I am a past residency graduate and now an assistant program director - Ask me anything about PA residencies, and check out my new guidebook for PA residency programs!

[SERENITY NOW]

Hello all!  As some of the long time forum crew may know, I wrote a blog about my experience going through an EM PA residency program in 2015.  A lot has happened since then... I've gone on to become a lead PA in the ED and even helped to found our own EM PA/NP residency program at our group where I now serve as an assistant program director (going to keep the program anonymous as I don't want this to be viewed as advertising).  I am also very excited to share a project that I've been working on for a long time now... a guide book for PA/NP students applying to and completing residency programs!  

It is the book that I wish I had before starting my program.  I definitely struggled through a lot of the program.  I loved the struggle, but it was still rough, and it could have gone much smoother.  The goal of this book is to give you the insider info to know what challenges to expect each step of the way and how to deal with them like a pro.  

I wanted to open this thread as an "Ask me anything" post.  I'd be happy to answer any questions you might have about the residency experience, application, admissions, completion, rotations... whatever you'd like!

-SN

 

Check out the link to the amazon page for the book. Let me know what you think!

 

Here is some of the content...

Overview of PA/NP post-graduate training programs

• What they are, what they offer, the different types of programs you’ll find, and the pros & cons of each.
• Checklists for key areas to assess in each program you research.
• Deciding which program is right for you.
• Examples of what the daily life and roles of real PA/NP residents looks like as they go through training.

The application and admission process

• The prerequisites, components of your application, and how to become the best possible candidate.
• The interview questions you’ll be asked, how to interview well and get a spot in your dream program.

The residency journey, the challenges you’ll face, and tools to succeed

• How to prepare for the start of the program.
• How to maneuver your first months in your new department.
• Review of a few key medical topics that challenge every trainee.
• How to write professional notes, call consults and admissions.
• How to survive on medical, surgical, and off-service rotations.
• How to deal with other common challenges in residency.

Graduating residency and finding your first job

• How to write a strong CV.
• Tips for applying and successfully leveraging your residency experience in contract negotiations.
• Key things to look for in your job contract.

Your first job after residency training

• Transitioning to your new role safely.
• Risk management pearls.
• Foundational personal finance steps to take with your first job.
• The learning journey in medicine that lays ahead of you.

 

Edited January 25, 2023 by SERENITY NOW
update

[dacks663]

Hey I've been reading your book and am enjoying it! Currently an S2 about ~6 months out from graduating.  I'm very interested in both EM and surgical residencies.  Any advise for how to apply to both? Do I mention it or no? Is it looked upon poorly if they discover I'm applying to two different specialities? 

Thanks! 

[EMEDPA]

This really fills a need for those seeking postgrad clinical education! Thank you so much!

[SERENITY NOW]

On 10/22/2022 at 10:35 AM, EMEDPA said:

This really fills a need for those seeking postgrad clinical education! Thank you so much!

That means a lot coming from a legend!  I appreciate it! 

[SERENITY NOW]

On 10/22/2022 at 8:07 AM, dacks663 said:

Hey I've been reading your book and am enjoying it! Currently an S2 about ~6 months out from graduating.  I'm very interested in both EM and surgical residencies.  Any advise for how to apply to both? Do I mention it or no? Is it looked upon poorly if they discover I'm applying to two different specialities? 

Thanks! 

Thank you so much for your support!  If you have any feedback on the book please send it my way

 

Great question.  By all means apply to both!  You can keep your options open, giving you time to reflect on what it is that you want long term.  Also you'll be able to hear what the jobs would entail through interviews so that you'd have more data to help make your decision.  

I would definitely advise that you don't mention applying to other specialties in your applications or interviews.  We have already had one trainee get accepted to our program and then decide after the fact they didn't like EM as much as they'd hoped and switched specialties.  Now we are very keen on making sure it is people who are 100% committed to the specialty.  That is logical from the program's perspective, but if you feel like you'd be happy and stick with either specialty, I wouldn't want you to be eliminated from consideration simply because of that fact.  

I doubt that they would discover you are applying to another specialty unless if you told them.  Just be careful to tell your references who are writing letters of reference that they'll need two versions of their letter.  If we get a LOR that is written for a different specialty that would not look good haha.  I hope that answers your question!  Please let me know if you have any others. 

[davidr14]

This would have been helpful before starting at Einstein. What a journey it has been, cant wait to be done in 1.5 months. AEMC will put some hair on your chest and challenge you to the fullest extent lol. 

[EMEDPA]

I have lots of students shooting for EM postgrad programs. Is it fair to say that if you are a reasonable student, have good LORs, and apply to 5 programs that you should get into one?

I hope so, because that is what I have been saying for years...without much evidence to support it...

[SERENITY NOW]

On 11/19/2022 at 11:22 PM, EMEDPA said:

I have lots of students shooting for EM postgrad programs. Is it fair to say that if you are a reasonable student, have good LORs, and apply to 5 programs that you should get into one?

