Do EM residency graduates command higher salaries?

[kjavadi]

I'm pretty set on a career in EM, but up until recently I have been against doing a residency. I graduate at the end of this year and my end goal is to practice at a CAH in Montana after several years of experience. This reason alone is probably enough to justify the residency, but I'm also weighing the financial implications. 

An average residency pays 90k for 1.5 years.  This equates to something like a 75k opportunity cost assuming I could get an EM job paying 110k/year straight out of school. If I completed a residency, what kind of salary bargaining power would I have? Could I expect my salary to be the same? 10k more? 20k more? I would like to get an idea of how long it would take before the residency would "pay for itself".

I know there are many benefits of a residency but I'm specifically wondering about finances. 

Thanks!

[EMEDPA]

The real advantage to the residency is getting the better job right out of the chute. I was not able to do a residency, so it took me 15 years to get enough experience to work at a high acuity/low volume rural, solo coverage job. A residency grad could get hired into this job right out of residency.

A few things have really helped me along the way:

prior paramedic experience has gotten me several jobs.

Changing jobs every time I maxed out the learning potential of a job. This equated to every 2-3 years. This also exposes me to different ways of doing things and gives me options for switching jobs seamlessly.

Lots of extra cme short courses like ALSO, APLS, ABLS, FCCS, Difficult airway, ATLS, etc to fill in gaps in my training that I would have gotten in residency.

Time in the OR with an anesthesiologist to fine tune intubations, LMA, bagging, vents, bipap, etc

Getting the CAQ as some employers recognize it as "board certified in emergency medicine"

Getting the doctorate as it implies a certain level of training and expertise in our society and culture

 

[LT_Oneal_PAC]

41 minutes ago, kjavadi said:

I'm pretty set on a career in EM, but up until recently I have been against doing a residency. I graduate at the end of this year and my end goal is to practice at a CAH in Montana after several years of experience. This reason alone is probably enough to justify the residency, but I'm also weighing the financial implications. 

An average residency pays 90k for 1.5 years.  This equates to something like a 75k opportunity cost assuming I could get an EM job paying 110k/year straight out of school. If I completed a residency, what kind of salary bargaining power would I have? Could I expect my salary to be the same? 10k more? 20k more? I would like to get an idea of how long it would take before the residency would "pay for itself".

I know there are many benefits of a residency but I'm specifically wondering about finances. 

Thanks!

No one is going to be able to give a solid answer on this. There are far too many variables. First, solo CAHs pay better already and you aren’t likely to get a job in one until you have either several years of practice or a residency. So how do we weigh that? One could say you’re getting an average salary for that position, but you got it way earlier. 
 

Next, it depends on your own negotiation prowess. I’ve known some people say it didn’t confer anything. Well, if you go work for the level one, no. You can’t negotiate with a 500 bed hospital in the most desirable area to live. Doesn’t matter what you’ve done. I’ve seen people with 10 years experience get just 5k more than a new grad at these places. At smaller facilities, one job offered me the same as a new grad. I pointed out my residency and they approved in 6 hours a 20k increase request. I should have asked for more. I did at my next job and it was approved in the interview. 

there are the other benefits. Job security. I always get a call back if I apply for a job. Any job I’ve pursued (3 so far) I’ve gotten offers in 24 hours. This is all anecdotal at CAHs. I’ve not applied to bigger centers, but have had lots of fellow residents break into tough markets in Colorado and Florida with ease. 
 

the other benefit is the larger scope of practice. I’ve never had a requested credential denied. I’ve had pushback in practice at one job because nursing wasn’t use to having someone do full scope EM, but that’s another matter.

This is also predicated I’m doing a true residency and not one of the pseudo-residencies that are more on boarding programs  done by many for-profit companies. I’ve heard from those it hasn’t been worth it.

for me, I can’t recommend it enough. 

 

 

[dphy83]

I agree with the above. Residency will get you to your goal of CAH much, much sooner. Without a residency you stand the chance of doing fast track for at least a year before being incorporated into the main ED to gain the real experience, depending on the practice setting.

