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Albany Med EM Fellowship Blog, Part Deux

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Hey everyone,

    It has been almost 6-7 months since my last update on here. At the time i was about halfway through the fellowship and I actually finished a little over a month ago. I just wanted to give a little bit more information about the remainder of my experience. In the springtime I did a little over a month of shifts in the trauma zone with primary emphasis on being involved in and/or running a trauma. It was a great experience and I was able to get exposure to all kinds of traumas and also racked up a bunch more procedures. I also was given the option to do some EMS shifts and work out in the field with the medics and EMTs. As much experience as I had prior to PA school I unfortunately never had any EMS experience so this was amazing. I would respond with the medics to the scene of anything from dyspnea to cardiac arrest and traumas. I had the option to do some time up at Malta Med (a newly built, amazing urgent care) which is roughly 30 min away from Albany. I chose to do some time there because I wanted to see what it was like in a different setting, seeing patients with more straight forward problems. This was great because it allowed me to really work on my speed. It seems a lot of ER and urgent care places today emphasize seeing X number of patient's per hour, so it is helpful to have a good sense of how many patients you can handle seeing (it definitely helps on job interviews because that is something places either asked, or they would ask if I felt comfortable seeing X number of patients an hour).

 

Towards the end of the fellowship everyone has 1 month of elective time which you can use any way you want (you can split it up and into 4 different 1 week rotations or you can do all 4 weeks in the same rotation). I loved all my off service rotations so it was a hard choice to make but I ended up doing some more time with trauma and I also went back to rotate in the SICU. I personally thought SICU was absolutely amazing. I found that it challenged me in new ways and expanded my knowledge on many things that I was weak in when I would be working in the ER. Since this was my second time back, a lot of the residents, fellows, and attendings remembered who I was so whenever a procedure needed to be done (i.e. central line, intubation, a-line), they were more than fine with me doing it on my own. My favorite thing to tell people was how when the new second year resident would have to go do a central line or a-line, the attending physicians would tell them to bring me and to have me teach them. There is no greater feeling that having the respect of attendings that trust you and recognize your skills to the point that they let you (a first year PA) go and teach a second year resident how to do a complex procedure. It was great because most of the residents would compliment me and tell me how they never really knew what a PA did and when they saw my level of knowledge and skill they were flat out impressed.

 

That pretty much sums up the bulk of my experience although i'm sure I could go on forever about all the awesome things I did and saw. When I finished I had a number of job offers which was tough because they were all fantastic options. Every person I interviewed with was blown away at my CV and what I did in the fellowship and every job I applied for I was offered the position and that was made clear during my interview. So I think it speaks volumes when you can apply for jobs and let them see what you accomplished in 1 year. Just to throw out some numbers to give people an idea of some of the procedures I did and how many within a 1 year period (not counting the ones I assisted other people on when I taught them): Ultrasounds 822, Central lines 24, Arterial lines 14, Intubations 78, Chest tubes 29, Lumbar puncture 10, Procedural sedations 7. I even helped put in Swans and transvenous pacemakers. In the SICU they let me do an entire bronchoscopy (with biopsy sampling and all) by myself (of course an attending was present for this to make sure I did it right. These are just some of the many procedures I accomplished, but hopefully that gives people some idea of how far ahead an ER fellowship puts a new grad PA in comparison to others (even compared to the residents in some aspects).

 

It has been a great year and I was really sad to have it end but on the other hand I decided to stay at Albany Med working overnights (in the trauma zone, still getting procedures) as well as doing what I can to help teach the new PA fellows. Best of luck to everyone in whatever they decide and please do not hesitate to contact me with any questions williae1@mail.amc.edu.

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I just discovered this thread today and it's been a really great read. I'm matriculating to AMC for its PA program in January - really excited, but also very, very nervous. I've spent the last few years working as an EMT and in the ER of a level 2 trauma hospital as an ER tech. I don't know if emergency medicine is where I want to end up yet, but it's definitely something I've considered because of my pre-PA experiences. If I decided to do emergency medicine, I figured I'd probably have to either do a fellowship or work in a less saturated location where I might have a shot at getting a job in a hospital ER or urgent care center for a few years' experience. 

