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Thoughts on this post grad EM program?


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I recently had my ER rotation and loved it. Never felt so on fire and energized and excited! So I applied for an ER fellowship... And got it. The idea of the ER excites me but I am divided on whether or not I should do this fellowship (or post grad program... It's not technically a fellowship or residency).

 

I graduate in August, was going to take the PANCE September 1... And this fellowship will start in October or November. So it would be two months before I could start working (that's one con). It's 6 month total for the fellowship... and they pay 30.00 an hour the first 3 months and 40.00 the last 3 months, working 40 hours a week. So it is like $25,000 for six months (another con). They say they will let you take things as slow as you want and it's all about a learning experience. Even if it's just one patient per day. Afterwards there's no certificate of completion or official residency completion (another con)... It is more for the experience, and they promise you they do whatever they can do give you whatever job you want (definitely pros).

 

I am divided on whether or not to take this. The pay is definitely not great, and technically, it's not a real residency or fellowship… That's what the guy told me. He says they won't offer you any certificate of completion or anything, that it's just for the experience (getting to be a student while being paid) -- he says they will do whatever they can to make sure that you get whatever job you want upon finishing. I guess the girl who last did the program got hired on at the location, but they can't guarantee that any spots would be available when I finished. The girl also said they don't pay you beyond your 40 hours a week. She said that most days she worked 1-2, even 3, hours after her shift and didn't get paid for it. They just give you a flat 40 hour week pay at 35/hr.

 

Part of me thinks this sounds fishy… Part of me thinks it would be a lot smarter to just work in urgent care job for a few years to get my experience...that way, at least I would be getting paid decently… Then try to slide on into the ER after I gained experience. I don't have a burning desire to be in the ER right now, just eventually. I feel like urgent care would be a great new grad job. However, I've also been told that fellowships are very prestigious and I would be a fool to not take up the opportunity because it looks great on a resume and sets me apart from everyone else. The fact that I can still be a student appeals to me, and it's a great way to get into the ER without being thrown into something I am not ready for. I would never take an ER job straight out of graduation without experience!

 

I've been told by other PAs that fellowships like these are just slave labor. But I talked to two of the PAs that went through it and loved the experience and got the jobs they wanted at the end of the day.

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It sounds like there are some red flags that warrant a little more investigation before committing to anything:

1) is there any sort of didactic curriculum? Will you have lectures, sim training, anything to teach you the fundamentals of EM?

2) Will you actually have rotations, giving you exposure to different components of medicine? Or is all of your time spent in the same ED?

3) if you can go as slow as you like, why is your colleague staying 3 hours past the end of shift and not being compensated?

4) if they don't issue any sort of proof that you even completed any sort of fellowship, is this much of a resume builder for you?

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Echoing Medic25's comments above...it not only seems up to par with some of the other residencies/fellowships that most of us recommend, but your statement comes across as someone who's not ready to dive in headfirst to the ER.  

 

Is this being put on by a private company or the hospital/academic institution itself?  A private company isn't interested in training you solely for your sake- they want to help create long-term employees for their company who can generate revenue.  They see it as a mutually-beneficial situation, where you spend time learning without the crush of seeing multiple patients, and they retain you for the long haul so that eventually you DO see multiple patients and bring in some money.  An academic institution or hospital-based program, while they may want to retain the residents they train, the first priority is always quality education and training that can translate virtually anywhere the resident decides to go afterwards.

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1) No didactic curriculum -- they say they just allw you to take things slow for the first month of two, then they expect that you can get up to speed and see patients more quickly... This is run by a private company not an academic institution

 

2) all time would be spent in the same ED

 

3) I agree with this statement -- not sure why she stays late and doesn't get compensated

 

4) No certificate but they say that all of their post grad PAs were able to go into an ER job right after the program and all but two stayed in ER (19 of them over seven years)

 

I guess what my thoughts are is -- why wouldn't an urgent care job for a few years be good Before trying to get into ER? What is more impressive to an ER -- a six month PGPA program or just a few years in urgent care or family med? Like how hard us it to get an ER job? And would a six month program prepare me, or would I come our of this feeling like I still wasn't prepared? Ugh, I have reservations but It is a bummer to turn this down.

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if there are no off service rotations this is just slave labor. arguably the most important part of any postgrad program is time spent outside the ER doing intubations, u/s, trauma surgery, ob, burn care, ICU,  etc. I would not do a postgrad program that lacked a significant off-service component.

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I agree with all of the people above. I think you know what the right call is here. It sucks to turn down an ER offer, but this really would not be the kind of training that would really benefit you in the long term anyway. It's just an excuse to pay you less than a nurse while deciding if they want to hire you full time or not.