Eat the salary loss for the length of the residency. Looking back I don't regret doing one and honestly don't pay attention to the lost income. Also, keep in mind that there are many very good 12 month residencies as opposed to the 18 month ones to seem to be referencing, so that could minimize lost income by 6 months since money seems to be at the forefront of your reasoning.

[kettle]

All of the above information is fantastic. I graduate in a month, take the PANCE and as long as I pass mid June I start residency. Yes it is a lowered income but I'll be cutting checks long before classmates. I was a paramedic for over ten years, taught a medical school procedural cadaver lab and I'm a 4.0 student. With that being said trying to work solo straight out of school scares the living daylight out of me. I'm doing an 18 month residency. I hear a lot of for profit hospitals saying they have a "residency" it's a few month on boarding process not a residency. I'm talking a huge hit doing a residency but it's still more than I made as a paramedic. I've already talked to hospitals about working for them post residency and showed them the list of compentiecs I have to do in residency and they were beyond impressed as most of their locum physicians don't do many skills you will learn in residency. I'm excited for residency!!!! I'd definitely look into it and you can always message me in a few months and I can let you know about my experiences.

[EMEDPA]

Kettle- Several folks have done day to day or weekly posts in the residency section during residency. feel free to do the same. 

you made the right choice. I think any new PA NOT doing an EM residency in 2020 and expecting to get a really good EM job will be fighting an uphill battle. Ditto ortho, critical care, and surgery. 

[kettle]

Thanks EMEDPA! I'll definitely start a topic/blog and do weekly reports. I initially wasn't that excited about a residency but in these uncertain times I feel super fortunate to be in one, learning additional information and just being employed. It's going to be tough living in a large city as I love the outdoors but will be worth it. I hope to practice full scope at some point in my career in EM on an American Indian reservation as I did a lot of my time as a paramedic working on a reservation.

[Randito]

I echo what other have said regarding the value of a residency and will look forward to hearing about your experiences. 

Here is a conference that you should definitely check out if it's rescheduled. Heard about it on a podcast called "Rural EM". The guest on episode 11 discusses his experience working on the Navajo reservation in northern AZ. 

https://www.eventbrite.com/e/postponed-2nd-annual-native-american-and-rural-emergency-medicine-conf-registration-83253460341

[JDayBFL]

As a residency grad (although not in EM, I am in surgery) I was definitely able to command a higher salary right out of the gate. The main advantage is that you will have negotiating power with all jobs you apply for— my training institution couldn’t even match several of the high offers I got from applying elsewhere. I applied for 5 jobs three months prior to graduation and received 4 interviews within 1-2 days of applying. Most places treated me as if I had 3-5 years of experience on the pay scale and credentialing was a breeze since I had case and procedure logs to prove competency. I would apply broadly after finishing a residency and take the best offer for you both financially and one that matches your skill set and what you enjoy doing. Assuming I lost $50k that first year doing a residency, I made up that money in 18 months at my current job and have financial stability in > 75th percentile of all PAs going forward. 

[travlmedpa]

 

@kjavadi Do the residency. I live in Montana and was set on EM (former EMT) and I have now been practicing for 6 years NOT in EM. Montana is tough in getting those positions, you may also need FP experience for a CAH as they cross cover clinic and ED in Montana frequently, even long term care. My current position is connected to a CAH ED and I was hired to cover that (with a doc on site) and the UC... 2 years in I still haven't had a single shift in the ED. I work locums in Alaska in rural solo provider sites and that is the closest I have gotten. The ERs in Montana have extremely low turn over of their APP staff (same 3 PAs in the town I live in for 8+ years, I met them when I was a student). I've tried getting PRN ED jobs and no go. Montana is still very pro physician in the "big" city EDs, even the CAHs try to hire physicians and use APP locums to fill gaps. 

Residencies weren't quite as common when I graduated now there are several more programs and it is becoming a more common path for PAs. I'm considering giving up my great pay to go to one so I can finally get back into the ER! Or like EMEDPA said, you can spend 15+ years working your way into one with lots of CME and certifications.