New Grad EM Fellowship Offer

[tally17]

Was hoping to get some opinions on an offer before I accept, this is my first contract as a new grad!

Position is a fellowship located in New York, level III trauma center seeing 70K patients a year. First 12 months a physician will always also see your patients, with review to determine if you can begin seeing level 4/5 independently for the last 6 months. Not the greatest area but that means a very diverse patient population. There is NO residency program, so the PA fellows have first dibs at procedures and other opportunities if they want to learn them. Lead PA has been there 10+ years which tells me something, and says PAs get a very high level of autonomy in this ED with great physician support. 

18 month contract (can sever with 120 days' notice)

Full time hourly at $40.95/hr (+$5/hr night differential). 36 hours/week at 12-hour shifts rotating between observation, fast track and main ED. 5 hours/week didactic education. Opportunities to pick up additional shifts at 1.5x base. (Based on scheduling preferences/OT, anywhere between 88-100K/year)

Full medical/dental/vision/disability benefits (Was told you don't get benefits summary until after you sign, is this standard? I find this strange and need to clarify)

401K match (need to obtain details)

Malpractice + tail

Full reimbursement for license/DEA

$1,500 CME allowance/year

NO PTO except as required by state law (was told they work with your requests and are able to schedule you early one week/late next to gain 7-8 days off for vacation though)

5K completion bonus at end of term, additional 5K retention bonus if you accept a position there at the end of the fellowship

ACLS, ATLS, PALS, emergency ultrasound and emergency airway training provided

Seems like a great opportunity as a fellowship to get my foot in the door of EM (have spent 5 months applying for EM positions in various states across the country with no bites, and I've been an EMT 8 years). Thanks in advance! 

[TeddyRucpin]

Not to powerbomb your thread, however, did they say what your pay would be if offered (and you accept) a job there after fellowship?

[tally17]

1 minute ago, TeddyRucpin said:

Not to powerbomb your thread, however, did they say what your pay would be if offered (and you accept) a job there after fellowship?

After I was given an offer I did ask this and was told she "did not know what the current offer is." To be fair, I have been working directly with a recruiter and not the physician group's HR directly. Hoping to contact them on Tuesday to get at least a ballpark, but I do know it is salaried and only the fellows are hourly. 

[ohiovolffemtp]

Are there any off shift rotations like ICU, anesthesia, U/S, ortho?  What is actually done in the 5 hours/wk didactic periods?

It may be a great place to learn, but it really sounds like what they're calling a fellowship is in fact an 18 month relatively low paying training job in a high cost of living area.  For comparison, I started out at a Level III trauma center 8 years ago with about the same volume for $50/hour.  We rotated through all areas, saw pretty much everything except level 1 pt's and grew at our own pace.  We didn't have dedicated didactic periods.

[LT_Oneal_PAC]

4 hours ago, ohiovolffemtp said:

Are there any off shift rotations like ICU, anesthesia, U/S, ortho?  What is actually done in the 5 hours/wk didactic periods?

It may be a great place to learn, but it really sounds like what they're calling a fellowship is in fact an 18 month relatively low paying training job in a high cost of living area.  For comparison, I started out at a Level III trauma center 8 years ago with about the same volume for $50/hour.  We rotated through all areas, saw pretty much everything except level 1 pt's and grew at our own pace.  We didn't have dedicated didactic periods.

No off service rotations means not a legit residency in my opinion. It’s structured on boarding. Not saying there is no value in it, but there are much better training programs. You could spend a whole year in a level one ED and only do a handful of lines and intubations. The average ED physician intubated about 12 times per year in one study. Not nearly enough to become an expert without an anesthesia rotation. Maybe a couple chest tubes? You’ll be knocking those out in a trauma surgery rotation. Slamming out bronchs in the MICU. But more important than procedures is knowing how to manage patients like a specialist and not being a consult machine.

ETA: not that anyone who hasn’t done a residency is a consult machine. No offense intended

[tally17]

9 hours ago, LT_Oneal_PAC said:

No off service rotations means not a legit residency in my opinion. It’s structured on boarding. Not saying there is no value in it, but there are much better training programs. You could spend a whole year in a level one ED and only do a handful of lines and intubations. The average ED physician intubated about 12 times per year in one study. Not nearly enough to become an expert without an anesthesia rotation. Maybe a couple chest tubes? You’ll be knocking those out in a trauma surgery rotation. Slamming out bronchs in the MICU. But more important than procedures is knowing how to manage patients like a specialist and not being a consult machine.

ETA: not that anyone who hasn’t done a residency is a consult machine. No offense intended

There are no outside rotations other than the ED, no. And the didactic sessions are lectures and hands on trainings with the residency program (the other hospitals have ED residents just not this one). 
 

I know it’s a relatively low offer for the area, but I’m from the area and would be fortunate enough to live at home with no rent. I do agree this sounds more like a lowball lengthy onboarding, but emergency medicine has been the end goal since high school. I’ve always know this is where I wanted to be. I’ve spent ~5 months applying all over the country and gotten zero interest in placement of a new grad without experience, other than a single recruiter who said she WILL place me, but it could take upwards of a year due to covid and hospitals currently wanting experience. I’ve also applied to half a dozen other residencies and been denied. While this isn’t perfect, the providers were willing to answer questions and discuss patients and plans and you’re always paired with a PA or physician. Are there better opportunities out there, absolutely. But for the pay and ability to live at home rent free it seemed like a busy place to get my bearings and the experience I need to be considered in other ERs. 
 

