Residency after PA school, or straight to work? Two PAs, two answers.

Jamie and Erin both work in emergency medicine. One of them did a PA residency and one went right into a job, so instead of guessing at the tradeoffs, you get to hear both sides from people who lived them.

Residency means another year or so of lower pay and long hours, but you come out with structured training and a level of confidence that's hard to build on your own in a busy ED. Going straight to work means earning sooner, but you're learning on the fly and how good that experience is depends a lot on the group you land with.

There's no universal right answer here. There's just what fits you, and this conversation should help you figure out which one that is.

What we cover:

• What a PA residency in emergency medicine actually involves
• Jamie and Erin's different paths after graduation
• The pay and time tradeoff of doing a residency
• Building confidence in a high-acuity setting
• What learning on the job looks like without formal training
• How to decide which route fits you

Resources:

Free Resume Download: https://www.thepaplatform.com/services/free-resume-download

Free Application Timeline: https://www.thepaplatform.com/services/free-application-timeline

Pre-PA Counseling: https://www.thepaplatform.com/services/pre-pa-counseling

PA Program Map: https://www.thepaplatform.com/pa-platform-map

Mentioned in this episode:

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Okay, I'm be up front.

Today's episode will be a little bit long, but that's because it's with two of my very close PA friends and we are talking about PA residency.

So I have Jamie and Erin, who are both ER PAs, and Jamie did not do a residency and Erin did.

So we're going to break down pros and cons what that looks like, and so you'll have a little bit more information about it.

Welcome to the Pre PA Club Podcast.

If you want to learn how to become a physician assistant, you're in the right place.

I'm your host, Savannah Perry.

Let's get to it.

Welcome to the podcast.

I'm Savannah Perry.

I am a dermatology pa.

I've been practicing for almost six years now.

And I started blogging at the PA Platform, which I love doing.

And I started this podcast because it is really fun to get to talk to different people.

But I do want to say thank you for just being here and listening and yeah, I hope you find it helpful.

If you ever don't, let me know or if you have ideas for an episode, I'm pretty accessible on Instagram.

You can always email me at the PA platform on Instagram and my email is info@wait infoepaplatform.com before we jump into today's episode, I have something so exciting to tell you about and it is something so okay.

If you've listened to the podcast for a while, you know that in March we were supposed to have this big Pre PA conference in Atlanta.

It was going to be awesome.

Guess what?

COVID 19 happened and we had to cancel, which was obviously the right call.

Very disappointing.

And you know, we are wanting to do this again in the future, but right now things are just so uncertain.

We're not really sure what that looks like.

So we came up with an alternative option which is a virtual prepa conference.

So this event will be held on April 25th.

If you go to prepaconference.com you'll see all the details.

You can still use the code future pa for free.

$5 Off.

And the registration is only $15 to begin with, so that means it's only $10.

This conference will be all day from 9am to 5pm we have seven sessions planned and they include an overview of just the application process.

CASPA answering a bunch of questions kind of how to make your application stand out.

We're going to have a PA Faculty and Admissions panel with faculty and admissions people from Yale's online PA program.

Marshall B. Ketchum and Emory, which will be so great.

I've spoken with Alan Platt from Emory in the past and he is amazing.

Then we will talk about choosing and researching and choosing PA programs and we have two of our pre PA coaches who are gonna go through all of that with you.

That's what they coach on constantly.

And so they're gonna help walk you through that process of how to narrow that down and then what you need to look for in CASPA for those schools.

And then we are going to have a PA student panel and then we will have a personal statement talk and then we will have a practicing PA panel and then we will have an interview talk.

And I think that covers it.

But it will be so much information in one day and there will be replays available for everyone who signed up.

So if you go to prepaconference.com again, use the code futurepa for that discount and we can't wait to see you there.

So it'll be really exciting and hopefully a lot of fun.

So that is my pre PA conference spiel.

It's really soon and so you won't hear me talk about it for very long, but I would love to have you join us there.

All right, now we'll get back to the regularly scheduled podcast interview.

Before we jump into today's interview, I do want to mention our sponsors.

The number one sponsor being mypa Resource, which is a personal statement editing service.

CASPA is opening soon, in about a month, I guess less than a month now.

So that means it's time, you know, if you've got some extra time on your hands, you should be working on your essay.

That's a great thing to do.

Right now my PA Resource only uses physician assistants to edit the essays for PA School and I am one of the editors.

You can use the code futurepa for a discount on their services.

And then once you get accepted to PA School, if you're looking for something to kind of refresh your knowledge, check out PA School Prep, which has a review in anatomy, physiology and med terms.

Again, you can use the code futurepa for anything there as well as on the PA platform website.

I am Erin.

I went to a PA school in D.C. and then I completed an emergency medicine fellowship in Florida.

I am now practicing in just a traditional emergency medicine job.