 

You and the other residents seem to have had a great experience living in Albany and working with the AMC faculty, clinicians, and staff, which is reassuring. It sounds like a very supportive and organized atmosphere, which is what I'm hoping for in the AMC PA program. I'm from a rural/suburban area so I'm still a little iffy with moving to a city but I've had many positive experiences meeting and talking with Albany residents. But I'll admit, the thought of street parking or parallel parking in a city is significantly more terrifying to me than getting the chance to learn and practice a central line. Do you generally feel safe in Albany and in the capital district region - assuming one has common sense and knows to avoid certain areas after dark, etc.? How's the traffic there and dealing with the snow? 

 

If someone was seriously considering emergency medicine as a specialty, what do you recommend they do for elective rotations besides different ER settings? Something in the ICU, cardiology, pediatrics or surgery? 

 

Thank you for sharing your experiences!! Congratulations on making it through!

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Hello all,

 

It has been a long time since I have posted anything, but I just wanted to do one last update. A bit of an epilogue... My fellow PA fellows and I all finished our program about 3 months ago. I found that, having done a fellowship, the whole job-search was pretty easy. A lot of recruiters and medical directors hadn't heard of these types of programs, so I did have to do a fair amount of educating. Those that were aware of what a fellowship has to offer were instantly more interested in making an offer. Ultimately, I ended up moving back to my hometown in metro Atlanta and taking a job at the hospital 10 minutes from my childhood home. My scope of practice out in the community setting is definitely not what it was at Albany Med, but that is to be expected.

 

When you're in the midst of it, it's really hard to grasp how much you've learned or how much your confidence level has changed. But my first week on the new job, it really began to set in. I have so much left to learn and by no means do I consider myself an expert PA. But when it's just you and one other resident on night shift and you have 5 critical patients with multiple stab wounds roll through the door, or when you spend 4 weeks working side by side with 3rd and 4th year residents in the ICU, or when you just spend a year dealing with the day to day controlled chaos that is an urban level 1 trauma center, it makes a lot of other things seem a whole lot easier and considerably less scary. You can debate whether doing a fellowship will make you more money in the end (I'm not sure it does, but it certainly lets you be picky about what job you take), but you simply cannot replicate or replace the kind of intense, hands-on experience I got from this fellowship program. It would take years to accumulate the kind of experiences that I've had in the last year. I still have years and years of learning to do, but I wouldn't trade my fellowship experience for anything. For anyone out there who is on the fence, I'll just echo what so many others have said: If you go into it with the right reasons in mind, you will not regret it. It was the most intense, challenging, and rewarding year of my life.

 

Feel free to ask any questions... I'll try to be better about logging in more frequently!

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Any particular reason you didn't seek out a job with a bigger scope? Any plans to in the future?

 

My wife and I wanted to be near family and I didn't want a long commute. Basically, the pay and location are so perfect that I was willing to compromise a little bit on scope of practice. Scope is probably the most fluid of the 3 variables (pay, location, and scope). There are plans for PAs to become more involved in critical care, and the medical director hired me specifically for that purpose given my training. I certainly don't feel under-utilized, but there is some room for growth.

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Hey everybody!

 

My name is Jamie and I'm one of the current Albany Med ED PA fellows for the 2015-2016 class! I've been wanting to introduce myself and give you guys some updates ever since starting in October so I apologize for not getting on here sooner. It's crazy how time is absolutely flying..!

 

A little background information about myself: I worked as a medical scribe in the emergency department for 2.5 years while obtaining my biology degree at the University of South Florida. Then I moved to Ohio where I did PA school at the University of Mount Union. 

