Recent Residency Conversation-Need Input!

[jtpas]

Hello all,

As a first year PA student, I've really enjoyed reading the threads on this forum, even if it takes my attention away from class sometimes. I'd like to get input from some EMPAs regarding a conversation I had with a recently graduated PA about residencies/fellowships. I've read a lot on this forum about them and I know the general consensus is they are highly recommended, which is why I have been strongly considering applying following graduation. In speaking with this new grad, he seemed to think that if you can get the job without the residency, there is no reason to do one. I tended to disagree- personally I don't have EMS/EMT experience, and I think the experience would really set me up better in the long run and make me more competitive for future positions. I'm not really concerned about the potential salary difference in the first year with resident vs. first year grad, as I think the experience will mean more down the line.

His argument was that residents do essentially the same job for less money, and you're no better off applying for future jobs than someone who has worked independently for a year (assuming the residency is one year). He also mentioned that residents won't work more than a first year grad due to resident hours being "capped", which was something I had not seen in my research. I am of the opinion that a future employer will value the dedication shown by a PA who has completed a residency in the field, an opinion he did not share.

I highly value your input as a community, please give feedback if you can! If this conversation has been had on another thread that I've missed, please let me know and I'll be happy to read up on it.

 

Cheers!

[SERENITY NOW]

This guy clearly didn't do a residency, and I'm not sure what his sources are, because he is wrong on almost all accounts.  Its a little upsetting that he is acting as a mentor for students and spreading things that are simply false.  Sorry for the block of text coming, but this clearly rubbed me the wrong way, so I want to set the record straight.  

Its true and everyone on the forum will admit that a residency isn't by any means mandatory - its perfectly fine to make a career in EM without doing one.  That being said, doing a residency clearly has its role and benefits.  

I'll address his thoughts one by one:

"Residents do essentially the same job for less money" - false... as a resident you will be in the main emergency department seeing the sickest patients, the trauma patients, the coding patients, doing all of the advanced procedures.  Most new grad PAs will be starting out in fast track.  Whats more, the job of a resident is to learn - the attendings and senior residents will be teaching you every step of the way while on the job.  As a PA, your job is to move the meat - nobody will be holding your hand and teaching you.   As a resident, you also have conferences every week from great lecturers dedicated to your learning.  Last, you are rotating throughout the hospital covering the consult service with ortho, neuro, ICU, and many other specialty services.  So, the job is not even remotely similar!

"Residents won't work more than a first year grad due to resident hours being capped" - so false I don't even know where to start...  Resident hours have been capped to an average of 80 hours per week during a month period, some weeks will be up to 90-100 hours as long as the average isn't over 80.  Not too many PAs in the ED will work more than 40 hours - in my experience most end up working less.   So, I worked more than twice as much and saw probably 3 times as many patients as a resident as I do now.  These patients were also wayyy sicker than the patients I'm seeing now in the community since it was a huge referral center in an inner city.

"If you can get a job without a residency, there is no reason to do a residency" - false... too many reasons to count.  While I did have medical experience before PA school, it wasn't in emergency medicine so I knew that it would be a very steep learning curve to get into the field.  I've seen many similar new grads think they can waltz into the main ED (or even fast track) and just crash and burn because its genuinely hard and high risk work.  So, I thought about all of the things that I'd want to have in my first job if I was going go into EM... I wanted a great support system, great mentors/teachers and learning capabilities, ability to see all spectrum of patients, learn advanced procedures... I ended up realizing that my criteria for an ideal job was basically describing a residency.  I saw it as the best available opportunity to learn as much as possible... and to get paid to learn was great if you had the right perspective about it.  After graduating, I immediately received multiple job offers even from across the country for the place I wanted to move to, because as you can imagine, the experience is top notch and definitely a resume-buffer which will stick with you forever.  I literally could write on my resume that I had over 5000 hours of clinical experience (vs the 2000 average from PA school) in everything from main ED to ICU, and had over 300 airways/central lines/ultrasound scans... it sets you apart for sure!

