting" whereas most of the other EM residencies include this in the curriculum. All the above being said there seem to be many positives about this residency as well, although I'm not sure that I will apply.

 

True Anomaly, I've been following your thread and I believe that your program was 18 months. If you get a chance could you share your thoughts on the idea of a 12 month program as outlined above.

 

And finally on a totally separate note, how bad is the new APPAP website. Wow.

[EMEDPA]

There are several other 1 yr em residencies. it can be done well in 12 months but 18 does allow for more exposure and more electives.

acls/pals are not unreasonable prereqs for a program like this. many folks had them before pa school and a lot got at least acls while in school but even if one didn't, acls and pals are 2 days each....acls/pals are the "basics" for em. it would be nice for a program to be able to assume you had that down so you could jump right into atls, abls, fccs, difficult airway, u/s courses, etc

[foley08]

I just don't see myself doing a residency if I don't do it right out of school and this one starts about a month after I graduate so I'll be studying for the PANCE. But definitely doable to get get acls/pals.

[EMEDPA]

if you are a good enough student to get into this residency( and it sounds like you are) than a month should be fine to study for pance. I would go for it.

( and what better way to study for a clinical medicine exam than work fulltime+ in a great learning environment).

[VictoriaO]

Hi Foley08, I'm so glad I'm not the only one in this predicament...

 

I've been hemming and hawing over applying to residency this year, vs getting a job then applying, vs really searching to find the perfect job that will train me to be the kind of PA I aspire to be.

From what I've heard from my school, it's much better to go to an already well-established residency like Einstein or Iowa than to one where the kinks are still being worked out. This program looks intriguing, I've been hoping another program would open since the one in UTexas has shut down. Do you know what type of hospital you would eventually like to work at? I'm actually leaning towards the Iowa program or the upstate NY program as I truly enjoyed my rural EM rotation and feel like the scope of practice is much better when you aren't competing with residents for procedures or interesting patients (though this based on my limited experience in OR).

 

As far as finding a new job, at least in my state, the urban areas are quite saturated with PAs and nearly all EM jobs want either 3-5 years experience or a residency under your belt. Some places will hire new grads, but will stick you in fast-track (which can still be a challenge, read the "fast track disasters" thread). I've been hoping to find a rural hospital that won't mind training a new-grad PA to cover during busy times and will eventually let me provide solo coverage. NY is supposedly a very PA-friendly state, and you may have better luck finding a job that will train you. Getting a job vs. residency is a tough choice, I'm currently going to try and do both, though I may be stretched a little thin.

 

What was your prior HCE? Having easily-recognizable EM related experience (EMT, paramedic, RT, RN etc) should be very helpful in finding in a job. This is part of the reason I'm leaning towards applying to residency first, I'll be able to explain my pre-PA experience better in an essay. My title "med aide" at an assisted living center in Old-Town doesn't really describe my scope of practice and training (think PA is to MD as ___ is to RN). I was delegated under my RN's license to administer all routes of scheduled and PRN meds, CBGs/insulin, do wound care, communicate with providers, chart, triage and intervene in acute decompensations (which happened almost daily). I quickly learned what v/s are "oh s***", who could get by with a nebbie or a glass of OJ and who needed to be sent out 10 minutes ago (even got to start a code). Interestingly I got to read all the discharge sheets from the hospital and initiate those prescriptions and care orders, got to see a lot of interesting internal medicine cases (my population group was heavy DM, CHF, CKD, Hep C, COPD, HIV, ETOH, IVDU etc). But without a job interview, I'm scared I will be dismissed as non-EM relevant experience by just glancing at my CV.

 

I took my PALS already and thoroughly appreciated it. If I were you, I would just go ahead and do it, mine was taught by an MD with 40 years PICU/NICU experience. She even showed videos of neurologic findings, whooping cough, etc. Part of my goals in PA school are to make up for where I'm weak in medicine (Peds, trauma/ortho). Doing a residency will certainly help with that, though I would like one with more time in Peds EM, trauma surgery, etc. I think being a residency-trained PA really puts you ahead for procedure credentialling at your new job as well. My only "cons" for doing a residency are leaving family and friends to go to a strange city and another year of being in debt.

 

As far as the PANCE goes, I'm planning to take it as soon after graduation as possible (August 15th). Does your program offer a 2-day PANCE review? Ours does, and we invite all the other graduating classes in the NW to a two-day seminar. I would try and get in on something like that if you can in your area, check and see if someone is offering PANCE review class.

 

Please keep us updated on what you decide, feel free to PM me etc. (Sorry this is so long, I was excited to vent to someone going through the same decision process!)

[True Anomaly]

I don't have much of a problem with a 12-month residency, so long as your ER experience offered you enough encounters to see a full spectrum of patients and pathology. We're all still fumbling around to see what the "ideal" time length for a residency in general, not just ER, should be. The only template is those residencies that have been around for years, such as Norwalk's surgery program (which I would argue is a "gold standard"- sorry Andersen!- I know you went elsewhere)- and those are 12 months in duration (correct me if I'm wrong, Andersen, but was yours 18 months too?).