I'm Jamie Trudell, formerly Murawski, and I went to school in Detroit.

I'm also a physician assistant in the er.

However, I did not do a residency.

I practiced in Michigan and my first job was just like straight out of School into the er.

Cool.

Okay, first question.

That's just my question.

Is there a difference in a residency and a fellowship for PAs, or is that just terminology?

It's just terminology.

So a lot of places will call it a fellowship because we don't have to do a residency.

It's optional.

And same thing for, like, a physician.

A fellowship is optional, while a residency is basically required.

But it's really just discrepancy of the program.

And so some places will be residents, some places will be fellows.

It's the same thing.

Okay, Jamie, did you think about doing a residency at any point or that wasn't on your radar?

No, it was not really on my radar.

I knew they existed, but I had networked my way into my position before I had graduated, so it wasn't something that I even, like, got to the point of considering because I didn't really need to look for a job.

It just kind of fell into my lap.

All right, and were both of you wanting to do er or how did you kind of choose that path or position?

So I knew I wanted to do er.

I went to PA school in DC and then knew I wanted to go back to Florida as quickly as possible, because I really like Florida and Publix.

And so when I started looking for ER jobs because I knew that's what I wanted to do, I encountered that a lot of places where I was looking to go required one to two years of experience.

Yeah, that's common here too.

Right.

And so I thought a lot about staying at a place in D.C. where I could have gotten my year of experience and then going to Florida.

I didn't really want to do that.

I was really tired of the cold.

And I actually had a friend who had gone through the residency program that I went to, and she had nothing but good things to say about it.

And I figured, hey, why not?

You know, I really want to go to Florida.

I might as well apply to this residency program in addition to applying to jobs, and then kind of whatever works out is what works out.

Okay, did you apply to more than one residency or just the one?

I only applied to the one because.

I really wanted to go to Florida.

Okay.

Are they competitive or not too much.

So not as competitive as, like, getting into PA School, but definitely very competitive.

So most programs will have anywhere from, like, two to six spots.

My program had five spots, and they have over 70 applicants for those five spots, so it's pretty competitive.

Okay.

Okay, so what.

What I want to know, Erin, your motivation for wanting.

I mean, you said to get a job and kind of get your foot in the door.

But.

Did you want me to answer the other question first?

Sure.

I don't remember what it was.

I did not start school wanting to do er.

Okay.

I didn't know what I wanted to do.

I thought I maybe wanted to do Women's Health, but after my Women's health rotation, I really didn't like the actual practice of it.

I remember that.

So I that like immediately after ER or immediately after Women's health was er, I think, or maybe vice versa.

And so they were like right side by side.

And I just liked ER a lot better.

It was very procedure heavy and very hands on.

And it was very similar to waitressing, which is kind of weird, like a weird analogy.

But like with waitressing you like have all your different tables.

Every table is doing different things.

And like you're walking room to room or table to table and serving them all differently, but you still like kind of reset each room and then you never see them again.

Of course you have your regulars and stuff, but you have your frequent flyers and ER too.

This is a great analogy.

I take it back.

It is.

So I just felt like really at home there because I like started my career at 16 in the service industry.

So it was like an easy transition and it just like felt comfortable.

Okay, so let's talk about being new grads coming out of school.

So me going into Durham, I did not feel prepared at all.

I needed definitely training on the job there.

I think there may be one Durham kind of fellowship residency in New York.

There aren't very many formal programs for Durham, but I definitely like.

It took me a while to feel comfortable.

Did that play into your decision at all, Aaron, to go in and do a fellowship versus how did you feel going into straight into the er, Jamie, as a new grad without that formal training.

So I absolutely wanted more training.

I was someone who struggled during didactic year and who was told that I struggled.

We'll phrase it like that.

I did a lot better in clinical year.

I felt a lot better actually seeing patients and being able to like put things into practice instead of just reading it in a textbook.

But I wanted a little bit more guidance and I wanted a place that was going to be as invested in my education as I was invested in, you know, becoming the best PA that I could be.

And so that definitely did play a role.

Like when I was thinking about what jobs I would want to do.

So I was only going to like accept a job in the emergency department if I knew that they were going to, you know, have an emphasis on my education and want to teach me stuff and be happy to answer my questions and all of those things.

And I did really feel like doing a fellowship, especially after talking to my friend, was going to give me that place.

And so, yeah, I would say that it played, like, a huge role into me wanting to do a fellowship was to get more kind of guidance than just being thrown in, out, like, as soon as I graduated and be like, all right, you're free.

Go save patients.

Yeah, that was my same goal.

I wanted to feel more comfortable, and I definitely wanted to be handheld a little bit.

And so that was a question I asked in my interview for my job, was like, how do you support your new grad pas to make sure that we're not just, like, thrown in practicing autonomously, because they don't feel comfortable with that.