 

Before I go into some details about this year, I just want to reiterate everything that all the past PA fellows have said. After going through the whole application process and reading all these threads prior to interviewing, then getting accepted and actually starting this program, I just want to say they were 100% truthful and accurate in everything they said!!! The experiences I have been afforded in the last 3.5 months are things that I NEVER thought I would be doing this soon after being a new grad!

So this year there are 5 PA fellows (increased from 4 last year!) and we all started at the same time in October. We spent 2 days doing hospital orientation, and then 2 weeks paired one-on-one with one of the previous PA fellows from last year’s class to help us get oriented to the department, learn the charting system, help us transition into the “I’m not a PA student anymore” mind-frame, and basically just have a support system in a brand new place! This was the first year that our co-directors Adam and Sara also designed a 3-day specialized emergency medicine orientation just for us PA fellows. There were multiple lectures all day by different ED attendings and other practicing ED PAs on various types of patients that we would be encountering, such as the “abdominal pain emergency” or the “psych patient”. One of the afternoons we spent in the simulation center where we got personalized feedback about a specific case that we ran through (kind of like an OSCE). Another afternoon we all got time in the cadaver lab!! Who knew that after my first week of ED fellowship, I already would’ve performed an intubation, placed a chest tube, placed an IO, placed a central line, and done a cricothyrotomy on a cadaver!

My first rotation after working a few ED shifts was toxicology. This rotation is one month. Currently we have 4 board-certified medical toxicologists who are ED attendings and they run a toxicology service at the hospital. I had 10 days of being on-call for any tox consults and in between then, there were toxicology lectures with just me, one other resident, and the attending. I also worked a few scattered shifts in the ED. My tox month was absolutely AMAZING and kinda crazy!!!! We had a code disaster where a bunch of local firemen were exposed to Hydrofluoric Acid!! I won’t go on too long of a rant about this, but let’s just say I’ve never seen so much calcium available in multiple different forms in my life!! I think I dropped like 9-10 consults that night. I also took care of 2 serotonin syndrome cases as well as one patient with classic anticholinergic syndrome! It was pretty crazy!! :D Plus your typical cases of acetaminophen overdose, benzos overdose, plenty of K2, etc…  Let’s just say I feel much more comfortable now picking up any patient coming in for overdose or taking a bunch of pills! I also went to New York City for a special toxicology conference for the day, and then I headed to Syracuse with the other fellows for an annual toxicology conference! It was awesome!

Since then I also completed one week of ophthalmology, two weeks of ultrasound training, became ATLS certified, and I’m currently in my second week of pediatrics. I could say so much about all of these amazing experiences but I’ll have to save that for a later post! But real quickly, I do want to mention that I also had the wonderful opportunity of becoming a Sexual Assault Forensic Examiner recently. I’m not sure if any of the other previous posts have mentioned this, but Albany Med has a wonderful sexual assault forensic program and you have the option of becoming a certified examiner. This involves obtaining a very thorough documented history, performing a detailed physical exam, photographing injuries, and collecting evidence such as oral swabs, clothing, and genital swabs for the forensic kit. This is completely optional and not a mandatory part of the fellowship, but it does offer an opportunity for extra side cash while learning another useful skill that you can apply in any emergency department!  

Alrighty well I think that’s enough for one post! I’ll end by saying: for those of you who are considering applying to this program, you truly cannot go wrong. I cannot imagine getting this kind of experience anywhere else, and when I talk with other classmates who graduated with me a few months ago, they cannot believe the kind of experience I am getting. I hope to update you guys with another post in the near future, but feel free to ask any questions that haven’t already been answered. You can also email me at hodesj1@mail.amc.edu.

Thanks for reading! J

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I know this residency starts in October - do they accommodate for graduation dates, say starting in June/July?

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ewillPAC, my goodness your numbers are absurd!  "Ultrasounds 822, Central lines 24, Arterial lines 14, Intubations 78, Chest tubes 29, Lumbar puncture 10."  That is extraordinary.  You honestly probably have more numbers than some of the physician residents at my program (and they go for 4 years!).  Jeez, and you guys have a cadaver lab too!!  Sounds like a really incredible program!!  Thank you all for writing your experiences here; they are great to read.  