 

With that said, until that "standard" is laid down (and its coming sooner rather than later),any kind of training that you can get at this point is better than none. There are some parts of that program that would be good to tweak (I agree that trauma surgery is more beneficial than gen surgery in an ED residency, and maybe ortho can be tweaked), but it also depends on the actual experiences in those rotations. If your general surgery rotation involved you helping to cover SICU patients and to do first-assisting in the OR on emergent abdominal cases, while the trauma service had you doing purely floor scut-work, I'd say that's a pretty good trade-off. Each department will run things differently, and with you being a brand-new entity ("Wait, are you a student, or a PA, or a resident????") you will have to struggle a tad with defining your role.

 

Off-service rotations, as noted above, are key to a residency. You will get to see patients with a wide range of pathology in that particular subset than you would purely working in the ED. For instance, I did many wrist reductions and other ortho procedures purely because I was on the ortho service. I spent my entire ophtho rotation learning the finer points of the funduscopic exam and using the slit-lamp because all I dealt with was eyes. I used as much time on my ICU rotations to learn all I could about ventilators and adjusting based on clinical conditions and gases because everyone was on a vent. Anesthesia was all about various intubations techniques and tools. ALL of these experiences dovetail into useful things you bring to the ER everyday. Think of them as expanding your toolkit as a clinician. The more you have, the more valuable you become.

[immanuel11421]

if you are a good enough student to get into this residency( and it sounds like you are) than a month should be fine to study for pance. I would go for it.

( and what better way to study for a clinical medicine exam than work fulltime+ in a great learning environment).

 

Do you know if most of the residency program will be qualified for student loan deferment? I called Cornell today and they said that they never filled out any form for loan deferment for people who got accepted into the residency program. I would like to do it except if I can't get loan deferment, I won't be able afford to live in NYC. Do you think doing one year of EM residency is better than having couple years of work experience in internal medicine and then apply for job in EM? Just want to make sure it's really worth it to put my family through another year of financial hardship since I am the breadwinner.

Thanks

[immanuel11421]

if you are a good enough student to get into this residency( and it sounds like you are) than a month should be fine to study for pance. I would go for it.

( and what better way to study for a clinical medicine exam than work fulltime+ in a great learning environment).

 

Do you know if most of the residency program will be qualified for student loan deferment? I called Cornell today and they said that they never filled out any form for loan deferment for people who got accepted into the residency program. I would like to do it except if I can't get loan deferment, I won't be able afford to live in NYC. Do you think doing one year of EM residency is better than having couple years of work experience in internal medicine and then apply for job in EM? Just want to make sure it's really worth it to put my family through another year of financial hardship since I am the breadwinner.

Thanks

[EMEDPA]

Do you think doing one year of EM residency is better than having couple years of work experience in internal medicine and then apply for job in EM?

Thanks

without a doubt.

if you don't do the residency do fp, not IM so you see kids, trauma, and women's medicine. IM is actually pretty poor prep for EM. fp is ok. urgent care is better. and em residency is best.

[EMEDPA]

Do you think doing one year of EM residency is better than having couple years of work experience in internal medicine and then apply for job in EM?

Thanks

without a doubt.

if you don't do the residency do fp, not IM so you see kids, trauma, and women's medicine. IM is actually pretty poor prep for EM. fp is ok. urgent care is better. and em residency is best.

[Joelseff]

Do you know if most of the residency program will be qualified for student loan deferment? I called Cornell today and they said that they never filled out any form for loan deferment for people who got accepted into the residency program. I would like to do it except if I can't get loan deferment, I won't be able afford to live in NYC. Do you think doing one year of EM residency is better than having couple years of work experience in internal medicine and then apply for job in EM? Just want to make sure it's really worth it to put my family through another year of financial hardship since I am the breadwinner.

Thanks

 

You dont need your school to certify a loan deferment. I simply called and said i couldnt pay and they deferred for a year....right there on the phone. I later changed the deferrment due to my masters program but that was just as easy. It may depend on your loan service company. But call them and see how you can defer. I have a friend (MD) who has deferred every year x 3 years. Only thing is while deferred it accrues interest.

 

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[Joelseff]

Do you know if most of the residency program will be qualified for student loan deferment? I called Cornell today and they said that they never filled out any form for loan deferment for people who got accepted into the residency program. I would like to do it except if I can't get loan deferment, I won't be able afford to live in NYC. Do you think doing one year of EM residency is better than having couple years of work experience in internal medicine and then apply for job in EM? Just want to make sure it's really worth it to put my family through another year of financial hardship since I am the breadwinner.

Thanks

 

You dont need your school to certify a loan deferment. I simply called and said i couldnt pay and they deferred for a year....right there on the phone. I later changed the deferrment due to my masters program but that was just as easy. It may depend on your loan service company. But call them and see how you can defer. I have a friend (MD) who has deferred every year x 3 years. Only thing is while deferred it accrues interest.

 

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