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I agree with all of the people above. I think you know what the right call is here. It sucks to turn down an ER offer, but this really would not be the kind of training that would really benefit you in the long term anyway. It's just an excuse to pay you less than a nurse while deciding if they want to hire you full time or not.

agree. any em job that is not a legitimate fellowship/postgrad program in 2015 should pay a minimum of 90-95k to start.

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Your responses are all soooo helpful.

 

Got a little more info from the girl who did it. I asked her if they had ANY formal education and she said no, and that's why she wished she would have done a residency. She didn't learn ultrasounds, didn't get to do LP or chest tubes... Did get to intubate and did learn closed reduction. When I asked her how helpful and supportive everyone was she said it was hit or miss, and that uptodate was her best friend. The more I learn the more I think this isn't a good bet.

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if she was not regularly seeing bad traumas, putting in central lines and chest tubes, doing advanced procedures, etc this is not a good training situation. I learned closed reductions working in urgent care, already knew medic level skills before pa school, and picked up paraentesis, LPs,slit lamp, etc over many years at many different jobs. better to just do a quality postgrad program at the start and have a procedure log to be proud of.

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Your responses are all soooo helpful.

 

Got a little more info from the girl who did it. I asked her if they had ANY formal education and she said no, and that's why she wished she would have done a residency. She didn't learn ultrasounds, didn't get to do LP or chest tubes... Did get to intubate and did learn closed reduction. When I asked her how helpful and supportive everyone was she said it was hit or miss, and that uptodate was her best friend. The more I learn the more I think this isn't a good bet.

 

You're right.  It's slave labor in the guise of "training".  To compare it to the established post-grad/residencies out there is impossible

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I have to agree with the other responses above. You aren't going to get what you need and want out of this program. But you also aren't going to be ready for the ED working on urgent care. I'd look for a true ER fellowship or post-grad program. There needs to be didactic teaching, US, difficult airway, and other procedure classes. The EDs and all providers should be supportive of you as a student and help teach you to be a better ED provider.

I've seen plenty of 'programs' like this. And what they are is to hope to get you up to being a good ED provider for their company cheaply. (I used a similar program to get my foot in the ED door). Problem is, if at any point they don't feel that you are progressing, they will let you go. And even though they say 1-2 patients a day is 'ok', usually it's not.

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So I have an update. I was doing my math wrong and the pay is actually 35K for 6 months... Equivalent to a 70K/year salary... Which isn't that bad especially for the cushion of being able to be "training." I also learned that I can forgo benefits (health, 401K etc) to get an extra 10/hr. I would just get private insurance if I did this. This calculated no benefits pay would then be 45K for the six months -- that to me does not seem bad for a new grad. Learning this was a game changer for me. Sure, since it's on the job training it will not be education that is equivalent to a residency. But for the pay, it seems like a good foot in the door option for ER.

 

Any thoughts on this in light of the recent development?

 

And as a side note -- I know there are legitimate residencies out there but I can honestly say I would not do one. I have been in school too long and have too much debt to justify doing the student thing for another 1-2 years. I know of a lot of PAs in the ER who have not done those long term residencies. I am sure the ones that do are thankful for it and probably better off and worth more -- but all I want to do is be in the awesome, stressful, energetic environment of the ER.

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So I have an update. I was doing my math wrong and the pay is actually 35K for 6 months... Equivalent to a 70K/year salary... Which isn't that bad especially for the cushion of being able to be "training." I also learned that I can forgo benefits (health, 401K etc) to get an extra 10/hr. I would just get private insurance if I did this. This calculated no benefits pay would then be 45K for the six months -- that to me does not seem bad for a new grad. Learning this was a game changer for me. Sure, since it's on the job training it will not be education that is equivalent to a residency. But for the pay, it seems like a good foot in the door option for ER.

 

Any thoughts on this in light of the recent development?

 

And as a side note -- I know there are legitimate residencies out there but I can honestly say I would not do one. I have been in school too long and have too much debt to justify doing the student thing for another 1-2 years. I know of a lot of PAs in the ER who have not done those long term residencies. I am sure the ones that do are thankful for it and probably better off and worth more -- but all I want to do is be in the awesome, stressful, energetic environment of the ER.

Well, sounds like you've already made up your mind. It also sounds like you would love to be a docs b!tch the rest of your life. I say this a matter of factly because you just had 8 experienced ER PAs who are trailblazers in our profession give you sound advice and you are selling out to a group who wants slave labor. You will make someone lots of money. You may also make a mistake in the ER that costs someone their life. See if your hospital is supporting you then...

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^ I have to laugh at the extremely harsh comment you just gave me because -- YOU ARE RIGHT. You all are right and I appreciate your advice because if it wasn't for all of you I would be going into this.