And they had a program where they call it, like, their collaborative agreement, but it's basically where you're coupled with the docs the entire first six months at a minimum.

And that six months, every single patient you see, even if they just stubbed their toe, you go and you tell a physician about it, they go, so see the patient.

And then they give you, like, they're like, yeah, agree.

Go ahead, discharge them.

Or, like, if it's more complicated and you missed something in their workup, they're like, you probably should consider pe.

Maybe you should add a D Dimer.

And so sometimes you get that, like, feedback.

And at six months, you have a meeting, you get evaluated.

Most people don't get cut loose that soon, but this is even the case for our new hires that have experience because we've had some that come out of urgent care.

And it's just a little bit different when you practice emergency medicine from any other specialty.

So they handled everybody at first.

And so some people get cut loose at six months, but then they continue every three months from there to keep evaluating you.

And at some point, you get cut loose.

So, like, me and the girl I was hired with, we were both cut loose at nine months, but there's a girl that we were working with recently that got cut loose at 12 months instead because she needed, like, a little bit more support.

But they try really hard to, like, review our cases, review our charting, and, like, make sure that what we're doing what they would agree with.

And so we, like.

That's the weird part about ER is you don't have one single doc that you're, like, collaborating with.

It's whoever's on the shift and whoever can take you.

And every hospital does that a little bit differently.

I work for a staffing company so I work at several hospitals so I can speak to that a little bit.

But my, one of my hospitals, like from 2 to 4pm you'll staff with this person.

From 4 to 6pm you staff with this person.

And.

But at the other hospital it's just like whoever's there or whoever you like or whatever.

And you, you kind of find docs that you're like that person I'm going to staff this person with.

And you have other docs where you're like, this person's great for if I just need to get them out the door quickly and like this person's going to make me do a huge workup.

And you get kind of a feel of like which doc likes which thing.

And you can get comfortable with that.

And then you like get to know them and they get to know you and they get to trust you.

And I work night shifts a lot with, it's just me and a doc and sometimes the doc is in a trauma or code or something and I'm seeing everyone else.

And sometimes they trust you and sometimes they don't.

And so it's nice to kind of find the people who you like work well with and get in the swing of things.

So I think that helps a lot with support too.

If they're like, if they like you and they're willing to teach you, you're gonna do a lot better than if they're just like this pa, like not self motivated at all.

Yeah, honestly, that was like very similar to kind of how my residency was, was for the first, you know, six months.

We were really handheld and we talked about all of our cases and you know, we talked about things before we ordered things and all of those, all of that.

And then after that we definitely got more autonomous and we're seeing patients more on our own and doing all of those things.

I think a big conception with residency or fellowship programs is that you're still a student and you're still in a student role.

And I absolutely was not still a student.

Like I was a practicing pa.

I was just a practicing PA who they were emphasizing educating and teaching me so that I could be better.

Okay, that's a good way to explain fellowship too.

Yeah.

And that's, I mean, that's interesting.

And that's, I think people don't understand that about that, about medical residencies either because people will still, I mean, Lane's done now.

My husband but he.

People would still ask him like, oh, you're still in school.

He's like, no, I've been a doctor for the past three years.

I'm just, you know, furthering my learning.

But.

Okay, Can y' all compare your kind of schedule those first years?

Like, Jamie, what was your schedule as someone new to ER but not doing a residency?

And then, Erin, what was your schedule as someone who is in a structured program?

You want me to go first then?

Sure.

I saw you phrase the question.

I worked 15 or 16 shifts a month.

We do 10 hour shifts and we swing shift, meaning like whatever shift they schedule you for is what you get.

So we work an 8am shift, an 11 o' clock shift, a 2pm shift, and a 9pm shift.

But when I first started, the 9 o' clock shift was a 5pm shift instead.

They recently changed it because we were having the bus come at 4 o' clock and dumped a lot of people and really killed the docks at night.

So we changed our shift overnight.

But they, they put you.

They try to trend you up.

So if you're gonna switch to night shift, they try to do like an 8am, then a 2pm, then a 9pm and not just be like 9, 9, 8, but you do 15 or 16amonth.

They're typically clumped into or three at a time.

And then you have like 1 to 5 off.

And then on your days off, you're completely off because you don't have anything to think about unless you're like me and you procrastinate and you have a lot of charts to do.

And then you can chart on your day off, or you can stay late at your shift and finish charting, or you can chart as you go and keep up with your charts and not.

Do any of those things.

So I will say that my residency program was probably more lenient than a lot of emergency medicine residency programs out there.

There are a lot of residency programs, especially ones that are actually affiliated with, like a physician residency program, where you are truly a resident and you're working 200 plus hours a month and you know you're doing a ton of shifts and all of those things.

Mine was a lot more laid back.

It was great.

We had to work 6 to 18 shifts a month, and then we had every Wednesday, we had four to six hours of didactics for our first six months.

