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U of Iowa EM PA resident - Ask Me Anything

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Hey all,

 

As there seems to be a lot of growing interest in EM PA residencies across the country, I just thought I'd start this to (hopefully) offer answers to any burning questions you guys have about EM residency in general or at Iowa in particular.

 

Ask away!  I'll edit this initial post to include all Q&A to make it easier on the reader.

 

Who I am:  Year-1 EM PA resident at the University of Iowa Hospitals and Clinics (UIHC); Graduated from South University - Tampa C/O 2015; formerly trained as EMT, paramedic.
 

***Obligatory disclaimer:  I do not represent UIHC, nor the EM PA residency program there, nor any other part of the institution of the University of Iowa in any other capacity than as a resident learner and medical provider in the Emergency Treatment Center.  All answers are based on my current knowledge, personal opinion, and/or cited references.***

 

Why did you choose this particular program?

     There's lots to love about the residency experience here: PAs are on equal footing with medical residents, the "your patient, your procedure" policy, high availability of attending faculty during your shifts, the well-organized administration, variety of electives (and option to create your own)... there's much more.
     However, far and away the thing that impressed me the most was the amazing faculty.  It was apparent from my interview day onward...  Easygoing, personable, humble, reasonable people; only ever as serious as they need to be; will often go out of their way to drop some knowledge on you.  They inspire respect not out of fear or intimidation, but by their scope of knowledge and willingness to teach.  Large egos are not in fashion here.  Everyone is known by their first name or nickname.  Since I've started, I realized this mentality has trickled down to the R2s and R3s as well; everyone is willing to help out.

    Other than that, moving to a small Midwest town has always been on my bucket list for some reason.  Iowa City is a great little town too; full of great culture for its size, but small enough that I walk/bike to work every day.  I probably couldn't have picked a better time either, with Hawkeyes having had a blowout season and the Iowa Caususes soon, I feel like I'm getting the quintessential Midwest experience.

 

 

Do you feel you get enough slit lamps, chest tubes, intubations, ect. without having several off service rotations?

       I know procedures is the big question; personally I feel like I'm off to an adequate start after 3 blocks in the ED, and just now starting to get confidence in picking up patients that need these procedures.  Also keep in mind this is (mostly rural) Iowa, and you're not going to see GSWs or similar trauma every night like you would in Baltimore or Philadelphia, although a good amount of MVCs.  That said, each resident's mileage will vary; if you're procedure-hungry, you could probably expect to increase your numbers up to about 30% over mine (total guesstimate).  

      So here's some numbers, keeping in mind this is a new PA grad, with 12 weeks in the ED so far, where I was the Primary on the procedure: 4 LPs, 4 paracenteses, 1 chest tube, 1 US-guided central line (fem), 0 intubations, 4 dental blocks, countless peripheral nerve blocks... and i haven't logged slit lamps but i'd say probably 5-6; I could have been doing many more slitlamps if I wanted.  There's a dedicated ophtho room with slit-lamp setup here, and if you want to pick up all the ophtho patients for a night I don't think anyone would fight you for it.

     One thing definitely worth mentioning that often gets overlooked, we have 2 or 3 portable ultrasounds for bedside studies available 24/7, with linear, curvilinear, and cardiac probes attached.  If you ever want to play around with ultrasound it's there.  We use it all the time for peripheral IVs on tough sticks, checking for abscess/pockets, FAST exams... even some fancy nerve blocks.  As cool as it is to poke prod and cut a patient, sometimes I feel that as a PA, the highest-yield learning during this residency won't be the procedures but my proficiency with ultrasound.  But again, your mileage may vary.

 

How is housing near the hospital?

    Housing nearby to the hospital is great, from what I hear.  I actually live on the other side of the river in downtown Iowa City (which wouldn't be my first choice for a family) but there are many available houses for rent in the University Heights area that I think would work well for a family (and it's closer to the hospital too).