I hope so, because that is what I have been saying for years...without much evidence to support it...

That's a good question and a pretty complicated one.  I think applications have risen pretty steadily over the past decade, as the job market has gotten saturated and it has been harder for people to jump right into the sought after generalist jobs (EM/IM/CCM etc) as a new grad.  At this point we usually have numerous applicants each cycle who meet all of those criteria you listed.  If you were to add one more criteria, "interviews well," then I think the answer would be yes.  But if they interview poorly, they might not get a spot anywhere.  Just my 2cents...

[ErSePA]

Hey, thanks for creating and sharing this resource! I definitely plan to purchase and utilize your book as a PA student.

I don't start PA school until this May, but I am already keenly considering applying for a postgraduate EM residency, particularly at one of the rigorous, high-quality programs (e.g. Albert Einstein, Iowa, UNM, UCSF, etc.). From my limited perspective, it seems as though these valuable experiences are becoming more competitive. Would you agree, and if so, would you be able to expand on your answer to EMEDPA's question? From your experience, what should a hopeful candidate focus on nailing as a PA student? High GPA, high EM EOR score, stellar EM/PD LORs, multiple relevant rotations? Regardless, I hope to be the best student I can be, but I was just wondering if you had any opinions on whether certain aspects of a student's application are more important than others.

Thanks again!

[RonnieAAJr]

 I have seen on this form that it is strongly encouraged by more experienced PAs. So, my question is if I had an interest in eventually going into Endocrinology or Oncology/Hematology as a PA. Would it be more beneficial to do an Internal Medicine, Hospital Medicine, or Family Medicine fellowship after graduation? Thank you in advance for reading and replies. 

[EMEDPA]

1 hour ago, RonnieAAJr said:

 I have seen on this form that it is strongly encouraged by more experienced PAs. So, my question is if I had an interest in eventually going into Endocrinology or Oncology/Hematology as a PA. Would it be more beneficial to do an Internal Medicine, Hospital Medicine, or Family Medicine fellowship after graduation? Thank you in advance for reading and replies. 

Or you could do an oncology program:https://www.mdanderson.org/education-training/clinical-research-training/clinical-education-for-non-physicians/physician-assistant-program-in-oncology.html

[RonnieAAJr]

But if I did the oncology fellowship first would that be to much of a subspecialty to eventually go work in endocrinology?

Edited January 25, 2023 by RonnieAAJr
Misspelling l

[EMEDPA]

6 minutes ago, RonnieAAJr said:

But if I did the oncology fellowship first would that be to much of a subspecialty to eventually go work in endocrinology?

If you only really know that you want to be hospital based you could do a general hospitalist position and do electives in both endocrinology and oncology and then have training in both.  I have heard really good things about the Mayo hospitalist program in AZ from one of our forum members here. 

[RonnieAAJr]

Oh wow!  Ok thank you so much I have spent the last 10 years in cardiology as a physiologist and really feel certain I would enjoy both subspecialty. Thank you this has truly been helpful.

[SERENITY NOW]

20 hours ago, ErSePA said:

Hey, thanks for creating and sharing this resource! I definitely plan to purchase and utilize your book as a PA student.

I don't start PA school until this May, but I am already keenly considering applying for a postgraduate EM residency, particularly at one of the rigorous, high-quality programs (e.g. Albert Einstein, Iowa, UNM, UCSF, etc.). From my limited perspective, it seems as though these valuable experiences are becoming more competitive. Would you agree, and if so, would you be able to expand on your answer to EMEDPA's question? From your experience, what should a hopeful candidate focus on nailing as a PA student? High GPA, high EM EOR score, stellar EM/PD LORs, multiple relevant rotations? Regardless, I hope to be the best student I can be, but I was just wondering if you had any opinions on whether certain aspects of a student's application are more important than others.

Thanks again!

 

Great question!  

All of those areas you mentioned are important, but I personally would prioritize your efforts as follows:

#1 priority: Doing really well on the interview.  We have designed our programs to provide you the training you need, as long as you can bring A) a passion for the specialty, B) the grit needed to get through it, and C) a personable easy-going personality that makes everyone in the department want to teach you.   The interview is where you convince us you are bringing these to the table.  These three qualities are all "must haves" for us, as they're the biggest predictors for successful completion in our experience.  

What's more, most programs make their admission decisions right after the interview... so while there are 5+ other parts of the application that we had read at some point in the preceding weeks, how you interviewed is what's most fresh in our mind when making the final decision.  (Availability + recency bias) 

Bonus points if you can convince the adcom during the interview that you want to stay in the area long-term... we want to keep great PAs as colleagues after they graduate!   

 

#2 priority: "Killing it" on your target specialty's rotation, to get a raving letter of rec, as well as a solid fund of knowledge (which comes across during interviews).  A preceptor who writes, "this student is one of the best I've ever had, very driven, and everyone loved having them around" will go a very long way.  If there is a single red flag dropped by a preceptor, that can seriously hinder an applicants chances unfortunately.  Choose your LORs wisely!

