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Primary Care/Emergency Medicine Residency Question

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Maybe I'm completely missing something but am quite confused on this whole residency bit. I love the idea of adding education and experience to my degree via a residency in Primary care or emergency medicine and am NOT making fun of the idea. I find the idea very appealing.... However, I am unable to see the advantages of such a residency as the work that I do now is IDENTICAL to that of the residents at our facility, except they get paid less and work more. We do the same procedures, trauma codes, diagnosis, interactions with supervising MD, etc. So how is a residency any different than just good old fashioned work experience? Can I just have my doctor write a note that says "Yup, she worked here with the residents for 6 years. She done good. Residency done."


If there is a higher educational level attained or achieved I would love to hear about it but have not heard how a residency would benefit primary care or emergency medicine. In specialities I can understand the residency benefits as procedures are limited usually to the MD's.


Please share as I would love to look into it further if there is someone with a much better understanding.

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That's kind of what I was wondering about as well. So does that limit the experienced provider's ability to advance their career by completing residencies because essentially, we have completed one? Maybe we should just start listing our credentials and the number or active years we've been working. :) PA-C;6


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it's the off service rotations that make a residency.

do you spend a month in anesthesia doing nothing but difficult intubations with an anesthesiologist, ICU with an intensivist, burn ctr with a burn surgeon, u/s with a tech, etc and do nothing else except learn while there? unlikely. at a job the reason you exist is to move the meat. in a residency the reason you exist is to learn.

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Well explained, however, how does one complete a primary care residency? I have not had the extra time in the OR intubating or extra time with burn surgeons so that is a very valid point. Thank you. I'm not doubting the value of a residency but rather trying to find out how to complete one and determine if it would be beneficial in my current rural situation. You have given me great ideas for furthering my experience. Thank you.

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Just to expand upon what Emed posted and I will apply this to my experience as a co-director of a PA/NP post grad fellowship in Trauma/SCC. I also have experience with the ER PA fellows rotating on our service for electives.


The major difference is that our PA/NP fellows have a formal didactic educational component that you don't get with on the job training. They have weekly lectures to attend, sometimes more than 1, monthly journal club, a minimum of 2 presentations during the course of the year to our group, as well as assigned readings. Over the course of the year we will cover all chapters in The Trauma Manual as well as Marino's ICU book. They are tested at the end of each month with a written exam. The primary focus of their year is education. This means that during dedicated education time they have no other clinical responibilities. They get constant feed back via monthly evaluations related to their performance. They receive remedial education/conseling as needed. This does not include the impromput education that occurs during rounds. Their level of autonomy is increased in a fashion that is commenserate with their level of competency. This includes evaluation of acutely decompensating pts on the floor/ICU, trauma bay alerts, trauma consults. Initially they are accompanied by myself or one of my colleagues. Eventually, they are sent alone to do the evaluation with us doing follow up and eventually reach the point of working fairly independently towards the end of the fellowship with a true sense of confidence that they really do know what they are doing. There is no "baptism" by fire that sometimes occurs with OTJ training where they may not be help by a more experienced provider readily available. They get the same opportunity to do invasive procedures and intubations that the physician residents do. They get ATLS certified within the first week of our fellowship. They spend 2 weeks early on in the OR focusing solely on intubations and airway management.

The experience they get in this 1 yr makes them capable of taking a Trauma/Critical Care job pretty much anywhere and hit the ground running with a set of competenices and a fund of knowledge that typically can not be matched in 1yr of OTJ training in the same specialty.

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  • 2 weeks later...



i want to do it, i want to do it! what a great set up you have created. there is no way a PA who wants to get to the "top of their game" would pass up an opportunity like this.


Tayce does make a point, tho.


IF she works in a situation where she is not only moving meat, but has a supportive and closely monitoring mentor who is making sure that she is developing a finer sense of the shades of danger and diagnoses in her field (like you were/ did when you started at your hospital and then went on to start the residency), then -perhaps- she should be able to equate practicum + reading to academics. To a degree.


I am not residency trained, but have had great mentors.. including being included in lectures and training modules with junior residents in training centers early on in my career... personal drive and being pimped daily led me to read the books and learn. eventually it all made sense.. the rote became reasoned.


That phrase: 'the rote became reasoned', is, of course why I am slowly coming around to endorcing residencies for all... we need to shorten the time from rote action/ algorhythmic approach to reactions based on reason and strong pathophysiologic and research proven actions.


The downside to residencies is the narrowing of career options if we want to change fields. And that they become a self perpetuating necessity to entry into the field.. further limiting options.


Eric's point of academics being the driving force behind residencies is spot on.


But Tayce's ascertation that self directed and monitored reading and teaching, while not a perfect system, is not an invalid one...


The two problems with trial by fire is


1. standardization and

2. procedure credentials.. the documenting capacity of doing things that you have been doing, in new institutions.


back to my point.. can I audit the next class?


huh? Huh?



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As always, great points! I agree with everything you have said. I feel that the type of supportive environment we are discussing along with the necessary drive to self educate is not easily obtained. It is not impossible, just rare, IMHO.

You can come and join me in my sandbox if I can join you in yours :D

Someday maybe......

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