 

Are they pretty bias about picking Iowa grass or would a person with FM/military medicine experience be given a good shot?

    I think any great candidate is given a good shot.  That being said, Iowa has a fantastic PA program, and most of the residency applicants are graduates from there, so if you look at the numbers it may appear that they're heavily favored.  However, I didn't graduate from there and I got in, and I didn't have to beg.  Two of the three initial acceptance offers given for the latest class were to out-of-state candidates, one of those being a military-trained PA.  So I would say everything considered, there's not a perceptible selection bias.

 

What's your biggest dislike of the program?

Honestly, I can't think of anything I dislike that would be particular to this program; I feel that any dislikes would be common to most if not all programs.

 

I really tried to come up with something and I've started writing several different things here but erased them, because they didn't seem like they were real problems.  Mostly just annoyances, ones likely to be encountered anywhere, and largely an issue that is outside the program's or ED's control.  But if you want to know the ups and downs of something in particular I can try to help.

 

 

Do you think that NOT being from an EM background hinders someone's chances? 

Hinders vs a candidate that has an EM background?  I have to say yes; at a minimum, an EM background shows a proven interest and ability to handle the particular stresses that come with EM.  I wouldn't let that stop me from applying though; I would just go wild on my EM rotations in PA school and do as much as possible there, and make sure to mention it during the interview.

 

What's the hour work week look like - Any time for picking up additional shifts for supplemental income?

During your ED blocks (which are the vast majority) you have about 45 hours (5 shifts x 9 hours) of scheduled work hours.  However, amount of shifts can vary from week to week.  Shift times also vary, from morning to day to overnight.  Scheduling for the most part always puts your next shift equal or later in the day than your last, which is helpful.

Also, it's rare to always have all documentation done before your shift ends.  I'd say I work at least 1 additional hour per shift, often several hours if it's been a rough day.  I finish my documentation before shift ends maybe 10% of the time.  I will say I'm not the fastest documenter, but in general I would probably my numbers are a safe estimate.

UIHC doesn't allow PA residents to pick up ad-hoc shifts as regularly employed PAs, at least last time I checked.  I believe working at an outside facility is possible with permission, but don't quote me on that.

 

How's the whole interview process, structure, day like?

Similar to PA school. Morning presentations by faculty and administration, a tour of the ED, the resident's lounge and offices.  Four or five 10-minute interviews by current faculty, then lunch.

I will say one big difference between PA school and residency interviews is it's much more of a two-way interview, with them selling the program to you and you selling yourself as a candidate.  I imagine PA school is so competitive that those adcoms don't see the need to do that.

 

 

Did you apply w/o PANCE scores (or contingent on completing it correct?)

Correct.  I applied without having taken the PANCE, and even got my offer before I had my scores back.  I'm not sure if having scores in-hand (or exceptional scores) is a factor in the selection process, but I'm anecdotal proof that they aren't required.  But of course my acceptance was ultimately dependent on passing.
 

 

(Continued below....)

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(Continued from above...)

 

Did faculty or previous residents share how much of a pay bump completing the residency will provide as compared to a new grad starting salary? 

 

I have not done any official research into this area, although I'm considering doing a formal survey of grads from different programs at some point.  The general feeling I've gained through talking with grads is that the residency is worth significant negotiating leverage.  Meaning, depending on your preference, it could could translate as opportunities opening into competitive areas (e.g., Colorado), more pay, or other big contract perks.  If you really want numbers, I'd say the residency is worth at least $20k more per year on a contract with all other factors being equal; more likely closer to $30k.  But these are not hard numbers and I have no great evidence, so don't quote me.

 

 I'll freely share my own numbers after I sign a contract.

 

Did you do any rotations in anesthesia for airway skills?

 
I would say this is one deficient area with this program, depending your love for intubations.  There is no anesthesia rotation in the curriculum.  One of our PA residents really pushed for an anesthesiology rotation (as the MD/DOs do) as an elective but wasn't able to make it happen due to administration.  I don't know specifics but I'll look into it and update when I can.
 