I planed to use CME allowance to do an EM course before starting as well to be better prepared. 

[CXPAC]

10 hours ago, tally17 said:

There are no outside rotations other than the ED, no. And the didactic sessions are lectures and hands on trainings with the residency program (the other hospitals have ED residents just not this one). 
 

I know it’s a relatively low offer for the area, but I’m from the area and would be fortunate enough to live at home with no rent. I do agree this sounds more like a lowball lengthy onboarding, but emergency medicine has been the end goal since high school. I’ve always know this is where I wanted to be. I’ve spent ~5 months applying all over the country and gotten zero interest in placement of a new grad without experience, other than a single recruiter who said she WILL place me, but it could take upwards of a year due to covid and hospitals currently wanting experience. I’ve also applied to half a dozen other residencies and been denied. While this isn’t perfect, the providers were willing to answer questions and discuss patients and plans and you’re always paired with a PA or physician. Are there better opportunities out there, absolutely. But for the pay and ability to live at home rent free it seemed like a busy place to get my bearings and the experience I need to be considered in other ERs. 
 

I planed to use CME allowance to do an EM course before starting as well to be better prepared. 

I understand the circumstances. If you really have passion for EM and not having luck for EM/ EM residency position, you just have to do whatever you have to do. I would have done the same thing knowing that at least I will be able to work in EM after this opportunity.  

[tally17]

12 hours ago, CXPAC said:

I understand the circumstances. If you really have passion for EM and not having luck for EM/ EM residency position, you just have to do whatever you have to do. I would have done the same thing knowing that at least I will be able to work in EM after this opportunity.  

Thank you so much for this. It's really nice to hear someone else understands my hesitation but also desire to just take it. I KNOW the offer isn't the best considering the lack of formal rotations, which sucks. But at the end of the day, EM is where I want to be. I thought I'd find another niche but the passion for the ED hit me immediately on my rotations. Have I considered other specialties, sure, but nothing makes me want to get up and go like EM did. And like you said, at the end of the day, if I stick it out 18 months or even a year, at least I KNOW I'll have a leg to stand on to be considered for EM positions elsewhere whereas right now, EM + new grad just seems minuscule with covid. Which I get, you want some experience to hit the ground running and help out, it's hard to find the time to train a new grad among delta.  

I have a call with the attorney in a bit and assuming my clarifications are not red-flags, I will be signing the contract. Thank you everyone for the help! 

[MediMike]

3 hours ago, tally17 said:

Thank you so much for this. It's really nice to hear someone else understands my hesitation but also desire to just take it. I KNOW the offer isn't the best considering the lack of formal rotations, which sucks.

Dude (or Dudette), you asked for opinions on the position and you got them.  The point folks are trying to get across here is that this wouldn't be considered a fellowship.  You've got many people on this board who have done fellowships, are part of a fellowship training program or are even directors of said programs.  They (we) have a tendency to take these terms pretty seriously as there are multiple programs out there who use exploit new grads as cheap labor.  Once they leave that program and tell the next hiring position "I'm fellowship trained" and then blow it their first week it casts a negative light on all fellowship programs.

Is this a fantastic sounding job for someone who wants to break into EM while they have the ability to live at home, in the location they want? Hell yeah. Would I call it a fellowship or a residency? No. If I'd chosen EM right off the bat it's an offer I likely would've taken as well.  The 120 days notice is a little brutal though, unless that goes both directions. Best of luck in the position and maybe I'll take a patient off your hands someday.

 

[tally17]

2 hours ago, MediMike said:

Dude (or Dudette), you asked for opinions on the position and you got them.  The point folks are trying to get across here is that this wouldn't be considered a fellowship.  You've got many people on this board who have done fellowships, are part of a fellowship training program or are even directors of said programs.  They (we) have a tendency to take these terms pretty seriously as there are multiple programs out there who use exploit new grads as cheap labor.  Once they leave that program and tell the next hiring position "I'm fellowship trained" and then blow it their first week it casts a negative light on all fellowship programs.

Is this a fantastic sounding job for someone who wants to break into EM while they have the ability to live at home, in the location they want? Hell yeah. Would I call it a fellowship or a residency? No. If I'd chosen EM right off the bat it's an offer I likely would've taken as well.  The 120 days notice is a little brutal though, unless that goes both directions. Best of luck in the position and maybe I'll take a patient off your hands someday.

 

No disrespect intended in any of my responses, I apologize if it ever came across as such, it was never my intention. I throughly appreciate everyones insight. Everyone confirmed what I was thinking myself: that this doesn't seem very fellowship/residency to me. But, it's a foot in the door to EM which it isn't always the most new-grad friendly field. Perhaps the training will surprise me (I hope.) 120 days does go both ways after the initial 6 months (thankfully). Thank you, and perhaps someday! 

[ventana]

is this an approved residency?  Like one that is listed on https://appap.org/programs/postgraduate-pa-np-programs-listings/

 

 

It sounds like they have figured out a way to hire new grads cheaper

 

by the end of the 18 months you should be seeing any patient coming in the department independently with back up.

 

 

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also I would NEVER sign a 120 day notice, no way.  Think of it this way - you are living with your Sig Other and you decide to break up.  Would you want to live together for the next 4 months???  That is what you are signing.  60 - 90 days is more then enough time.  8 weeks is okay for both parties.