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PA2017m

What To Look for in a Residency / Fellowship

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I'm a current 2nd year PA student about to graduate this upcoming fall and I've been applying to different ER fellowships. I've been accepted to 2 different fellowships, which I'm so excited about! I thought it would be helpful to create a list of helpful things to look for in a residency / fellowship & red flags to stay away from. This may be geared more towards ER fellowships since that's mainly what I've been applying for. 

Would appreciate all of your input on this as well, since much of this is coming from what I've read on this forum and online - as well as my personal experience from comparing the different fellowships I've applied to. Let me know what you think!! 

What to look for:

  • Specific clinical rotations through the fellowship 
  • Dedicated lecture time on a routine basis 
  • Dedicated / required list of procedures to complete - means that they won't just train you in the procedure but also make sure that you have enough experience under your belt before leaving the rotation. 
  • Ability to sit for the specialty CAQ exam afterwards (minimum 3000 hrs, equivalent of 18 mo full time practice) (more info: https://prodcmsstoragesa.blob.core.windows.net/uploads/files/CAQGoverningPolicies.pdf
  • Connected to a university / training hospital +/- medical residents - means that they're dedicated to training you as a priority, not just move the meat (not always the case, but it gives you a little more peace of mind). I guess there's some cases where medical residents are more competitive. 
  • "Your Patient - Your Procedure" policy with medical residents / interns that may want to steal a procedure from you. 
  • Reasonable salary >$50k - $60k, with CME allowance, paid vacation time (~2 weeks?), full benefits with insurance 
  • AAPAP / other Credentialing: not required, but helpful knowing that the fellowship has been scrutinized & under a specific review process. AAPAP has discontinued the accreditation process though, so may not have a lot of weight now. 

Red Flags:

  • Claiming to primarily teach you through "exposure", for example, throwing you into the ER without any dedicated rotations or lectures, with maybe lower expectations on how many patients you'll see. You're basically working with lower expectations, and much much lower pay. 
  • Through a PA contracting company & not a university/training hospital. Possible that they're only interested in having low-paying PAs while claiming to give you extra training 
  • Excessive amount of research requirements. Ex: At least 10 hours per week on research, writing articles/case studies, poster presentations, clinical trials, QI studies, etc. 
  • Salary <$50k. One of the fellowships I was accepted to is in one of the most expensive cities in the US and paid about $40k, which was alarming - but this might be normal? I've read that some people have salaries anywhere from 40k - 80k, so I wasn't sure what a reasonable salary amount would be. 
  • Not eligible for the CAQ exam afterwards 

Anything else? 🙂

Edited by PA2017m

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Agree with all except being able to take for a CAQ exam immediately upon completion. From my understanding, CAQ eligibility basically requires 3000 hours/18 months of work experience + 150 recent CME credits... so that point implies residencies/fellowships should be at least 18 months long. If I'm going to work in EM right after a fellowship anyway and the fellowship provides a solid foundation over a shorter duration (i.e. 1 year), then might as well get paid a normal salary during the time between completing residency and being eligible to take the exam. Just my two cents!

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I think aiming for programs that allow you to take the CAQ is a good thing. My program is 18 months and there is still not enough time for the electives I want to do. Personally I feel 18 months should be the minimum and didn't even look at them after seeing what they were missing in electives and off service rotations, though plenty have become great clinicians through year long programs. 

I would disregard the AAPAP certification until it starts again. Currently programs that have this aren't being reviewed and great new programs can't get it.

Only thing I would add is that the program has a "your patient-your procedure" policy. This protects you from senior residents or a physician intern stealing a procedure from you. 

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Great list! Based on my fellowship interview experience I would also add one more thing to the list of "red flags." I interviewed at one EM program that expects fellows to spend at least 10 hours per week on research, writing articles/case studies, poster presentations, clinical trials, QI studies, etc. Which is fine if you're genuinely interested in those things, but that is not at all why I wanted to do a fellowship year. I'd much rather spend those 10 hours per week seeing patients in the ER or learning new procedures.

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4 hours ago, karebear12892 said:

Great list! Based on my fellowship interview experience I would also add one more thing to the list of "red flags." I interviewed at one EM program that expects fellows to spend at least 10 hours per week on research, writing articles/case studies, poster presentations, clinical trials, QI studies, etc. Which is fine if you're genuinely interested in those things, but that is not at all why I wanted to do a fellowship year. I'd much rather spend those 10 hours per week seeing patients in the ER or learning new procedures.

