ER Fellowship With an end goal of rural ER (SOMEDAY!)

[thulegreen1101]

Hi!

I’m a new grad in my mid-30’s with prior ER experience. I’m interested in *SOMEDAY working in more rural ER’s and live in an area where there are still many solo PA’s running small ER’s. I have no interest in jumping straight into a solo practice and definitely want 3-5+ years of experience prior to working in more remote areas. I am considering applying for a fellowship (and then working in a high volume ER) and wondering if others have found this helpful in terms of gaining more skills that eventually help them be better providers in rural more solo practice type settings, vs. just working at a high volume ER for multiple years. I.e. is an ER fellowship worth it if the end goal (down the line) is more rural/solo practice type settings or can you truly gain those skills by just working in a high volume ER? Does anyone regret doing or not doing a fellowship? Thank you for your input!

[ohiovolffemtp]

I went from high volume ED - level 3 trauma center to rural critical access.    I'm also a paramedic.  So, some things and some procedures like intubation were very familiar to me.  By pushing fairly hard I was able to get experience with central lines and U/S at my high volume job.  If you're willing to spend the 12-18 months of a residency, I believe the amount of training you'd get in an environment structured to provide learning is going to be much more that you'd get just working at a busy facility.  From the learning point of view, I very much wish I'd done a residency.  For me, though, the right choice was to start working and spend more time with family.

[CAdamsPAC]

12 hours ago, thulegreen1101 said:

Hi!

I’m a new grad in my mid-30’s with prior ER experience. I’m interested in *SOMEDAY working in more rural ER’s and live in an area where there are still many solo PA’s running small ER’s. I have no interest in jumping straight into a solo practice and definitely want 3-5+ years of experience prior to working in more remote areas. I am considering applying for a fellowship (and then working in a high volume ER) and wondering if others have found this helpful in terms of gaining more skills that eventually help them be better providers in rural more solo practice type settings, vs. just working at a high volume ER for multiple years. I.e. is an ER fellowship worth it if the end goal (down the line) is more rural/solo practice type settings or can you truly gain those skills by just working in a high volume ER? Does anyone regret doing or not doing a fellowship? Thank you for your input!

IMHO a "new grad" should be looking for a practice area to develop new skills and reinforce what the learned in PA School. I'm not sure of your timeline is but  I do think even with a "ER Fellowship" you should have 5 years of solid broad based clinical experience. In my remote practice experience of  delivering babies, operating lab equipment and x-ray machines, riding ATVs to accident sites, avoiding hungry bears were routine on top of doing FM , ED, Ortho, Psych (tell me about it) as a solo practitioner. I think being able to do good Clinical Medicine without CTs, more than very basic labs, limited formulary, minimal if any support staff, no specialty consultants at hand will be a challenge for most PAs.

[EMEDPA]

I did the OJT route and would have much preferred a residency. There are things a resident would do lots of that I have still done only rarely over 23 years working as an EM PA. a residency is structured learning with off service rotations and specialists. A job is just "moving the meat..."

[narcan]

Agree with above. Do the residency if you can get into a legit one. Avoid the corporate internships.

[LT_Oneal_PAC]

Depending on how rural you are speaking of, and I’m not talking about CAdams “I operate the XR machine” rural, with a good residency you can go into these solo provider positions. Trust me, you’ll do a better job at these critical access hospitals than a lot of the non-EM trained providers that they can usually attract. While o spent 3 years in the military before residency, I went straight from residency to a solo provider job. Heck, the problem I’m running into these days is getting the nurses to not lose their $hit and send an email to my boss every time I do some fancy EM trick.