 
I wanted to ask how are you still liking UIHC? Particularly your opinion of the off-service rotations. Do you have a hospitalist rotation with FM or IM?   
 
The off-service rotations in the current curriculum are EKG/ultrasound/radiology, burn, ortho trauma, surgical / neuro ICU, and general surgery trauma.  I'm done with everything but SNICU currently.  There are no FM or IM blocks... although I think I'm glad for that.  I see the off-service rotations as learning opportunities in specific areas as they relate to emergency medicine, and I feel like IM/FM isn't specific or acute enough to be of huge benefit. 
     Burn is short and sweet (currently 2 weeks); UIHC is a burn center, so you see a good amount of burns of varying thickness and TBSA and usually a few cases of necrotizing fasciitis.  
     Ortho trauma is pretty tame (also 2 weeks), you work in clinics and see follow up appointments to bony trauma and also respond to ED ortho trauma when able and do some splinting.  I thought it was good to know what to look for for ppl that present to ED with re-injury of a limb or problems with casts.
     Gen-surg trauma can be a great experience but it can also be a bear.  Your primary responsibility (along with other interns and a senior) is to respond to trauma alerts in the ED, do rapid trauma assessments, assess C-spine, FAST exams, etc.  This part is great experience.  Your secondary responsibility is to round on trauma inpatients, develop plans, verify orders, respond to nurse's requests from the floor.... in short, inpatient medicine.  Whether this part is your bag or not, is completely a personal preference.  But it's not mine.  These can be very long hours too.  Over my 4 weeks of gen-surg trauma I averaged 75-80 hours a week, and was scrambling most of those hours.
      EKG/ultrasound/radiology is a tame month that's mostly self-directed.  Show up to the ED, ultrasound whatever patients seem interesting.  Self-study an online radiology course that's actually pretty well-designed.  Then 12-day crash course in emergent EKG reading by a pretty well-respected cardiologist (who also overreads ED EKGs in daytime hours).
I'll update with a SNICU rundown when I get through that block.
 
 
What electives are you choosing?
    I chose the Wilderness Medicine elective, which was 4 weeks of didactic and practical survival skills training, plus a trip to Colorado to go rock-climbing, hiking, snowshoeing, and cross-country skiing (with LOTS of rescue scenarios thrown in).
Later on this year I'll be doing a Toxicology elective and spending 2 weeks in Sioux City at the state poison control center.  Also will be doing 2 weeks in advanced ultrasound techniques.
 
 
Do they let the PA residents run codes, traumas, and pick up the level 1/critically ill patients, or are those patients eaten up by the senior residents?
 
The policy of "your patient, your procedure" holds true for codes; that said, as a beginning intern (1st year) you'll probably have staff directing any codes.  Once you get confidence in handling them, there's no issue with you directing the code (with staff observing).  In no case does a code automatically go to a senior, although I would caution against jumping in over your head without backup nearby.
Critically ill patients are all yours.  Just be careful about taking on too many at once (learned the hard way).
    The one exception to all this is traumas; you can't be primary on a trauma until out of intern year, which for us means the last 6 months of residency.  This is because they want you to go through the gen-surg trauma block before taking on traumas from the ED side of things, which I feel is reasonable.  However, this doesn't mean you can't help out and learn; you just won't be head-of-bed or managing airway (although I did once as an intern when the senior was busy, don't tell anyone).
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I'm very interested in this program. Do you feel you get enough slit lamps, chest tubes, intubations, ect. without having several off service rotations? How is housing near the hospital? I have a family and would probably need more space. Are they pretty bias about picking Iowa grass or would a person with FM/military medicine experience be given a good shot. What's your biggest dislike of the program? I understand if you don't want to answer publicly as you are still in the program.

 

Thanks for sharing!

