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New grad advice on picking first EM job


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Hey everyone, I graduate very soon and have been lucky enough to have 3 offers before finishing school. I'm struggling to pick what option would be best as my goal is to practice with a broad scope of practice down the road in 5 years-ish when I become more proficient. Little background I have about 3 years of EM experience prior to PA schools as 911 ALS EMT and ED/trauma tech at a level 1. 

Option 1 

-Level 1 trauma center, PAs mainly see ESI 3-5 with the ability to see some more acute patients with attendings. This is high volume ED with the ability to see a wide variety of complaints. 

-More rural area, midwest with low cost of living, pay is better than I expected (but right now it is not for the money I just want to learn and become a good provider.)

-Met many of the current PAs working and all were very nice, and the attendings are willing to teach. 12 weeks of one on one onboarding than I will most of the time have another PA (and obviously attendings) in the department because it is a large ED. The environment seems very collaborative after a site visit. 

 

-Option 2 

-Large West Coast city with a high cost of living, split between 2 community hospitals 

-PAs mainly see ESI 4-5 and triage not a whole lot of onboarding besides just working with the attendings

-In the area where I want to live, but I only met the 2 medical directors and no other current staff

 

-Option 3 

-Level 2 trauma center more rural west coast, but lower volume than option 1 

-PA see ESI 3-5 with the ability to see higher acuity with attendings 

-12 weeks of one on one onboarding with some didactics.

-In the state I want to be in but not the general area, part of a large EM group so the ability to transfer sites after a few years. 

-Higher pay than option 1 but the cost of living is much much higher

 

I am currently in the mindset that the first job you take is typically not your last job. I am leaning towards option 1 as it seems to be the best learning environment, low cost of living, and I have some family nearby. Even though I want to end up back on the west coast and not in the midwest. I do feel like if I can get offers on the West Coast as an out-of-state new grad with no provider experience it shouldn't be much harder to get an offer with 3-5 years of experience at a high volume ED. It may seem obvious but I know I shouldn't pick a job based off location and more on how much I can learn. I hope this was the right section to post in I was just looking for some advice from those who have more experience. Thank you for your time and any advice. 

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The EM PA job market is very much 2 tier: "new" being new grad to 1-3 years experience and 5-ish years being considered experienced.  Over the past 1-2 years, the job market for experienced has been very good.

Whether you are "part of a large EM group" or not, switching sites is basically getting hired again.   There's only a small advantage if any to staying with the same employer.  It's very common in EM to switch employers either as you change sites or contracts change hands.  I've experienced both in my 11 years of practice.

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Pick the job with the best learning environment and is more friendly to new grads. It sounds like the Midwest job is the best choice based on the interview and site visit. 

If you're still between options as they are both equivalent in terms of being friendly to new grads, then pick the job in the location you want since that is a priority. The one with lower COL will help you pay off loans like crazy and start your retirement fund much much faster (the time value of money is real and financial independence buys you freedom). But if you're not going to be very satisfied, go for the west coast and live like a student to compensate for the high COL.

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