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Thanks for sharing your experiences with the EM fellowship ! I'v heard many great things about the fellowship and the PA program in general.  I'm from the area originally and was also born at AMC  ;) Definitely considering applying to the PA school in the near future !

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In the past they accommodated some fellows starting in August while others started in October. I am unsure how our program directors are feeling about that for this upcoming year; however, usually if there's a way, they try to make it happen!

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Hard to believe it has been almost a year since graduating the program. I still get a lot of messages regarding Albany Med and PA residencies in general. It makes me very happy to see the level of interest out there and to see all the awesome new programs popping up across the country. Just wanted to re-extend the invitation that, if anyone has any questions about residency programs, feel free to PM me. 

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Hi All!

 

My name is Amanda and I just graduated from the AMC ED PA Fellowship this October. My apologies for not blogging sooner!

 

Well first of all to summarize, I had an absolutely great year at Albany Medical Center and I would highly recommend it to anyone. I just started my new job last week and it is amazing how comfortable and confident I feel compared to last year just getting out of school. The things I learned this year definitely gave me a leg up and gave me the advanced knowledge to excel in the emergency medicine environment. Also, it definitely made a difference on the job search. Places I interviewed told me they wouldn't have even considered me 1 year out of school without doing a fellowship/residency, however now instead they were giving me job offers. Pretty cool.

 

Regarding the details of the fellowship, I think a lot of previous posts touched on our rotations etc which is also listed online, so I will just tell you what I liked about them. Ophthalmology was one of our first rotations and it was extremely helpful. I had never learned how to use a slit lamp before and now I feel pretty comfortable. I also felt I knew NOTHING about eyes after PA school and, though the rotation was only one week, I felt I had enough knowledge to know what was bad and what I can handle. I think the important thing with optho is to know what you can handle and when you need to call a specialist. This rotation really gave me a good handle on that. I also learned how to detect retinal detachment with an ultrasound which was pretty cool :)

 

The next rotation was ultrasound. It is a 2 week rotation which is great. Lecture style, hands on style and lot's of practicing in the department. It is good to learn this in the beginning because you can keep practicing all year. At the end, you will get a certificate saying how many scans you did which helps for credentialing purposes at your next job. It also is a very useful skill to have. One thing that is incredibly useful to learn here is how to perform US guided IVs. When nobody can get IV access and you can, it is a pretty great feeling. Also, AMC has an ultrasound fellowship so there are a lot of people passionate about ultrasound around.

 

Next was airway and anesthesia. This was one of my favorites because I found it so useful (I also chose to go back during my elective time). By the end of the year I had performed 54 advanced airways, most of them in the OR. After many intubations in the OR, I had my first intubation in the ED. I was told I looked very relaxed the whole time even though the situation we were in was getting pretty crazy. I attest that to the anesthesiologists and nurse anesthetist who taught me their zen ways of the OR.

 

Toxicology came after which was another very useful rotation. It is a month spent with 4 dual-board certified toxicologists/ED attendings. It is spent doing lectures, having on-call time mixed in with ED shifts. I learned a lot this month and found it very useful.

 

We also do 2 weeks in CCU and 1 month in SICU. SICU may be the most challenging rotation but it is well worth it.

 

We do a trauma month which means we do a lot of overnights in the summer and therefore are managing a lot of traumas. I did 4 chest tubes this month. Enough said.

 

We also spend a total of 4 weeks in the pediatric section and 4 weeks in the E-zone (fast track area) split into 2 week blocks. I know no one does a fellowship to spend time in the fast track however I believe it is a very important rotation. It is where you see the bread and butter of emergency medicine which you don't always get in the main ED. The second week of fast track is done at the very end of the fellowship and gives you an opportunity to start working independently and improving your efficiency before going out into the real world which I found helpful. 