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I'm very interested in this program. Do you feel you get enough slit lamps, chest tubes, intubations, ect. without having several off service rotations? How is housing near the hospital? I have a family and would probably need more space. Are they pretty bias about picking Iowa grass or would a person with FM/military medicine experience be given a good shot. What's your biggest dislike of the program? I understand if you don't want to answer publicly as you are still in the program. Thanks for sharing!

Thanks!  updated

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1.) Do you think that NOT being from an EM background hinders someones chances? You came from an EMT background and I've noticed other PA's who were accepted to other EM programs - they had previous EMT experience (ie: multiple residents of Yale's EM PA-C class as an example)
2.) What's the hour work week look like - Any time for picking up additional shifts for supplemental income
3.) How's the whole interview process, structure, day like? (I'm starting rotations in a few months and most likely will be applying to Iowa)
4.) Did you apply w/o PANCE scores (or contingent on completing it correct?)
Thank you!

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1.) Do you think that NOT being from an EM background hinders someones chances? You came from an EMT background and I've noticed other PA's who were accepted to other EM programs - they had previous EMT experience (ie: multiple residents of Yale's EM PA-C class as an example)

2.) What's the hour work week look like - Any time for picking up additional shifts for supplemental income

3.) How's the whole interview process, structure, day like? (I'm starting rotations in a few months and most likely will be applying to Iowa)

4.) Did you apply w/o PANCE scores (or contingent on completing it correct?)

Thank you!

 

Updated, thanks!

 

Sorry it's been so long between updates, sometimes residency kicks your butt ;).

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I work with a recent grad of this program. she is awesome. as someone only a few years out of school she is applying for (and getting) rural solo em pa positions that it took me 20 years to qualify for.

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Did faculty or previous residents share how much of a pay bump completing the residency will provide as compared to a new grad starting salary? Also, did you do any rotations in anesthesia for airway skills?

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Wanted to ask how are you still liking UIHC? Particularly your opinion of the off-service rotations. Do you have a hospitalist rotation with FM or IM? I see some different things on what the curriculum involves. What electives are you choosing?

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Do they let the PA residents run codes, traumas, and pick up the level 1/critically ill patients, or are those patients eaten up by the senior residents?  It seems like in my ED the senior residents (4th years here) are expected to get the critically ill.  PS - good idea for this QnA format!

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Did faculty or previous residents share how much of a pay bump completing the residency will provide as compared to a new grad starting salary? Also, did you do any rotations in anesthesia for airway skills?

 

 

Wanted to ask how are you still liking UIHC? Particularly your opinion of the off-service rotations. Do you have a hospitalist rotation with FM or IM? I see some different things on what the curriculum involves. What electives are you choosing?

 

 

Do they let the PA residents run codes, traumas, and pick up the level 1/critically ill patients, or are those patients eaten up by the senior residents?  It seems like in my ED the senior residents (4th years here) are expected to get the critically ill.  PS - good idea for this QnA format!

 

Looks like its time for the quarterly update! Thanks for the questions guys.  Post got too big so now it's split up.

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Awesome! That's great you got to pick up wilderness, tox, and ultrasound electives. I would have a hard time choosing, but the wilderness elective is one of my big draws to the program.

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Hello everyone,

i just started residency here at UIHC. I’ve noticed the previous resident trailed of and thought I’d pick up where he left off. I only can answer some basics now as I’m still orienting, but willing to answer all I can about the area and the program I can. Promise not to disappear so that way you can see how it progresses if you continue to ask.

I’ve been practicing 3 years in FM. I had significant high level HCE prior to PA school. 

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What is the orientation like? Did they tell you how many ppl applied vs interviewed? Thanks!

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32 minutes ago, PA-SGuy said:

What is the orientation like? Did they tell you how many ppl applied vs interviewed? Thanks!

