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UpperLeftPAC

Residency after working - not as a new grad.

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Hi all, 

I haven't seen much on the forums about people completing a residency after already working. I've been in hospital medicine since I graduated two years ago and I do enjoy my job, but my hope has been to get into critical care/emergency medicine at some point. I think I could likely do that in my area without too much difficulty, but now that I've seen what 'on the job training' really amounts to typically, I am concerned that I'd get pigeon-holed into fast track or something because of the lack of training I'd receive. My fiance and I don't have children (yet, maybe never), and I'm still young enough (early-mid 30s) that I have many years of practice left. I think the extra training, knowledge, and experience would be worth it for the enrichment of my continued career.

Has anyone here done a residency after working? or know anyone who has?

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@LT_Oneal_PAC, thanks for your reply, and also to my other question to you on the other board. What was your experience like getting into the residency? Did you feel your time in the field worked for or against you?

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I will be starting an EM residency in about a month. Have been working for about 4.5 years with 1 year in FM, 1.5 in outpatient transplant/hepatology and 2.5 inpatient transplant. I can echo your concerns regarding on the job training. Since i started my inpatient role, I have been promised opportunities for advanced procedures and OR training. Neither of which really materialized. 

I think that my previous experience, especially the inpatient experience will be a significant benefit. I've been working with residents, calling consults and generally caring for pretty sick patients. However, after working in a subspecialty, it will be challenging getting back into a more generalist field. This later point wouldn't necessarily apply to you if you've been working as a hospitalist. The other big challenge will of course be the schedule. I currently work anywhere from 42-50 hours a week, all days. In the fellowship I will have consistent 55-60 hour weeks with alternating schedules, something that I haven't done in a while. 

In the end, I'm hoping to have significantly greater autonomy and confidence in working with really sick patients. I also feel that I was starting to get pigeon-holed into transplant. I've alway loved EM as my pre-PA experience was as an EMT and ER tech.  I also appreciate the greater opportunities to move to new regions of the country and work part-time or per diem as life and finances allow. 

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Wow @Randito, that's very cool. Hopefully you'll post a few things about your experience as you go. 

I do nights exclusively now as a hospitalist so I do think that experience would translate well to EM. The schedule would def be a bit of a shock. Right now I'm contractually obligated to do only ten 12-hour shifts a month, although I usually do more like 12-14 for the money... but it would definitely be a lot more work.

My group is being absorbed by Providence locally and I just attempted to get permission to train and get credentialed to place central lines on the floor when needed. We have an IV therapy team at night but they frequently find themselves unable to place PICCs. The new group management didn't flat out say no but certainly weren't encouraging. They seemed more interested in getting RT trained and credentialed to intubate than to get me and the other APCs the same thing. Kind of solidified my desire to pursue further training. As long as they have me there to cross cover and do some of the admissions, they would rather cobble together some other solution for procedures than allow for what I think would be meaningful personal growth. 

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On 9/25/2018 at 10:26 PM, UpperLeftPAC said:

@LT_Oneal_PAC, thanks for your reply, and also to my other question to you on the other board. What was your experience like getting into the residency? Did you feel your time in the field worked for or against you?

Sorry, I don't remember seeing a notification for this. 

Definitely worked for me. I had some outstanding letters of recommendations from the assistant program director for the FM residency I worked at, as well as from colleagues that commented on my ability to function as a full provider. Plus, I wasn't as stressed at the interview. They did ask some questions. To paraphrase, they stated I could probably get a job in EM just fine without a residency based on my experience in the military and my high level of functioning in FM, so why would I want to do the residency. 

FM specifically has been very beneficially to me in EM because I have seen so many EM follow up visits in my clinic and know exactly what an FM provider would and would not be comfortable handling, though sometimes I think I was more comfortable than some of the guys around here based on what they send into the ER for me to work up, lol. I end up being much more comfortable than some other providers in not ordering several lab tests and scans, being confident in my physical exam skills, which have improved significantly with my implementation of US. I'm also more willing to start patient's on medications until they can have follow up with their PCM. Lastly, I know a lot of long term management/complications in chronic medical problems that many of the EM providers either don't know or are very rusty on. 

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