We were always the swing person, which for us meant that we were like the evening shift, which was like 1 to 11 or 10 to 9, 10am to 9pm or 2 to midnight.

And that was really just so that there would be another app on shift with us in addition to the attending thing with us.

And then once we got off of our, like six months of training, we were able to do kind of the more random shifts, which were like a 7am shift, a 10am shift, so on and so forth.

My hospital that I did my residency program at actually only had one app on staff overnight.

And we had this one really, really amazing PA who worked probably 26 days out of the month.

And so I never had to do a single night shift during my residency.

God, that's crazy.

Wow.

Yes.

We have a PA like that at my job.

She works like at least 22 shifts a month.

And that's bananas to me.

Like, I do not want to be at work that much.

I've done.

I don't know how she did it.

One and I wanted to die.

It was terrible.

Do not recommend 0 out of 10.

I agree, I agree.

I don't know how.

I don't know how this PA did it, but she was amazing at it.

There would be like times where I would be like, trying to finish something up and she would come in and she'd be like, no, no, no, go home, I will do this.

And it was amazing.

And I would just go home and she would finish up things for me.

It was, she was fantastic.

Is fantastic.

Yeah.

Nice to have good coworkers.

Yes.

Very important.

A question we got a lot on Instagram is, do you get paid during a PA residency?

Absolutely.

You absolutely get paid.

Is it less than what you would make as a new grad going into emergency medicine?

100%.

Most residency or fellowship programs tend to be around 50 to 60,000 a year.

My residency program was on the upper level, so it was in the 60s.

And then we actually got paid a regular, like the regular rate for any hours we did over our required amount a month.

So that was great because, you know, on months that my hospital was short staffed, I could pick up extra shifts and I actually made real money and it was fantastic.

Yeah, I mean, I would, I would expect you to at least get paid.

But that's the same like, pay scale I have currently.

Like, we have a required amount of hours each year, and if you exceed that, there's an hourly rate that you get paid out for any extra hours you pick up.

So these people who pick up tons and tons of extra shifts, they.

They do get paid more.

And then once you hit like full time hours, which is considered like a 40 hour work week for 50 weeks out of the year.

I've never worked that much.

I haven't.

Like, my clinical experience is relatively limited, so I haven't actually needed to get paid out overtime.

But that is a nice part of the job as well.

Yeah, yeah.

My job that I'm at now actually does something similar as well.

So we have a certain amount of hours that were contracted for a month, and then anything over those contracted amount, we make like an extra stipend.

It's not time and a half, but it's an extra hourly amount.

And it's really nice.

Especially like during season for us, which is snowbird season, when we're very, very busy and everyone is working more shifts than they're actually contracted for, so we get paid extra.

Nice.

Okay, somebody had a question on Instagram about do you think that PA fellowships or residencies exploit PAs?

I definitely think that there are programs that do.

There are all of these little quote unquote residencies.

Yeah.

Not just emergency medicine.

Like, we're just talking residencies.

Yeah.

What other have you all heard of?

I know I've heard of icu, ob, gyn.

Yeah.

Critical care.

I think those are the big three.

I've heard about, like, smaller things, though.

Like, I've heard one that where it was like, it's a dermatology fellowship, but this is the exact situation I think Eric Aaron was just about to talk about of, like, they say, oh, this is a fellowship.

We're going to train you.

But really they hire you for their office and they just pay you 50,000 a year.

Yeah, exactly.

It's a big issue in Durham, like I said.

I think there's one in New York that's like more of a real program, but otherwise structured.

Yeah.

A lot of derm jobs.

Because it is so competitive and people want to get into it.

What will end up happening is they'll offer them like a training period and sometimes it's long, like six to 12 months, and they want to pay them a medical assistance instant salary.

Even though, like, you are a certified pa. And so, I mean, from that regard, I don't know if I want to call it, like, exploitation, but it kind of, it kind of is.

I mean, I, I, it's, I'm in a bunch of, you know, I mean,.

It'd be different communities doing the MA role and you weren't licensed yet.

Like, if they're like, oh, yeah, we'll take you on.

So you can have an income in this three months while you're waiting for your credentialing and stuff to kick in.

Right?

Sure, you can pay me minimum wage and I'll do my minimum wage job, but if I'm going to be doing my actual, actual clinical role, you better pay me my clinical money.

Well, and I think they.

They come at it as like, there is a huge learning curve with derm.

And so they'll say, you know, nah,.

You guys just look at a bunch of rashes, tell people to put some.

Exactly.

No, if it's not one of the five deadly rashes, like, you know, y'.

All don't discount derm.

Jamie, you definitely sent me a picture of something today to diagnose for you.

So calling you out on that.

But touche.

But that wasn't for my job, because at work I would have been like, I don't care.

It's not gonna kill.

It's not an emergency.