 

Other cool things I got to do was fly in a helicopter with LifeNet for a day, co-author a chapter in a PA emergency medicine book/journal, and go to San Diego for a conference for a week while staying at a house on the beach (that was mostly paid for with CME money). I can't finish this post without attesting to our program directors. They are such nice people who truly care about helping us excel. They understand you have a life out of work and are very accommodating.  There is no pressure to have you stay at Albany when you are finished, though they would really like if you did. They truly made this fellowship what it is. They listen to feedback and really try to make it the best experience possible.

 

Oh, one last thing. The attendings and other PAs there are very receptive to teaching which is nice. The medical residents and us get along pretty well too. We do a lot of things they do like Wednesday morning conference, etc so we get to know each other pretty well. I think with anything, as long as you are a team player with them, they will be the same for you. I only mention this because when I was deciding if I wanted to do a fellowship I wasn't sure if the residents wouldn't want us there or if they would feel we were stepping on their toes. This is definitely not the case in my experience.

 

Anyway, I hope that answers some questions! In the end, if you are deciding to do a fellowship/residency, I wouldn't hesitate. It was the best decision I could have made and don't regret it for a second. The knowledge you learn here you can take with you throughout your whole career and gives you a great platform to build upon. I can't attest to other programs as I didn't go there, but the Albany Medical Center ED PA Fellowship is where it's at!

 

Good Luck!

 

-Amanda

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Hey everyone, just wanted to give another update. If you have already read my previous posts, then you probably know I am a graduate of the Albany Medical Center ER PA fellowship from 2015 so I finished about 1.5 years ago. Since finishing my fellowship, I actually stayed at Albany Med and took a job working overnights in the ER. One of the greatest aspects about working my overnight shift is that there are very few residents and I (being the only PA on during the night time) work solely in the trauma section of the ER. I have to say that without a doubt it would be difficult to handle such an intense area of the ER. I don't think that I would be able to function so well if it had not been for my fellowship training. Additionally, having done a fellowship and having the skills and knowledge I acquired, the attending physicians love how autonomous I am. Since it is only myself and 1 resident in the trauma zone, when we have multiple trauma's or sick patient's simultaneously, I can manage them confidently, and the attending physicians love it. I continue to have the ability to perform all the procedures that I did during fellowship, which yet again would be a huge challenge if I did not have so much prior experience. Often, I go off by myself without anyone in the room and perform invasive procedures (i.e. chest tubes, central lines, etc). I have done so many at this point, that I even teach and let PA students do some of these procedures. It is also not uncommon that the attending physician will have me even teach some of the residents how to do these procedures, since I have done more than many of them.

 

Another area that I have now become more involved in is the academic side of things. I love getting to work with the current PA fellows and passing my knowledge to them, in addition to giving away procedures to them that I may have (which they greatly appreciate) because I want to help contribute to trying to make the program be the best experience possible for anyone that goes through it. Since I have so much ultrasound experience, I was even asked to be the point person that trains all the PA's on ultrasound. I feel very honored to still be a relatively new PA, yet because of how good I am at ultrasound, I am now in charge of training a large group of physician assistants (with many more years of experience than me). I have also become involved with SIM center training and myself and another PA have worked hard to try and make SIM training better than ever. I absolutely love my job, and I love all the emails I receive from everyone who has interest in a fellowship. If i've said it before, i'll say it again, hands down the best thing I ever could have done out of school. So for those that are interested, please do not hesitate to contact me as I am always happy to answer any questions that people may have. Williae1@mail.amc.edu

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Hey Everyone, 

 