Similarly, tailoring your rotations and electives to your target specialty is also a fantastic way to demonstrate a passion for your specialty as well as bolstering your fund of knowledge prior to starting the program.  For example, if you wanted to go EM, choose your peds rotation in the peds ED, your surgery rotation as trauma surgery, your elective in critical care, etc.  

 

#3 priority: A tie between the personal statement and keeping your GPA preferably over 3.3-3.4 range.  These are a "nice to have," not a "must-have" for us, as they don't always do a great job of predicting success.  That being said, don't bomb your GPA or your personal statement.  Strive for at least average, but don't stress for perfection.

The other things like board scores / EORs and other factors I think are low priority for similar reasons.

 

Practically speaking, how do you accomplish the above?  How can you best prepare for the interview and reliably do great on your specialty's rotation?  This "how" is harder to explain over a forum post and is what I have attempted to detail in a few chapters of the book.  I hope this post has at least answered your question from a high-level view!

Best, SN

Edited January 25, 2023 by SERENITY NOW
update

[ErSePA]

11 hours ago, SERENITY NOW said:

 I hope this post has at least answered your question from a high-level view!

Definitely! Thanks so much for your thoughtful response. These are great principles to keep in mind in anticipation of clinical rotations and beyond.

[RonnieAAJr]

@SERENITY NOW thank you for the response I actually just viewed your book, and will be purchasing it ASAP thank you for giving those priorities to focus on. Also when interviewing for the fellowship positions would my previous job experience/advance degrees in the medical field look favorable? 

[SERENITY NOW]

1 hour ago, RonnieAAJr said:

@SERENITY NOW thank you for the response I actually just viewed your book, and will be purchasing it ASAP thank you for giving those priorities to focus on. Also when interviewing for the fellowship positions would my previous job experience/advance degrees in the medical field look favorable? 

 

Yes, absolutely, your prior experience if it is even semi-related to the field will be a big positive and should be emphasized.  I hadn't mentioned that above because by the time people get into PA school they can't work on that area much further, but thank you for pointing that out.  And thank you so much for the support!

 

[PAEMed]

On 1/24/2023 at 8:38 PM, EMEDPA said:

Or you could do an oncology pro

On 10/24/2022 at 10:42 AM, SERENITY NOW said:

That means a lot coming from a legend!  I appreciate it! 

It appears that preference is given to new PA grads. How are applicants that come from the community practice and looking to change specialties regarded?

What would make a good applicant in someone with 2-3 years of experience in another specialty?

[SERENITY NOW]

On 6/25/2023 at 8:14 AM, PAEMed said:

It appears that preference is given to new PA grads. How are applicants that come from the community practice and looking to change specialties regarded?

What would make a good applicant in someone with 2-3 years of experience in another specialty?

Sorry for the delay.  Tough question!  We thoroughly review all applicants, including experienced clinicians, but those with experience often face unique challenges in a residency program. To prevent a participant from dropping out, we must ensure the program is a good fit for everyone. Here are a few key challenges that experienced clinicians might face:

1. Financial Adjustment: A residency typically entails a significant pay cut, which discourages many from pursuing this path. Applicants must assure us that this salary reduction won't be a problem.

2. Intense Schedule: Coming from a normal job, the residency schedule can feel miserable.  Compared to PA school, it’s not so bad, so new grads don’t have as much of an issue with this challenge.  You'll need to consider if your personal life can truly accommodate such a tough schedule.  My program had cycles of six 12-hour shifts in a row followed by 2 days off.

3. Teachability: Many residency applicants are perfectionists with a set idea of how they want to practice medicine. Once they're a few years out of school, some people can be particularly hard to teach. Residents need to be open to critical feedback, even if it contradicts their understanding of the right approach. 

4. Specialty Selection: We often ask applicants, "why our specialty?" It could be challenging to convince the committee that this is your ultimate specialty unless you have compelling reasons.

I’m sure we could brainstorm more. 

 

As for what makes a good applicant with 2-3 years of experience in another specialty, consider these qualities:

1. Practical considerations:  They have all of their ducks in a row to handle the financials, time commitment, etc.

2. Strong Motivation: They have solid reasons for switching specialties, and it's evident they intend to stay in this new field long-term. They can articulate their reasons and show evidence of their commitment (e.g., getting an EM:Rap subscription if they want to switch into EM).

3. Resilience and Adaptability: They can endure challenges and adapt to changing situations.

4. Humility and Teachability: They're open to learning, take feedback well, and maintain good relations with others.

5. Relevant Experience: Any transferable experience from their previous specialty would be beneficial.

I’d take a lot of time to craft a strong application that demonstrates these qualities. I hope that helps!  Let me know if you have any other questions.