Most versatile residency choice?

[Dariv83]

I'm a new grad who's been applying to jobs in my (metro) area for 3 months so far with little success.

For over a year now I've been on and off about the idea of pursuing residency.  On one hand I do desire the formal, rigorous training PA residency provides, think it's valuable for one's career, and am willing to sacrifice time and money, even relocation, for it.  But on the other hand I have interest in multiple fields (EM, hospital medicine, critical care, some surgical fields) and have been reluctant to commit to any one of them.  What I am sure of is that I like high acuity fields, and that I'm interested in staying a generalist at least for the beginning of my career, rather than jumping into a niche specialty off the bat.

Which, if any, of these residencies may provide the most broad and versatile experience that could be applied to other fields?

[LT_Oneal_PAC]

In my opinion that has is substantiated only by my logic, EM residency is by far the most versatile. It is the longest of the residencies at 18 months at many institutions so providing the highest level of experience, it provides the greatest variety of experiences with off service rotations, greatest variety of cases from lowest to highest acuity. It's applicable to any field as you learn about emergent problems in every area of medicine, so no matter what specialty you're in it will help you recognize an emergency. It helps you know who does and does not need to come in to the hospital from clinic. If you're a hospitalist, which I do from part time, it will help you speak to EM in terms they understand about how someone doesn't need admission or if they need higher level care than the floor can provide. If you're in the ICU, you are much better resuscitationist with EM experience since you are well versed in the undifferentiated crashing patient. 

[dphy83]

I agree with LT that EM may be the most versatile, though I wouldn't necessarily say "by far." I admit that I may be biased as I've done an EM residency. Even with the 12 month EM residencies I think you become a well rounded provider. I would say that a close second (or maybe a tie?) would be a hospitalist residency as you're also exposed to a WIDE range of pathology (as in EM) but you manage them for longer periods of time, as opposed to just hours in the ED. You will not necessarily become as proficient in the initial resuscitation of the sick if you complete a HM residency, but the sick patients are still very sick even once they get to the floor. Another downside is that you likely will not get as much procedural experience with a HM residency as you do with an EM one. I would say the least versatile would be a critical care one. For the most part you would be managing the sickest of the sick (though there are some soft ICU admissions, admittedly) so you would likely miss out on a big chunk of the patient population. Good procedural training in the ICU, though.

 

The choice all depends on where you see yourself working after completion of one. What type of jobs are you applying to? That may tell you which residency you need.

[EMEDPA]

There are a few out there called "Acute care fellowships" that divide their time between EM, ICU, Trauma,  surgery, etc That would be applicable to any inpt setting. It is basically a rotating internship through all the acute care depts in the hospital. Similar to both EM and HM, without focusing on just one area.

[LT_Oneal_PAC]

4 hours ago, dphy83 said:

I agree with LT that EM may be the most versatile, though I wouldn't necessarily say "by far." I admit that I may be biased as I've done an EM residency. Even with the 12 month EM residencies I think you become a well rounded provider. I would say that a close second (or maybe a tie?) would be a hospitalist residency as you're also exposed to a WIDE range of pathology (as in EM) but you manage them for longer periods of time, as opposed to just hours in the ED. You will not necessarily become as proficient in the initial resuscitation of the sick if you complete a HM residency, but the sick patients are still very sick even once they get to the floor. Another downside is that you likely will not get as much procedural experience with a HM residency as you do with an EM one. I would say the least versatile would be a critical care one. For the most part you would be managing the sickest of the sick (though there are some soft ICU admissions, admittedly) so you would likely miss out on a big chunk of the patient population. Good procedural training in the ICU, though.

 

The choice all depends on where you see yourself working after completion of one. What type of jobs are you applying to? That may tell you which residency you need.

“By far” may be a little much, but we are the “any patient, anywhere, any time” specialty  A good HM residency would also be very applicable to multiple areas in the acute setting.

[EMEDPA]

7 minutes ago, LT_Oneal_PAC said:

 we are the “any patient, anywhere, any time” specialty

Love this. We should put it on a t-shirt.

EM: Any patient, anywhere, anytime. 24/7/365

[CSCH]

I’d like to put in a vote for critical care! (Recognizing I’m totally prejudiced since that’s what I did.) I do agree that EM is definitely the most broad, but I would put CCM in second because we take patients fresh from the ED or floor, and send them back out to the floor, and in between we’re managing all kinds of “floor problems” in addition to the critical ones. A good critical care residency should expose you to medical, surgical, cardiac, and neuro patients, plus plenty of off-service rotations. Some even include ED time as an elective.

I can vouch for the fact that I would feel comfortable transitioning to pretty much any specialty, and that I have been offered jobs in a number of other specialties. Not sure how I would be received in the ED because I haven’t applied for that type of job, but I assume my ICU experience would be well-received.