But no, but I think, I mean, the issue with that is that.

Or what they'll say is that you're not bringing in money because you're not like seeing patients on your own or billing.

But I just don't think that's fair.

I don't think it's fair to do across the board because, like, my job told me, you know, we don't know when you're gonna start seeing patients on your.

My very first job.

When you're gonna start seeing patients on your own.

Like, probably because I was on a salary plus commission based on my production bonus types setup, but they were like, you're probably not gonna like, bonus your first year.

But what they found was that, number one, I was very motivated.

Number two, I was a pretty quick learner and I was seeing patients pretty much at six months.

They also, I had two supervising physicians and they both had pregnancies that first year.

And so I kind of had to step up and step into more of a role to cover for them.

And so I think, I think it's like, in that case, even though it wasn't, they didn't.

My job did not try to do that to me at all.

But, like, that's a situation where that would have not been a great setup for me had I taken an offer like that.

So, yeah, I mean, I guess I do see how it could be exploitation.

Yeah, I definitely think that there are fellowships that exploit you, and those are the ones that aren't really truly like a structured fellowship.

Like, my fellowship was structured even though it was maybe a little bit more relaxing than Some of the other ones out there we had weekly, you know, didactic classroom training.

We had off service rotations.

So I went and did a trauma rotation.

I went and did an orthopedics rotation where I was off service for a month.

You know, we went to SEMPA and competed in the Quiz bowl and did all of those things.

And there are definitely, like, other, like, fellowship programs, quote, unquote, that are really just like Jamie is saying, they're paying you less money because they're trying to, quote, train you, but they're not actually giving you, like, the true education aspect of an ideal fellowship.

So I think it's hard.

I think the only way to combat that is to do your research and so to ask them the hard questions, like, am I going to have an off surface rotation?

You know, every week?

Are we going to meet and are we going to do a classroom training?

Am I going to have a lecture somebody?

Are we going to do some labs, like, things like that?

The off service rotation, I think, is the biggest benefit to a fellowship because I have never been in the icu.

I.

They told me for my intubation credentialing that I could go to the OR and intubate because we need to get at least five tubes.

And right now I'm like, no, I'm staying very far away from intubations.

Go ahead and let that lapse.

I'd like to stay as far away from that as possible, but that's only because I don't to want to die of coronavirus.

The.

But like, I don't really get to go off service at all.

And I think that would have been a huge benefit to understanding the ER a little bit better.

Is like seeing where your patients go and how they get managed there.

Yeah, it was nice, absolutely.

Like, we went to the OR as well.

I tubed patients once a month for my entire fellowship and I would get like 10 tubes a day, which was great.

It wasn't an OR.

It was in a controlled setting.

I was able to do direct and video, which was always nice because we really only did video in the emergency department.

And then also seeing them in the ICU after I had stabilized them and sent them away was nice because I got to see the whole picture.

And I definitely think that's helpful now because when I'm sometimes in the emergency department, I think to myself, oh, like, they're going to really want me to do this instead of doing this, because this is what they're going to do in the icu.

Yeah, that's Interesting.

That's knowledge that I don't know that I necessarily would say I lack because I go to the cdu, which is our like clinical decision unit.

So I have like a little bit of that inpatient brain.

I can kind of say like, okay, like, I know for a stupid example that kidney stone, they're going to want to strain the urine.

So like, I'll start straining it in the ER just because I know that's what they're going to do once they get admitted.

Or like, I'll start a fluid infusion or I'll put their diet order in or like silly stuff like that.

But there's definitely a huge benefit to knowing, like, okay, I'm going to start a presser on this person because their blood pressure is crap and like, what one did they like upstairs?

And that kind of stuff is helpful.

Okay.

So I guess when I think of it, I mean, the only experience I know of with residencies is like medical school, school residency, where at times, like it does feel, I don't want to say exploiting, but they've put some regulations in place.

But I mean, they're working, you know, six on, one off for weeks and weeks and weeks at a time and crazy hours and all this stuff.

Is it similar to a medical school residency or do you think it's different?

There are definitely some that are.

So like, at my current job, I have a co worker who did a residency at John Hopkins and their residency was much more like a physician residency and they were doing 200 hours a month and theirs was a lot more intense than mine was and they put a lot more hours in for the same amount of pay.

So, you know, their hourly rate was a lot lower than mine.

And so, you know, you could definitely find one of those residencies and like, maybe, sure you can say, oh, they're taking advantage of you because you're working a ton for, you know, a low stipend.

But at the same time, like, my coworker is amazing, like, absolutely fantastic.

They do an amazing job.

They are really good in so many different aspects of emergency medicine.

And while I also think that I'm good, I mean, they definitely probably have like a one up on me because their residency program was more intense.

I, you know, in hindsight maybe would I have done a program like that?

Yeah.

But I was really, really ready to get back to like my support system in Florida.