My name is Katie and I am a current fellow ('16-'17) here at AMC. I just posted in the other group but thought I would add on here as well. I just wanted to reach out as I don't think you have heard from anyone in my current fellow class. As everyone has noted previously this has been an amazing experience. I am about 6-7 months in and have completed rotations in Ultrasound, Ophthalmology, Toxicology, Pediatrics, CCU, and community medicine. Currently I am on my airway rotation. Today we started interviews for the next class of fellows and one of the popular questions was "What is your favorite rotation so far?" For me that is difficult to answer because I really have enjoyed all of them, and learned so much on each and every one. I will say that following each rotation I return to the Emergency Department with more confidence in treating patients with those specific conditions. I still have a lot to accomplish and a couple more rotations left however I have learned so much over the past couple of months. As many people have mentioned before the procedural experience has been amazing. From what I have heard from prior fellows, when they look for jobs potential employers are always astounded at the amount of procedures we have under our belt (I will keep you posted on that one--I am just starting that process.) I also want to speak about the acuity of the patients that we see here at AMC. Many are very sick, therefore you are able to get exposure to a wide variety of pathology. I know that in comparing the patients that I see in a day to some of the patients my classmates from PA school care for is eye opening. At the same time the attendings that I work with have been really amazing. If you need help or guidance they have your back. They are also very open to teaching--and really pro-PAs (which unfortunately isn't always the case elsewhere). Our program directors are also amazing. They are always open for feedback and interested in making this the best experience possible. Every year they make subtle changes to ensure that we are getting the most out of our experience. I think the prior fellows in this blog have gone over the curriculum and process really well. If any of you have further questions or want to hear more about the process feel free to reach out to me. I am here to answer any questions you may have. Thanks. -K

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Hey everyone, 

      Graduate of the program here. This is a long overdue post. Have been meaning to put this on the forum for some time unfortunately life and work have gotten in the way. I want to offer a perspective of someone who has completed the program and since moved on to an entirely different location and non academic hospital system. For starters I want to echo the previous posters comments on the quality of this program. The program directors are excellent. Its a demanding year but I have to say that Adam will do everything he can to accommodate you during the process. The focus of this program is education. Yes you will pull many shifts per month and be required to attend many lectures conferences etc but 100% this program is about making you better. At no point did I feel as though this program was a waste of time nor did I feel I was being utilized as cheap labor. You are essentially completing intern year at an MD residency with great Attendings fellow residents rotations etc. Not all programs are created equal and though it may be difficult it will be up to you to ensure it is not the "residency" or "fellowship" that sticks you in triage or fast track paying you resident salary without appropriate learning opportunities. I have talked with graduates of such programs and several of my friends have regrettably attended such programs. As is mentioned previously in these posts there are a great deal of critical care opportunities and procedures. I didn't get quite the numbers that Eric pulled but I wasn't too far behind. Many people in these forums are asking the real value in such a program. I have heard many of my colleagues in school state that they would rather "learn on the job" or do a few years in urgent care and transfer over to EM to be proficient. These options are fine for the person that wants to stay in triage/fast track but lets not kid ourselves as there is no comparison in the work being done. The person seeing URI and sprained ankles for years will never get the hands on experience managing the actual sick patients. Several have also asked the question what is the point of learning how to operate at such a level if you're not going to be able to perform such work at your next job. The short of it is that you will be able to replicate the environment at Albany. When I was looking for jobs there was no difficulty finding positions. I currently have two jobs. The first one I obtained out of the program wasn't hiring however was familiar with the program and made a position for me. I was offered a sign on bonus and an hourly rate fitting for the experience I have acquired. At this point in my career I have worked RME/triage a total of 2 times. Both of my jobs are main ED coverage. I pick up charts alongside the docs interchangeably. I am credentialed at both hospitals for intubations central lines chest tubes etc. No one blinks an eye when I pick up the crashing patients. I can also say that having completed this program and being able to operate at a higher level in these ERs I have gained a great deal of respect from my SPs. I still study daily. Many hours spent with Mel and Billy. There is much for me to learn however this experience has given me a base for which to operate proficiently in a main ED environment. If youre serious about learning real emergency medicine and are fortunate enough to be offered a spot in this program I personally wouldn't hesitate to take the position. 

Thanks for the read

CB

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Awesome prospective CB. 

 

Currently plugging away in a residency now and it's good to hear perspective from "the other side." Even if I'm not in the same residency, mine correlates well. 

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