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Is a residency worth it?

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Trying to decide a few things over the next couple of months as I am halfway done with clinical year. Just brief back ground paramedic for 14 yrs which included 911, ground critical care, and flight for 2 yrs. Total healthcare experience 17 yrs mixed of EMT, cardiology, and ED tech before I was a paramedic. I don't have any EM fellowships near me and not in a position to move after school. There is a ARC-PA accredited critical care fellowship within a reasonable distance. I guess my overall question is do I need a EM or other fellowship to work in the more rural/critical access EDs with taking my paramedic background into account? I don't expect day one to get one of these jobs but, say obtainable in a few years without a fellowship. 

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Before becoming a PA I had 30+ years in fire/EMS.  I spent 5 years working in a very busy high acuity level III trauma center before going rural.  I was just ready, having taken U/S, ATLS, and other courses and pushed learning procedures and taking higher acuity patients in my 1st job.  Over the 6 years I've worked rural, I've learned a massive amount and am still learning.

Being a medic teaches you many things, including initial resuscitation of just about everything.  Flight will teach you some about maintaining stabilization of critical patients.  PA school depending upon your school may teach you some advanced procedures like central lines, LP's, chest tubes, etc.  None of those really teaches you the full initial management and diagnostic workup of the very sick or about to be very sick patient.  An EM fellowship will do that.  I would expect there's some overlap with a critical care fellowship.  But, ICU's get the patient after that initial stabilization, workup, and diagnosis has been done in the ED.

An EM residency is the fastest way to get the knowledge you'll need to be best prepared for rural with limited or no physician backup.  So, you don't "need" the EM residency or fellowship (and it has to be one of the right ones), but you'll be so much better for it.  Yes, you'll can get a rural job without one, but again, you won't be as ready.

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