[Wellness]

34 minutes ago, SERENITY NOW said:

This guy clearly didn't do a residency, and I'm not sure what his sources are, because he is wrong on almost all accounts.  Its a little upsetting that he is acting as a mentor for students and spreading things that are simply false.  Sorry for the block of text coming, but this clearly rubbed me the wrong way, so I want to set the record straight.  

Its true and everyone on the forum will admit that a residency isn't by any means mandatory - its perfectly fine to make a career in EM without doing one.  That being said, doing a residency clearly has its role and benefits.  

I'll address his thoughts one by one:

"Residents do essentially the same job for less money" - false... as a resident you will be in the main emergency department seeing the sickest patients, the trauma patients, the coding patients, doing all of the advanced procedures.  Most new grad PAs will be starting out in fast track.  Whats more, the job of a resident is to learn - the attendings and senior residents will be teaching you every step of the way while on the job.  As a PA, your job is to move the meat - nobody will be holding your hand and teaching you.   As a resident, you also have conferences every week from great lecturers dedicated to your learning.  Last, you are rotating throughout the hospital covering the consult service with ortho, neuro, ICU, and many other specialty services.  So, the job is not even remotely similar!

"Residents won't work more than a first year grad due to resident hours being capped" - so false I don't even know where to start...  Resident hours have been capped to an average of 80 hours per week during a month period, some weeks will be up to 90-100 hours as long as the average isn't over 80.  Not too many PAs in the ED will work more than 40 hours - in my experience most end up working less.   So, I worked more than twice as much and saw probably 3 times as many patients as a resident as I do now.  These patients were also wayyy sicker than the patients I'm seeing now in the community since it was a huge referral center in an inner city.

"If you can get a job without a residency, there is no reason to do a residency" - false... too many reasons to count.  While I did have medical experience before PA school, it wasn't in emergency medicine so I knew that it would be a very steep learning curve to get into the field.  I've seen many similar new grads think they can waltz into the main ED (or even fast track) and just crash and burn because its genuinely hard and high risk work.  So, I thought about all of the things that I'd want to have in my first job if I was going go into EM... I wanted a great support system, great mentors/teachers and learning capabilities, ability to see all spectrum of patients, learn advanced procedures... I ended up realizing that my criteria for an ideal job was basically describing a residency.  I saw it as the best available opportunity to learn as much as possible... and to get paid to learn was great if you had the right perspective about it.  After graduating, I immediately received multiple job offers even from across the country for the place I wanted to move to, because as you can imagine, the experience is top notch and definitely a resume-buffer which will stick with you forever.  I literally could write on my resume that I had over 5000 hours of clinical experience (vs the 2000 average from PA school) in everything from main ED to ICU, and had over 300 airways/central lines/ultrasound scans... it sets you apart for sure!

Awesome response! I am curious, and I do not mean to hijack your post. I believe this may be something that would help you as well, jtpas. Serenity, when do you think it is appropriate and inappropriate to do a EM residency? I would think it would be best to do it right after you graduate, if you were accepted, but what if someone were wanting to spend some time in fast track before entering a residency. What are your thoughts?

[SERENITY NOW]

Thats a bit of a tough question.  I think that a residency will always have a ton of benefits for basically anyone - heck, even Emedpa said he would enjoy doing one and he is the best of the best.  The question of whether or not its appropriate for someone is largely based on whether or not the benefits outweigh the negatives, and really the negatives are kind of specific to the person.  I've heard residency is extremely challenging with children, at least if you don't have a partner who is willing to stay at home during that time period... so the negatives might outweigh the benefits then.  Also, if you've had a ton of experience as an ER nurse or paramedic, you'd probably do well as a new grad in the ED and it might not be as important as someone like me who didn't have ED experience -- not saying there wouldn't still be huge learning benefits for those people, but it may tip the balance of positives / negatives.  

