Post Graduate EM Residency

>>Josh:

There are currently 29 Emergency Medicine PA postgraduate programs. These are commonly called either residencies or fellowships. For either new or experienced PAs this allows further training and knowledge expansion in the EM profession.

Rotations in PA school are very condensed and only allow a brief look into a specific specialty. An EM fellowship is a way to further your education and improve your clinical skills (suturing,splinting, central lines, chest tubes, intubations, ultrasound, etc.),

There are many questions that arise when deciding whether to do an EM fellowship/residency. We will address some of the questions that we considered ourselves before starting our program.

Many of these questions/answers are uniform across the postgraduate programs, however, each program is unique and these responses are based on our personal experiences and do not portray all programs across the country.

QUESTIONS TO CONSIDER:

Who should do an EM Post Graduate Program?

>>Mike:

Emergency Medicine (EM) postgraduate programs are great for those of us that know for SURE that EM is what we want to do for the rest of our career. The truth of the matter is that only a select few new graduates know that EM will be their career choice. If you are one of those few then doing a postgraduate program is invaluable. The training you will receive can fast forward your career to a level of experience that most achieve after 5 + years of practice.

On the flip side if you are NOT SURE emergency medicine is where you want to spend at least the next several years of your career as a PA, it may be better to work in an ED for a year and then decide if transitioning into a postgraduate program is the next best step in your career path.

The last thing you want to do is spend a year or more doing a program then realize…. the hours aren't right for you, you don't like the speed/stress of the ED, or that you would be happier in another specialty!

What is it EXACTLY about Emergency Medicine that you enjoy?

>> Josh:

If what you enjoy is critical care, sick patients with sepsis, MI, CVA, and other life threatening illnesses then doing a postgraduate program will expedite exposure to these types of patients in the main treatment area (MTA).

When looking for your first job you will find that EM groups have determined PAs generate the most value when working low acuity, minor care shifts. After all...medicine is a business. It's rare to find a job with immediate or even future exposure to sick patients in the main treatment area. In my opinion the best way to guarantee exposure to sick patients with the level of training necessary to appropriately take care of them is to do a post graduate program.

Some would argue joining an EM group in a small ER may allow you to see the same patients without taking the pay cut of a post graduate program. In our experience the vast amount of knowledge you need to care for these patients appropriately is simply too much for your attending to teach you during your shift.

For example you may learn how to care for a patient with CHF, but what happens when your CHF patient requires BiPAP? What are the settings? What if nitro paste isn't helping the patients blood pressure? Do you start a Nitro Drip? If so at what rate? … Wait a sec this is a dialysis patient! Do I treat them the same way?? Hopefully this gives you an idea of how much there really is to learn! … Simply just too much to learn on the job.

Procedure Lovers Beware!

>> Mike:

Those that go into post graduate programs realize very quickly that procedures such as suturing, splinting, abscess incision and drainage become much less common in the MTA. I can go weeks without suturing a patient whereas a PA in the Fast Track or lower acuity area will struggle to go a few hours without doing a procedure. Some of us love doing procedures while others prefer complex medical workups. I am happy to allow other PAs to do a complex laceration repair or splint a fracture while I work up an elderly altered mental status patient.

If what you love about Emergency Medicine is doing procedures you may find that doing a post graduate program actually takes you away from what you love about the ED.

>> Josh

While I agree with Mike that certain procedures (suturing, I&D, splinting) are not as common in the MTA, not all shifts done in the fellowship or afterwards are in the MTA. During the fellowship you get ample experience with these procedures, including more difficulty complex closures on the trauma rotation.