The orientation is a bit longer than for the physicians because of the way we are credentialed (we are actually licensed providers) and includes multidisciplinary shadowing (ED social workers, pharmacy, etc), EKG course, EM “crash course”, EMR training, and ultrasound training. The first day was very encouraging and felt very welcome. Very pro-PA. I only heard the word mid level once and I’ve never seen it in writing. It was mentioned several times we are to have the exact same learning opportunities as the physician residents and to bring anything less to their attention immediately. They were very open to my research ideas (not mandatory). I walked away knowing I had made the right decision.

No idea of the number applied. 8 were interviewed for 2 spots and they take PAs and NPs. I guess the applications were in the dozens.

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Congrats on your acceptance. Iowa is a very strong program. I have a friend who went through the program who is a rock star.

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4 minutes ago, EMEDPA said:

Congrats on your acceptance. Iowa is a very strong program. I have a friend who went through the program who is a rock star.

Thanks! I’m really happy to be here. Keep me in mind for any awesome rural jobs you hear about out there.

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I suppose an update is in order. I've completed about 2.5 blocks. Started in Peds and now in the main ED, which sees kids but primarily adults. The experience has been amazing. There was growing pains learning the system, the attendings, working odd hours with a family, adjusting from FM to EM, but overall great.

For those considering transitioning from prior practice and returning to a residency I'll offer this experience. I'm perpetually fatigued, partly of my own doing trying to make time with family. I feel my prior experience in FM is both good and bad. The staff seem to overall like it. No one has complained of needing to get rid of prior "bad habits". They feel very comfortable with me taking the vast majority of non-critical patients. The main criticism I've received is I'm sometimes too long in my presentations and I need to learn to be more "sensitive" and less "specific" in my work ups. Not that my differentials are incomplete, but my risk stratification leans sometimes more towards less testing.

The clinical experience has not disappointed. I've managed many level one patients already. Mostly they were level 2s that decompensated quickly. Only led one trauma with a senior resident by my side since this is typically reserved only after your trauma rotation. Only ran one resuscitation alone, but again that's more than anyone 3 months in. Part luck in timing and my willingness to always jump up when someone asks for an intern, not suggesting I'm given these by preference for me by the staff. 

Since it's an easy objective measure to describe, I'll talk about procedures. I've been very lucky procedurally and done a few procedures that even PGY2s haven't done yet such as PTA drainage (2 in fact) and penile cavernous aspiration with penile block. Managed to get these without cherry picking patients, but I'm very forward in asking to perform procedures and not leaving it to the consultants. Several intubations and LPs. One thoracentesis and only one central line and no chest tubes, but I have not done any electives so this is not unexpected. 

I've chosen to set up my elective rotations in MICU and Wilderness Medicine. I tried to set up an OB rotation, but this for some reason did not work out. Not for lack of trying on the program's part. Several factors went into it falling through, not the least of which no PA resident has ever requested OB time. I originally wanted it because I felt it would be wise to have if I go to practice in a rural solo location. We have a mandated rotation in the SNICU. Mine isn't until the end of the program though and thought it would be better if I did MICU earlier to beef up my critical care in the ED rotations anyway. I will also be the first PA resident in the MICU from my understanding, but they sounded excited to have me which gives me a good feeling about it. 

Next month I'll be doing ALS month with the new MD interns in addition to some shifts in the ED. After that I have ortho, anesthesia, trauma rotations coming up close together, so it may be a few months until next post. 

As always I'm open to questions.

 

ETA: Forgot to talk about rare procedure day, or "ER christmas". Practiced umbilical vein cannulation, cricothyrotomy, canthotomy, chest tubes, subclavian lines, and more. My favorite: I got to do a thoracotomy on a cadaver. Well partly. Had to share. I didn't open, but I did get to do the cross clamping of the aorta. 

Edited by DLane

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22 minutes ago, EMEDPA said:

Sounds awesome. I am jealous.

Just trying to live up to the emedpa legend ?

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