And I was single minded in that goal.

And so I went for something like this.

Like, this was my, this was my only option.

I put all of My.

My eggs into one basket.

Yeah.

So do you think having a residency would make you less likely or prevent you from switching specialties in the future?

That's a good question.

I think if you're doing a residency, you typically want to be in that specialty.

So I think that plays more of a mindset, like, more of a role into, like, whether or not you're going to change down the line.

Like, I feel like I've invested a lot into my education in emergency medicine, and I'm definitely going to stick out emergency medicine for as long as possible.

I don't think that it's going to be a negative.

Like, when I try and switch.

It would be really like me trying to switch if I had just done emergency medicine for five years and not done a residency and was trying to get into derm or whatever.

So I really.

I don't think that it would inhibit you in any way.

I just think that maybe people who do residencies are less likely to switch early.

Yeah.

And I think that it depends on your residency, too.

Like, if you do a.

Like, ob GYN or a dermatology rotation or.

Sorry, residency.

Those, I feel like, are more limiting because that's something that's difficult to pivot from to begin with.

So I've said this again and again.

I say to pre PA students a lot.

It's a very common misconception that PAs can easily move laterally within specialties.

Like, you were not going to be a cardiothoracic surgery for 10 years and then try and get into derm when they could take a new grad and groom that new grad, and that new grad has all their, like, experience fresh.

Out of school and no bad habits.

And no bad habits that they have to fix.

Yeah.

But er, internal medicine, family medicine, urgent care are very easy to pivot from.

Like, if you start in any of those roles and you decide you want to go into ob GYN or you want to go into derm or you want to go into whatever.

It's easy at that point to say, okay, well, I have experience in ob gyn.

I do pelvic exams every day.

Granted, there's STI checks most of the time, but I am capable of finding.

The source or tampon removals.

Oh, my God, the smell that you just made me remember.

But it's one of those things where we can say, like, I can do a fetal ultrasound.

Like, I know exactly.

Like, I know the bad that can happen in ob gyn.

So, like, I'm a good candidate.

If you're gonna, like, take me on because I have that medical knowledge and, like.

Yeah.

I also know how to treat kids, and I know how to treat old people and whatever else there may be.

But, you know, that.

That cervix, I'd have got that, too.

So I think depends on the residency of whether or not it would be limiting.

And I don't think it's the residency that's the limiting part.

It's just the specialty by nature.

That makes sense.

That's much more eloquently said than what I tried within.

What I tried to say.

Yeah, no, both are good.

Okay, so for both of y'.

All.

Wait, how do I want to phrase this?

Let me read the question again.

Okay.

Is there anything that you did or could.

Or somebody could do during PA school to.

Aaron, make them more competitive to get a residency, and Jamie more competitive to make them able to just jump right into a job right out of school?

Erin wants you to go first, Jamie.

Oh, sorry.

I.

Okay.

I didn't know that's what that meant because it didn't make her bigger.

And I was like, where's her doing them?

She's pointing at you and saying, you go first.

I was pointing to say, you go first.

I feel like I've done all of the talking because I'm a talker.

Oh, I'm a talker, too.

It's okay.

Anyways, so to get into, like, any job.

So I don't know how all programs are set up.

I guess I can only speak to my school.

But at my school for clinicals, you have a preceptorship at the very end where you repeat one of your core rotations, whether that's internal medicine, family medicine, or er.

Those are your choices for us.

And so if you are interested in er, my first recommendation would be to repeat your ER rotation rather than something else, because obviously that's going to be more helpful.

The other thing I would say is make your ER rotation, if possible, closer to the end so that it's like your fourth or fifth rotation rather than your very first one, because you want to make an impression on the people that you're rotating with.

I take students now, and I have had students that.

There was one student, I had him overnight for three days in a row.

And on that third day, I called the massage place at 8am when they opened, and I booked myself a massage for the same day because working with him was so stressful and so terrible, and he was so dumb.

And then I had the very next week from his same program the best BA student I've ever had.

She helped me literally double my numbers because she would go see a patient, I would go see a patient.

At the same time, she'd staff it with me.

And I, like, after a couple of shifts together, I trusted her.

I thought that her clinical judgment was good.

I still obviously went and saw the patient, made sure I agreed with her.

But, like, she just gave me a really good exam.

She made a good impression.

And I immediately texted our lead and was like, hire her if she applies.

She's great.

Take her.

And I think that's really important.

And that's exactly how I got my job.

I don't know if they said I was great, but they did say, hey, this girl wants to work in the er, you should hire her.

And networking if you're gonna get a new grad job is really, really important, because otherwise, everything you're gonna see is one year or more of experience, and then they just throw your application away if you don't have a year.

I agree with Jamie on a lot of the points.

So I went to PA school in D.C. i wanted to go back to Florida.

Really hard to network when you don't have rotations like in the hospitals.

