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I’ve been having some discussions about doing a CCM residency at my institution after completing my residency. Everyone seems interested in me doing it. A few things would have to be altered such as my current residency would have to be extended 4 months (for a total of 22 months) to coincide with the start of the fellowship, which they also seem interest in doing. In exchange I would also get more elective time. I’d prefer this over doing locums so it would be a simple transition, but isn’t necessary. The CCM residency is a year long and pays about 7-10k more than I make now (which isn’t much lol), so in total I’ll have done just shy of 3 years post grad training. The talks are going that I would eventually split my time between CCM and EM like the docs with 6 shifts per month in the ED and 1 week per month in the unit. It would be more for management of the various ICU patients (rotate through Cvicu, micu, snicu, picu, and other areas) as I’ve already learned the majority of the procedures, though I would learn bronscopy and percutaneous trachs.

Pros: I think it would just be cool to be, I think, the first formally dual trained EM-CCM and truly fellowship trained PA.

it would be nice to have the variety of working CCM and EM.

I have more GI bill to use to supplement my income, which pay about 1900 per month.

it would help with my PSLF. The less I’m paid the less I pay them, and finding a non-profit to work for in EM with all the groups is hard.

maybe could led to some consultancy work establishing residencies elsewhere? Or maybe speaking/lecturing/podcasts for EMRAP?

Con:

another year putting off settling down, renting a so so house,

 

thoughts? Should I just go straight to work? Am I overinflating the pros?

Edited by LT_Oneal_PAC
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Pros

- You would be a total stud and the envy of your peers

- Sounds like a dream job at the end.

- The mixed schedule seems like a good way to avoid long-term burn out. 

- Possible non-clinical opportunities like you mentioned.

- You already know that you can handle the stressors and schedule of a fellowship/residency.

Cons

- Do you want to stay at your current institution for the long term? Not sure how many positions like this exist for PAs. Certainly you can find part-time or per diem EM work, but I haven’t seen many such positions in critical care.

- Probably not financially prudent, though this is diminished due to you having GI Bill funds available. 

Only you can determine if it would be worth it, but personally I hope that you do just for the cool factor. 

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18 minutes ago, Randito said:

Pros

- You would be a total stud and the envy of your peers

- Sounds like a dream job at the end.

- The mixed schedule seems like a good way to avoid long-term burn out. 

- Possible non-clinical opportunities like you mentioned.

- You already know that you can handle the stressors and schedule of a fellowship/residency.

Cons

- Do you want to stay at your current institution for the long term? Not sure how many positions like this exist for PAs. Certainly you can find part-time or per diem EM work, but I haven’t seen many such positions in critical care.

- Probably not financially prudent, though this is diminished due to you having GI Bill funds available. 

Only you can determine if it would be worth it, but personally I hope that you do just for the cool factor. 

Not sure where I'll be in 10 years, but I definitely could stick around here for a long while. It would be hard to find such a position elsewhere. Spoke with the docs who do it and say its hard for them to find positions as well and sometimes you have to convince a potential employer of its benefits, often swinging more CCM or more EM depending on the need at community hospitals. 

It probably turns out to be a wash with what I would be saving in loan forgiveness and what my GI bill makes up for.

It does sound really cool, though, right?!

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7 hours ago, LT_Oneal_PAC said:

Or maybe speaking/lecturing/podcasts for EMRAP?

As an avid listener of podcasts myself, this seems really cool and the experience would help. Pulmcast has a PA host. 

 

I think it’s a great idea if you can afford it and are willing to work as a resident. Try calling St. Luke in PA. Their ER residency is combined with a CCM residency. They have the same 6 month rotations then diverged the last 6 months. Maybe your experience can mitigate the time investment. 

 

 

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1 hour ago, kidpresentable said:

Are these all 12-hour shifts? Have they mentioned a starting salary for when you finish the training?

They aren’t twelve hour shifts. I believe they are 10.

It’s a state institution, so I can look up everyone’s salary and I feel I’ll be well compensated for an academic hospital.

The benefits of working here don’t concern me very much. They offer APPs a very fair package I think. 

Edited by LT_Oneal_PAC
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Look heavily into the logistics of doing this post graduation. As mentioned above, finding a job outside of your place to let you do this will be tough I think. I think you end up working CCM and moonlighting/locums in EM long term unless you stay where you are since the splint like they have at your current place is unique.

I do like the thought of this. You will be uniquely prepared. You'll just have to find an environment where you can utilize those skills. 

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2 hours ago, JMann said:

Look heavily into the logistics of doing this post graduation. As mentioned above, finding a job outside of your place to let you do this will be tough I think. I think you end up working CCM and moonlighting/locums in EM long term unless you stay where you are since the splint like they have at your current place is unique.

I do like the thought of this. You will be uniquely prepared. You'll just have to find an environment where you can utilize those skills. 

Was hoping to get your take on this.