 

I still think that for those students who are absolutely desperate to get their foot into the ED in any capacity and feel their knowledge base is adequate this is an option. Especially if they have had solid prior healthcare experience and ER experience but I haven't. This whole time I've been feeling in my gut that it just isn't a good idea for ME...The truth is I am too unprepared and too insecure in my capabilities at this point to think about living and breathing the ER without adequate supervision AND training. I personally feel like I would be a risk for patients going into the ER without this. I realize everyone has fears when they graduate school, but I really do feel like a risk and that's why I wanted to be certain that this program would really offer me some solid training. And if this experience won't REALLY prepare me and give me the confidence I need then it isn't worth it, especially when I consider the low low pay. How can it be worth it when there is no didactic portion, no specific doctor(s) who are responsible for teaching and leading me on the job, no procedure experience... And then no guaranteed job at the end?

 

Last night for a few hours when I posted my last comment I had a change of heart when I heard about forgoing benefits for a more decent pay. I also had a few people (mostly non-PAs but only one PA) telling me that it is only six months and I might as well do it because I will never get this opportunity again (which is true). So for a little bit I was convinced it could be worth it for the "experience." But sure enough, the feeling in my gut came back and I've officially decided I'm not going to take up this opportunity. When I talked to the guy on the phone today about my concerns about not learning procedures like lumbar punctures and intubations and central lines, he sort of laughed and told me that reality the PAs don't do major procedures and that the six month program he was offering would prepare me everything I actually needed to know. Something about that didn't sit right with me. Not only was it sort of a deprecating and false statement about PAs, and a "shut down" to me for wanting to know those procedures... I got the feeling he felt I was demanding. Even if it works that way in his ER, it sure doesn't work that way in all ERs and it would suck to go into an emergency job totally unprepared because I didn't learn things I needed to in my "fellowship." So as hard as it is for me to turn down a post grad program, I feel like it is what I need to do.

 

My goal is now this -- family med for a few years with a little urgent care on the side, and then I will revisit the ER idea when I have built up my confidence as a PA. I won't give up the ER dream.

 

Thank you so much, everyone.

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^ I have to laugh at the extremely harsh comment you just gave me because -- YOU ARE RIGHT. You all are right and I appreciate your advice because if it wasn't for all of you I would be going into this.

I still think that for those students who are absolutely desperate to get their foot into the ED in any capacity and feel their knowledge base is adequate this is an option. Especially if they have had solid prior healthcare experience and ER experience but I haven't. This whole time I've been feeling in my gut that it just isn't a good idea for ME...The truth is I am too unprepared and too insecure in my capabilities at this point to think about living and breathing the ER without adequate supervision AND training. I personally feel like I would be a risk for patients going into the ER without this. I realize everyone has fears when they graduate school, but I really do feel like a risk and that's why I wanted to be certain that this program would really offer me some solid training. And if this experience won't REALLY prepare me and give me the confidence I need then it isn't worth it, especially when I consider the low low pay. How can it be worth it when there is no didactic portion, no specific doctor(s) who are responsible for teaching and leading me on the job, no procedure experience... And then no guaranteed job at the end?

Last night for a few hours when I posted my last comment I had a change of heart when I heard about forgoing benefits for a more decent pay. I also had a few people (mostly non-PAs but only one PA) telling me that it is only six months and I might as well do it because I will never get this opportunity again (which is true). So for a little bit I was convinced it could be worth it for the "experience." But sure enough, the feeling in my gut came back and I've officially decided I'm not going to take up this opportunity. When I talked to the guy on the phone today about my concerns about not learning procedures like lumbar punctures and intubations and central lines, he sort of laughed and told me that reality the PAs don't do major procedures and that the six month program he was offering would prepare me everything I actually needed to know. Something about that didn't sit right with me. Not only was it sort of a deprecating and false statement about PAs, and a "shut down" to me for wanting to know those procedures... I got the feeling he felt I was demanding. Even if it works that way in his ER, it sure doesn't work that way in all ERs and it would suck to go into an emergency job totally unprepared because I didn't learn things I needed to in my "fellowship." So as hard as it is for me to turn down a post grad program, I feel like it is what I need to do.

My goal is now this -- family med for a few years with a little urgent care on the side, and then I will revisit the ER idea when I have built up my confidence as a PA. I won't give up the ER dream.

Thank you so much, everyone.

Much respect for this. You get it. Set your goals high and don't sell yourself short. you will be a good provider. Get some experience and don't give up on a REAL EM residency down the road.

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You made a great decision, and I think his response to you wanting to learn LPs and central lines is very telling. He wants to use PAs in the narrowest possible sense. You would not have gotten the kind of experience you wanted out of that job.

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You made a great decision, and I think his response to you wanting to learn LPs and central lines is very telling. He wants to use PAs in the narrowest possible sense. You would not have gotten the kind of experience you wanted out of that job.

 

Couldn't agree more.  As I said in your other thread, and Ffighter pointed out, residencies are not shut off from you- they can and do take experienced PA's who want to further their training in the ER

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