>>Mike:

There are critical care procedures that are specific to the acute care side of the emergency department. Post graduate programs will train you to perform central lines, chest tubes, and intubate patients. PAs typically are not permitted to do these procedures unless they receive specialized training, in some states certifications are required. It is very difficult to learn “on the job” how to perform critical procedures since the patients who need them are often quite literally dieing. For example I would not expect an attending physician to walk me through a central line when a patient's blood pressure is 60/40, nor would I expect to be allowed to intubate someone for the first time who presents in acute respiratory distress with an oxygen saturation of 70%. I hear from a number of PAs applying for jobs that they have been told they will be doing these procedures or be taught how to while on the job without doing a postgraduate program. I would be interested to hear how often that actually happens. My guess is not as often as promised!

When it comes down to it, really sit down and think about what you like about EM before deciding to do a post graduate program. Feel free to message us, let us know what you like about EM and we will help you decide if a post grad program is right for you.

More studying! How much work is involved in a postgraduate program? ?

>> Josh:

Post graduate programs are a big commitment and require a passion for academics. Typically programs last 12 - 18 months. There is no way that you will learn all you need to know from the lectures you receive during the program. In order to be successful you will need to study on your own time, listen to podcasts, read articles, ect. If PA school was overwhelming and you cannot imagine doing any more studying then doing a post graduate program is certainly not for you! If you felt PA school was challenging but enjoyed learning and even more so enjoyed learning about EM topics then you will love doing a postgraduate program. It no longer becomes “work” or a “job” you have to do. You are done with PA school now you and are learning about things that you can apply everyday with your patients! I spent significant time during my fellowship reading articles, listening to podcasts, and watching lectures. If that sounds like something you are into then a postgraduate program is right for you.

Is it worth taking a “pay cut”?

>>Mike:

Post graduate programs will typically give a stipend around $50,000 per year. Depending on your family/financial situation this could be a deciding factor in whether or not to do a post grad programs. Remember you can defer your loans during the program and there are some jobs that offer loan forgiveness. The next thing you have to figure out is where do you want to work after the program is complete? If you want to continue working at the same ED as your program then simply ask the other PAs what their compensation package looked like after completing the program compared to those who did not do the program with the same number of years of experience.

Every group has some intricacies when it comes to RVUs, productivity pay, critical care pay, 401k benefits ect. Josh and I will do a deep dive into understanding the benefits of these components of your paycheck in a future post.

Do the Math!

In this example a PA that completes a post graduate program by year 4 is already 13,000 dollars ahead of a new hire! Plus on a pathway to make significantly more money and is now more marketable for future positions. You have to decide if making a sacrifice now is worth the benefit you will receive in the future.

Salary Yr 1

Post Graduate Program: 50K

New Hire:85K

Salary Yr 2

Post Graduate Program: 110K

New Hire:96K

Salary Yr 3

Post Graduate Program: 110K

New Hire: 96K

Salary Yr 4

Post Graduate Program: 120K

New Hire:100K

Totals

Post Graduate Program: 390K

New Hire:377K

“I’ve been told postgraduate programs are overrated! What are the cons of a fellowship?”

>>Josh:

So why do some PAs say it is not worth doing a postgraduate program? I will start this off by saying, find a PA who has completed a program and works in the ER, ask him/her if doing the program was worth it. Universally the answer will be Yes. Most of the time those who disagree with a post graduate program have NOT done one. It may surprise you that I partially agree with people who say doing a fellowship is not worth it; well...it isn't worth it for Everyone... BUT it is totally worth it for those who love emergency medicine, want to see critical patients and enjoy academics.

If you want to just get out of PA school, not take the risk of a pay cut and learn on the job, you are not wrong, but realize you may never see a critically ill patient or it may take you years to get to that level.

I worked for two years before doing the fellowship and certainly had to take a pay cut when I started, but I knew that in the end it would benefit my career and my ability to care for patients.

There are currently studies being performed looking at the benefits of post graduate programs, pay differences, and the potential benefits to hiring a postgraduate trained PA. We will discuss these studies in a future post.

Take into account everything we discussed and decide if a post grad program is right for you.

Send us a message! We will be happy to help you make a decision that will impact the rest of your career

Next we will discuss “ I want to do a Post Grad EM Program … Now What!?”