I actually wrote a blog post towards the beginning of the residency regarding the topic of starting residency right after school vs waiting a year or two.  At the time I was a brand new PA seeing the sickest of the sick and I felt very very overwhelmed, and when you are that overwhelmed sometimes the stress limits how much you are able to actively learn and retain.  I had wished that I had done an easier more straightforward job for a year or two to get the fundamentals under my belt before jumping in the deep end of residency.  I later realized that this overwhelmed feeling is normal and something that all physicians go through as well.  Still, I think that I would have been able to learn more and retain more if I had that base of experience before going into the residency instead of struggling to keep my head above water haha.  That being said, I've heard that admission committees tend to favor new grads for some reason I don't understand... maybe because they are theoretically more malleable and tend to have less responsibilities outside of medicine?  At any rate, I'm not sure how realistic it would be to get accepted after a few years, even if I think it would actually help your learning, so I'd recommend you reach out to the residency programs you are interested in to get their thoughts directly.  

[jtpas]

Serenity, thank you for the time you took to write that post! It really reaffirmed what I have been thinking about residency and the opportunities they offer. If it helps, the new grad I spoke with doesn't work in EM, and tends to talk without fact-checking first. Hope he didn't get you too riled up!

If there are other opinions on the matter I'd love to hear them, thanks again!

[gbrothers98]

There is some truth to what the new grad spoke...with some caveats.

A PA EM resident will work for less money than the PA hired into the EM position...but the PA resident's job is to learn rather than be employed. The PA resident will also rotate through different services and gain that experience while again, the employed PA would have to seek out that experience on off scheduled time, if at all. Last, medical resident hours are capped by law. PA residents on the other hand are likely capped by the sponsoring institution and possibly by an accreditation body. Regardless of prior experience, the new PA grad has zero experience being an EM PA. They may have some experience and skills that potentially transfer but on day one of EM employment or residency, the new grad PA are relatively equal concerning training. Alternatively, the PA resident on the first day of EM employment has up to or more than a year of EM training. The true downside to any PA residency or fellowship is that there are not a lot of them which means the competition could be substantial as compared to the EM job. Last, not to malign new grads but the only experience they have is being a new grad. Good luck. George

[EMEDPA]

there are 30 EM PA residencies now. some don't even fill every year. I tell students to apply to several (3-5) and they will likely get a slot.

[True Anomaly]

I won't repeat a lot of what has been said here, but I was in a similar place as you when I was a student- I had a mentor I trusted who did not think I should do a residency, but it was mostly her beliefs about PAs not being limited by specialty training rather than what was best for ME.  She had some similar things to say as your mentor did.

If you read my thread regarding residency, you'll also know that I felt it was more than worth it for me, for too many reasons to count- many of which were described by Serenity very well above.  

I've said this before, but I think it bears repeating- what exactly does it mean to have "clinical experience" and take care of patients in a particular specialty?  It means you know how to approach patients and THINK like someone who also has experience in that particular specialty.  The ability to think in an ER mindset is different than other specialties.  You learn what the standard of care is, how to understand the latest literature, who the "experts" are in the ER world and how they think- and maybe you'll be lucky enough to work with someone like that (I got to work with Richard Levitan the first part of my intern year, since he was one of my attendings).  It's great to tout how many advanced procedures you get to do, but the greatest value of a residency- to me- is teaching someone how to think in that specialty. 

[ohiovolffemtp]

I chose not to do a PA EM residency but instead go straight to work in an ED.  For me, the driving reason was I was ready to get back to living in my house with my family after PA school.  Much smaller reasons were the income differences: $50-60K/year as a resident, > $100K working in my 1st year and the fact that my PA school faculty suggested that after my 30+ years in fire/EMS I wouldn't benefit as much as others from a residency.  I was very fortunate.  I work at a level 3 trauma center with high acuity with great APC's & doc's.  I've learned a lot in 4.5 years there.

However, I still feel that I'm behind professionally where I would have been if I'd done a residency.  There's just not the focus on learning or the availability of off-service rotations to really get good at all of the assessments, procedures, and treatments in the various disciplines that deal downstream with the patients you see in the ED.  When you're working, the focus is as it should be on getting patient's dispo'd.

You can (and I have) pick up some of this knowledge through CME: SEMPA, ATLS, ultrasound courses, etc.  Still, if you and those close to you can afford that 1-1.5 brutal year of residency I'd do it.   Work will teach you to "think EM", but it won't show you all of what is out there like a residency.  That's why the docs do a residency, which has all of those off service rotations.