I didn't know anybody.

So, you know, when I was applying to those jobs that said that they took new grads, my application still kind of got tossed because I didn't know anybody.

So I didn't have my foot in the door.

I had no networking.

In terms of standing out for a PA Residency fellowship, they do look at your gpa.

So you've got to make sure that you have a good gpa.

They will require letters of recommendation.

So similar to PA school, where someone is writing you an actual letter and not just a reference, you've got to have at least one from emergency medicine.

In terms of, you know, doing emergency medicine residency, like your rotations, early versus late, I agree with Jamie.

It shouldn't be like your first one.

But a lot of residency programs will actually have you apply in, like, November, December, January before you graduate, because they start typically in either the summer or September.

And so you do want to have your rotation at least in, like, November so that you can have that letter of recommendation from an EM provider.

And if you were going to do any sort of extra, like, your elective rotation, I actually really recommend doing a peds emergency medicine rotation because I think if you can go to a true pediatric emergency department and experience that it is so different than adult EM doctors practicing emergency medicine, the fellowship trained pediatric emergency medicine Physicians are amazing and excellent teachers, and I am so thankful that my residency program had a true peds ed in it and I was able to experience and learn from these people because, you know, I just feel leaps and bounds more comfortable with treating pediatric emergencies than I would have ever felt without having them as my mentors.

Then obviously doing again, just like another emergency medicine elective is also a really good thing.

But if you can do like a true BGM elective, I think that's a great way to stand out to programs.

Yeah, we did electives as well as our preceptorship, but our electives, we had two of them and they were each two weeks.

If yours are similar to that, where it's like a very limited amount of time and there's no peds ER available to you, because that is kind of like a niche thing.

If that's not something that's going to be feasible, I would highly recommend doing either a trauma rotation or an ortho rotation as your electives, because those are probably the two biggest things in the ER that you need to know how to do.

I actually did a peds ortho rotation for my elective, and it has made me very good at reading, like, pediatric elbows.

And peds has a lot of growth plates and there are a lot of things that look like fractures, but they're not.

They're like weird nutrient canals.

And knowing that has allowed me to like, I had a three year old who had a spiral tibial fracture that the radiologist missed.

And when I reviewed my own images, because I look at all my own images, I was like, that's where she's tender and that's definitely a spiral fracture.

And I called the radiologist and I was like, hey, you want to look at this again and tell me if you agree with this?

And they actually said, yeah, it could be a fracture, especially if she's not walking on it and she tender there.

So I ended up putting her, like, in a long leg splint and sending her to a pediatric emergency department where they could, like, treat her and get her, like, seeing ortho.

But that, like, I wouldn't have known that if I hadn't done my peds ortho rotation, because I would have just like blindly read the radiology report and I would have been like, okay, no fracture.

And I would have sent this kid home with no splint.

And that's a no no with toddler fractures.

Yes.

I actually, I really.

That was a great point.

And I don't even ever think about trauma or ortho, which is crazy because that's what my, like, off service rotations were in my fellowship.

But trauma and ortho are amazing rotations to take during PA School as well.

Ortho.

I mean, how many ortho complaints do you think that you have a day?

Jamie, do you want to hear my favorite example from yesterday?

So this lady comes in.

She broke her arm because she fell.

We're about to discharge her.

She falls again in our freaking ER and breaks her hip.

Oh, no.

Oh, my God.

Oh, my God.

I cannot.

Like, that was.

It wasn't my patient, and I don't know how old she was or any other details about her, but I got the text message from my friend that was like, I'm literally about to discharge her home, which is my last patient.

I was about to leave an hour early, and this happens.

And I was like, oh, no, no.

Well, y' all know I don't do.

Ortho.

Complaints in emergency medicine are so, so common.

There's always falls.

You know, there's always.

Or, like, I have a lot of open joints where.

Where I'm right now because there's a lot of college students, and college students like to do silly, dangerous things when they're inebriated.

And so they come in, and they'll be like, yeah, I, like, you know, was doing something, and my buddy had a knife, and I put my hand through the knife, and now I have this open fracture to, you know, my proxima phalanx.

And I'm like, great, thanks.

I'm.

I'm glad that you came to my emergency department with this.

Let me fix you.

Or they, like, they hold up their arm.

They're like, it's not supposed to look like this.

And, like, obviously deformed.

And you're like, yes.

You're like, aren't you?

They really love saying that.

No, I'm very drunk.

Reasons I don't do er.

I think that is my favorite thing is they come in and they're like, it's not supposed to look like this.

I don't know what this means, but it's not supposed to look like this.

Yeah, well, it makes y' all feel better.

I get those cheap complaints, too.

I had one last week or a couple weeks ago, and I was still seeing patients.

That was their chief complaint was things are growing that shouldn't be there on their skin.

So that's everywhere.

