For Graduates of an EM Residency

[narcan]

I am hoping to get a sense from a variety of EM residency grads what their experiences were like at their jobs after residency. Specifically, were you able to get the hospital/group to credential you for procedures that other PA's in the group don't do, and is your scope of practice reflective of your training? Did you work at a place that had never had a residency trained grad before? Did you find it was easier to negotiate a higher salary than your peers?

I'm considering going back for a residency, but I've honestly never worked in a place where PA's have a wide scope of practice, so I'm curious if you're required to seek out those jobs and thus relocate, or if you were able to negotiate your expanded scope of practice because of your residency training.

[GetMeOuttaThisMess]

I think that this is a great question to ask (it would be an even better study paper). As EMEDPA has pointed out, as with real estate, it's all about location, location, location.  My guess is that in a major metropolitan area where EM physicians are a dime a dozen the answer is that it makes little, if any, difference.  If you go remote like E has done then it may pay off.  It's the same scenario when I considered doing an online MS bridge program with only a couple of years to go.  Would it make a difference in already occupied positions?  No.  To get a job?  Probably.  Financially, would it provide a significant return on the initial investment?  Only if it's between yourself and another basic trained PA for a job versus no job, or as noted, if you're trying to go rural.

[narcan]

I'm thinking less in terms of money and more in terms of scope of practice. I feel like a lot of the groups I've worked with or seen are pretty set in their ways as far as how they feel comfortable using PA's. Now, I also haven't met any residency trained grads in these organizations, so that may change, but I'm curious if anyone has been able to use that to expand scope of practice in a place that was previously restrictive. Money will follow that (not that it matters per se) once you can see more patients and bill more critical care time.

[EMEDPA]

critical care time bills out less than you think. A 2 cm 2 layer closure of a laceration pays more than 30 min of CC time.

[SERENITY NOW]

On December 5, 2017 at 10:08 PM, narcan said:

Specifically, were you able to get the hospital/group to credential you for procedures that other PA's in the group don't do, and is your scope of practice reflective of your training? Did you work at a place that had never had a residency trained grad before? Did you find it was easier to negotiate a higher salary than your peers?

I'm considering going back for a residency, but I've honestly never worked in a place where PA's have a wide scope of practice, so I'm curious if you're required to seek out those jobs and thus relocate, or if you were able to negotiate your expanded scope of practice because of your residency training.

 

Well I did a residency and am in my first job after graduating now, so I can answer your questions with my N of 1.  I was credentialed in everything I had experience with (I think our hospital required 3-5 prior documented procedures to be able to be credentialed in it) which is essentially 99% of the procedures done in the ED: intubating, central lines, LP, you name it (not transvenous pacing, ED thoracotomy, etc).  My scope of practice has been nice for a first job; I work both in fast track of our large hospital and in the main ED of the smaller community EDs that we cover.  I am able to pick up any patients that I want, regardless of how sick they are, though sickest patients will require physician consult.  I'm glad that I still have the support, because the reality is that residency is great but it doesn't mean you are going to come out knowing it all... you will still have a lot to learn!  My place had never had a residency trained grad before, but hired me sight-unseen from across the country for a pretty great compensation package IMO (I didn't ask how it compares to my coworkers, but it is higher than what most all of my friends from PA school are getting).  

I can understand your concern for scope of practice.  I've now rotated or worked in around a dozen hospitals and many of the APPs have limited scope.  I have also met many PAs who are go-getters and are doing everything.  To be honest, my gut feeling is that your job as a PA is one that you can mold into whatever you want it to be as long as you take the initiative.  No job is going to handhold you and teach you advanced procedures, how to see sick patients, etc... but if you come in to a job already able to do those things (thanks to residency or other experience) and can prove your worth, I think that the flexibility is there in many places.  Most PAs I speak with are happy with a more limited role, so most end up staying that way, which I think skews people's ideas for potential scope of practice at large.  

With the explosion of new PA programs and saturation of the job market... I think we'll unfortunately have to find a way to set ourselves apart from the rest of the pack, and hopefully having this unique experience and skills to do advanced things can do that for us.  I've said this before, but being able to put hard data on my resume that I have 5000+ clinical hours with sick patients in main ED to ICU and 250+ intubations/central lines/ultrasound scans/advanced procedures I think will have a big impact on future prospective employers, so I definitely think the value of residency is there.  Just my 2 cents...

[EMEDPA]

2 hours ago, SERENITY NOW said:

I can understand your concern for scope of practice.  I've now rotated or worked in around a dozen hospitals and many of the APPs have limited scope.  I have also met many PAs who are go-getters and are doing everything.  To be honest, my gut feeling is that your job as a PA is one that you can mold into whatever you want it to be as long as you take the initiative.  No job is going to handhold you and teach you advanced procedures, how to see sick patients, etc... but if you come in to a job already able to do those things (thanks to residency or other experience) and can prove your worth, I think that the flexibility is there in many places.  

this, but you may have to change jobs every few years to get the experience you want every time you max out autonomy and scope of practice. I am now on em pa job # 7 since PA school graduation in 1996 having worked my way up the ladder to the place a residency grad could apply for right out of residency.

[True Anomaly]

I wasn't able to negotiate any increased salary

Since I started my new job a few years ago, I was able to show I was competent enough in emergency medicine to quickly gain the trust of other APPs and attendings.  I only got there because of the effort I put into my residency and then working in the same place as a staff PA for a few years after the residency.