[jtpas]

Ohio, it seems like you made the right decision based on your life outside of work. Fortunately, I have the flexibility (or at least it looks that way now!) to be able to dedicate the 12-18 months for a residency program. I appreciate your input, as it seems there is still significant value in a residency program even from someone with such extensive experience as yourself. 

[ohiovolffemtp]

Jtpas,

If you're wanting to do solo coverage or work in an ED where you can manage the most difficult cases, I'd recommend doing the residency and then carefully picking jobs, especially your first, which permits you to do that.  BTW, I found a new learning avenue: spend time with the hospitalists.  I've made friends with the night hospitalists.  One is a real ultrasound guru who does a fair number of procedures: central lines, pigtail catheters - for pneumo's that don't need full chest tubes.  I'll probably spend a few hours after the end of my shift.  Once I get enough central line experience, I can get credentialed by my hospital to do them.  He likes to teach and he'll get more lines in patients prior to admission.  Win-win for both of us.

[nuggetmamaa]

This guy clearly didn't do a residency, and I'm not sure what his sources are, because he is wrong on almost all accounts.  Its a little upsetting that he is acting as a mentor for students and spreading things that are simply false.  Sorry for the block of text coming, but this clearly rubbed me the wrong way, so I want to set the record straight.  
Its true and everyone on the forum will admit that a residency isn't by any means mandatory - its perfectly fine to make a career in EM without doing one.  That being said, doing a residency clearly has its role and benefits.  
I'll address his thoughts one by one:
"Residents do essentially the same job for less money" - false... as a resident you will be in the main emergency department seeing the sickest patients, the trauma patients, the coding patients, doing all of the advanced procedures.  Most new grad PAs will be starting out in fast track.  Whats more, the job of a resident is to learn - the attendings and senior residents will be teaching you every step of the way while on the job.  As a PA, your job is to move the meat - nobody will be holding your hand and teaching you.   As a resident, you also have conferences every week from great lecturers dedicated to your learning.  Last, you are rotating throughout the hospital covering the consult service with ortho, neuro, ICU, and many other specialty services.  So, the job is not even remotely similar!
"Residents won't work more than a first year grad due to resident hours being capped" - so false I don't even know where to start...  Resident hours have been capped to an average of 80 hours per week during a month period, some weeks will be up to 90-100 hours as long as the average isn't over 80.  Not too many PAs in the ED will work more than 40 hours - in my experience most end up working less.   So, I worked more than twice as much and saw probably 3 times as many patients as a resident as I do now.  These patients were also wayyy sicker than the patients I'm seeing now in the community since it was a huge referral center in an inner city.
"If you can get a job without a residency, there is no reason to do a residency" - false... too many reasons to count.  While I did have medical experience before PA school, it wasn't in emergency medicine so I knew that it would be a very steep learning curve to get into the field.  I've seen many similar new grads think they can waltz into the main ED (or even fast track) and just crash and burn because its genuinely hard and high risk work.  So, I thought about all of the things that I'd want to have in my first job if I was going go into EM... I wanted a great support system, great mentors/teachers and learning capabilities, ability to see all spectrum of patients, learn advanced procedures... I ended up realizing that my criteria for an ideal job was basically describing a residency.  I saw it as the best available opportunity to learn as much as possible... and to get paid to learn was great if you had the right perspective about it.  After graduating, I immediately received multiple job offers even from across the country for the place I wanted to move to, because as you can imagine, the experience is top notch and definitely a resume-buffer which will stick with you forever.  I literally could write on my resume that I had over 5000 hours of clinical experience (vs the 2000 average from PA school) in everything from main ED to ICU, and had over 300 airways/central lines/ultrasound scans... it sets you apart for sure!

@serenity I am an EM PA resident at UCSF Fresno and came here to write this. Thanks for beating me to it. I am 100% an advocate for EM PA residencies.

OP you will have a plethora of opportunities if you do an EM residency and way more experience than a PA new grad working for the same amount of time. That being said really do your research and find out what is best for you. Residencies are not for everyone but if you do have a chance to do one, trust me, you won’t regret it.


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