10 hours! F-that...I think some academic work in residency is useful, but I’m talking maybe 30 hours in the whole program. I published one article, wrote one case presentation, and a few internal patient follow up blogs, and that is the limit of what I ever care to do. I attempted to start a new research project, but without a dedicated research month like the physicians get, it was just too much work on top of clinical hours

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On 6/14/2019 at 6:22 PM, SeaBird said:

Agree with all except being able to take for a CAQ exam immediately upon completion. From my understanding, CAQ eligibility basically requires 3000 hours/18 months of work experience + 150 recent CME credits... so that point implies residencies/fellowships should be at least 18 months long. If I'm going to work in EM right after a fellowship anyway and the fellowship provides a solid foundation over a shorter duration (i.e. 1 year), then might as well get paid a normal salary during the time between completing residency and being eligible to take the exam. Just my two cents!

Thanks for replying! I didn't know about the 18 months work experience requirement. The fellowship I'm preferring is only a 12 month long program, but they did make the statement that all fellows who complete the program were eligible for the CAQ at the end. the NCCPA website stated that the specific term of experience required of physician assistants seeking Certificates of Added Qualifications in emergency medicine is a minimum of 3,000 hours (the equivalent of 18 months of full-time practice). 

So the 18 months may not be a hard number? Feel free to correct me on this! 

On 6/15/2019 at 12:34 PM, LT_Oneal_PAC said:

I think aiming for programs that allow you to take the CAQ is a good thing. My program is 18 months and there is still not enough time for the electives I want to do. Personally I feel 18 months should be the minimum and didn't even look at them after seeing what they were missing in electives and off service rotations, though plenty have become great clinicians through year long programs. 

I would disregard the AAPAP certification until it starts again. Currently programs that have this aren't being reviewed and great new programs can't get it.

Only thing I would add is that the program has a "your patient-your procedure" policy. This protects you from senior residents or a physician intern stealing a procedure from you. 

Thanks for your input! I did read something about the AAPAP certification process being discontinued, so I will add that to the list! 

Do you mind sharing a bit on some of your experiences with the "your patient-your procedure" policy? How do you go about protecting your procedure time while still maintaining a good relationship with the residents or interns? 

On 6/15/2019 at 6:26 PM, karebear12892 said:

Great list! Based on my fellowship interview experience I would also add one more thing to the list of "red flags." I interviewed at one EM program that expects fellows to spend at least 10 hours per week on research, writing articles/case studies, poster presentations, clinical trials, QI studies, etc. Which is fine if you're genuinely interested in those things, but that is not at all why I wanted to do a fellowship year. I'd much rather spend those 10 hours per week seeing patients in the ER or learning new procedures.

Oh wow I will definitely add that! Yeah I definitely don't have much interest in doing research haha. The fellowship I'm preferring includes a monthly journal club with the medical residents and has the option of pursuing more research opportunities if interested... which I'm gonna say hard pass on that haha 

 

 

Edited by PA2017m

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20 minutes ago, PA2017m said:

Thanks for replying! I didn't know about the 18 months work experience requirement. The fellowship I'm preferring is only a 12 month long program, but they did make the statement that all fellows who complete the program were eligible for the CAQ at the end. the NCCPA website stated that the specific term of experience required of physician assistants seeking Certificates of Added Qualifications in emergency medicine is a minimum of 3,000 hours (the equivalent of 18 months of full-time practice). 

So the 18 months may not be a hard number? Feel free to correct me on this! 

Thanks for your input! I did read something about the AAPAP certification process being discontinued, so I will add that to the list! 

Do you mind sharing a bit on some of your experiences with the "your patient-your procedure" policy? How do you go about protecting your procedure time while still maintaining a good relationship with the residents or interns? 

Oh wow I will definitely add that! Yeah I definitely don't have much interest in doing research haha. The fellowship I'm preferring includes a monthly journal club with the medical residents and has the option of pursuing more research opportunities if interested... which I'm gonna say hard pass on that haha 

 

 

In my residency, if you sign up for a patient and they need a procedure, you do it. Simple as that. If another resident wants it, even if senior to me in PGY year, you have to give it up. My residency was very up front that I’m not different from the physician residents. It’s expected that I get all the same experiences and have the same expectations. If something happens that diminishes my residency experience, I’m to bring that up to administrators. So I don’t have to worry about “protecting” my procedures any more than other residents do with each other, because I’m the same as they are, a EM resident.

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