I agree that I need to go in eyes wide open about having a split ED/CCM position. It will be a rare situation to find a split job and probably only at large academic centers that are committing to PA residency training. It may end up being just like you mention, because I assume there is no job until I’m actually starting. 

I think it would still be worth it, even if I only did EM, given my unique financial situation with having GI bill and needing to work for a nonprofit for loan forgiveness. 

Really it just feels like do I want to put myself and family through another year of it. At least one of the attendings says it’s easier in terms of exhaustion compared to the ED with more regular hours and time to think as opposed to rotating shifts and constant bombardment with patients/nursing questions.

Edited by LT_Oneal_PAC
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Really interesting idea. Being EM/CCM trained seems like you would be exceptionally well-rounded. Even if you can't keep the dual-job thing going at other institutions, a lot of critical care happens in the ED, and you'd be a huge asset at your next institution if you knew how to manage those patients in a way that doesn't make the CCM people roll their eyes. (I always stick up for my EM colleagues when a patient rolls into the unit in a less-than-ideal state--you guys have my eternal admiration for the number of patients you juggle at once, and the difficult decisions you have to make with very little information!)

Not to get off into a side discussion, but EMEDPA, what/where is that US fellowship?

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3 hours ago, CSCH said:

Really interesting idea. Being EM/CCM trained seems like you would be exceptionally well-rounded. Even if you can't keep the dual-job thing going at other institutions, a lot of critical care happens in the ED, and you'd be a huge asset at your next institution if you knew how to manage those patients in a way that doesn't make the CCM people roll their eyes. (I always stick up for my EM colleagues when a patient rolls into the unit in a less-than-ideal state--you guys have my eternal admiration for the number of patients you juggle at once, and the difficult decisions you have to make with very little information!)

Not to get off into a side discussion, but EMEDPA, what/where is that US fellowship?

I agree. It would be great to be the departments critical care expert. And thank you for defending us ?

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On 9/1/2018 at 12:34 PM, LT_Oneal_PAC said:

Was hoping to get your take on this.

I agree that I need to go in eyes wide open about having a split ED/CCM position. It will be a rare situation to find a split job and probably only at large academic centers that are committing to PA residency training. It may end up being just like you mention, because I assume there is no job until I’m actually starting. 

I think it would still be worth it, even if I only did EM, given my unique financial situation with having GI bill and needing to work for a nonprofit for loan forgiveness. 

Really it just feels like do I want to put myself and family through another year of it. At least one of the attendings says it’s easier in terms of exhaustion compared to the ED with more regular hours and time to think as opposed to rotating shifts and constant bombardment with patients/nursing questions.

I don't know if we have any PAs that split between ED and CCM but some of the CCM PAs moonlight in the ED. For us we work 3 days a week so there is time work elsewhere. We also staffed up critical care beds in the ED. Critical care in the ED is more difficult just due to the nurse staffing in our institution. On the other hand we do have PAs splitting jobs between departments. One of my coworkers is 1/2 time CCM and 1/2 time with our ID department doing sim training in Serious communicable disease (Ebola). She works six shifts a month then spends the rest of the month flying around the country doing training so the opportunity exists. 

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Sounds like an awesome opportunity.  Agreed that it would be very difficult to find the same setup as a PA outside of new age academic EDs, but I would totally do it if I were in your shoes!  A year will pass in no time and you'll take that experience with you for your whole life.  I would see if you could get some shifts in the ED throughout the year though, since you'd be surprised at how quickly things atrophy after you leave the ED and put all of your attention to a new specialty.  

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13 minutes ago, SERENITY NOW said:

Sounds like an awesome opportunity.  Agreed that it would be very difficult to find the same setup as a PA outside of new age academic EDs, but I would totally do it if I were in your shoes!  A year will pass in no time and you'll take that experience with you for your whole life.  I would see if you could get some shifts in the ED throughout the year though, since you'd be surprised at how quickly things atrophy after you leave the ED and put all of your attention to a new specialty.  

That's definitely something I've considered and agree, as I've seen my FM knowledge slip away in residency. I wouldn't want my EM skills to become rusty. I think I would have to establish some time to moonlight.

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Culmination of intense experiences (e.g. a residency) almost always bring about thoughts of what the next intense experience should be. Sounds a lot like marathon runners that forget what miles 20-24 were and think the next day "should I do an ultra?" 

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DO IT! I finished my EM residency and have considered going back for a CCM one, but slicing my salary by 60-70% is a tough pill to swallow. As others have mentioned, you'd be well-suited to avoid fatigue/burnout in either of the specialties, which is something that I am trying to balance in the ED right now. I have been searching for some critical care opportunities to help with these feelings, as a result.

Finding a similar split post-fellowship would be very hard, so realistically I would bet you'd find a critical care job then do PRN work in an ED (might not even be at the same hospital). During my residency, I actually worked alongside a PA who did the reverse PRN role - he was full-time ED and did occasional shifts in the SICU. Opportunities are there or like you said you may have to sell some facility on creating one.

Either way, I think the experience would be incredible.

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