Okay, I have one last question for both of you, and this is more related to current events with all of this crazy coronavirus stuff because you guys, unlike me, are like, in the thick of it, seeing these patients.

And I feel like there's been a lot of talk online and like the Pre PA Club Facebook group about people maybe like, questioning whether they want to go into medicine because of everything that's going on.

Being in that role that maybe you did or didn't expect to ever be in, because I don't think any of us predicted this.

Has that changed your thoughts on being a PA or being an emergency medicine or what would you like, tell those people, like, who are thinking, like, I don't know about this anymore?

I would say no, but I'm not really like a flight if it's gonna be fight or flight kind of person.

So, like, my first instinct when this happened was like, I'm excited I get to help rather than having to sit at home.

And I also am a very extroverted person.

And if I had to socially isolate with no one to talk to but my husband, I would go bananas.

I love him to death, don't get me wrong.

But it's nice to still be able to go to work and have that normalcy.

But this, these patients are sick.

It is haunting.

I have colleagues that have been in medicine for like 15, 20 years, and we've never seen anything like this.

I mean, these patients come in and I'm sure you've seen this, Aaron, but they, they come in, they're so sweaty, they're breathing so hard, and they crump so quickly.

Like, you can tell from looking at them that their pulse ox is going to be 79%.

And you, like, get them on the non rebreather and they cannot do anything further because high flow oxygen aerosolizes it.

And we try so hard to not tube them.

But every recommendation right now is that if you think you're gonna get there, you're gonna do it.

And within an hour, a lot of these people are getting tubed.

So we are taking care of them.

And almost all of them are day seven to 10.

I think most people are coming in on day nine for us, which is really weird.

But I mean, I've had.

I have.

We have several wards that are just completely turned into Covid units.

And you can walk in the room and just like.

It's like a kidney stone.

Like, kidney stones, when you walk in the room, they're always writhing in this, like, particular way.

And you're like, you have a kidney stuff stone.

You don't even need to examine them.

You just know Covid is like that.

It has Like, a very distinct look.

Like, when you walk in the room, you hear their cough.

You see how sweaty they are.

They're all just really diaphoretic.

You're like, you have Covid.

Like, in the very beginning of this, some of them were convincing for flu.

Like, especially the.

The day four or fivers, we were like, just can't stop coughing.

I've had this for, like, four or five days.

And I think we talked about this a little bit before we started recording.

But they do tend to turn the corner.

There are a lot of these people who get totally healed.

They never get intubated, and they do fine.

But there are also a lot of these people, and there seems to be.

I mean, a lot of these people who are young are either obese or they have hypertension, but they've never been diagnosed, so they're not truly otherwise healthy.

Like, they do have comorbidities.

And the ones who are older have, like, 100 different comorbidities, and they all get sick the exact same same way, the exact same pace.

So it's been just very, like, weird to see.

And it's cool to be in a time of, like, they're literally gonna write about this in textbooks.

And, like, I can say, like, I was in the thick of it.

Now, I will not think it's so cool if I get sick and end up very sick.

But I'm not terribly worried because I don't have kids and I don't live with my parents.

Like, they.

I'm not really worried about the people I'm gonna infect because, like, my husband and I are both young and healthy, and we exercise.

We don't have meds.

Like, so even if we do get sick, we're both just kind of like, that's our fate.

Like, this is just what it is.

This is my job.

And in the.

I.

Like, there's definitely been waves of emotion.

Like, there are days that I'm just scared shitless.

There are other days where I'm like, this is cool.

I'm pretty proud of myself.

And there are other days where I'm just, like, worried and anxious.

But I think today, because I have today off, and I've been not really digesting any coronavirus stuff, and I got some vitamin D, and I'm in a pretty good mood, and my husband just brought me a beer.

I'm in, like, a very optimistic mood about this.

I think that it's going to be, like, a lot of people are going to get really sick, but I think we are doing the Very, very best we can to learn about it.

And I'm like kind of in awe of how much research that is being done on vaccines and treatment, whether it's anti malarials or it's antivirals or whatever they're trying to do.

And the only thing that I don't like is political and we won't go there.

So I, I think it's actually great that you're asking Jamie and I, because I think our perspectives are different.

In terms of being a fight or flight person, I am 100% a flight person.

And in terms of being extroverted versus introverted, I'm also 100% like an introvert.

I would love to be self isolating at home right now and doing nothing but hanging out with my cats all day and like, you know, cleaning my house and just doing, working from home.

With that being said, no, this would never ever make me change wanting to go into medicine.

And I think if.

But I love that, I love that we're so different.

But ultimately our conclusion is the same.

That was not what I expected that you were gonna be like, nope, never do any hair again.

I'm out.

No, peace out.

No, I mean I.

So I can definitely say I would never change doing medicine.

I love doing medicine.

I love helping people.

I love making a difference.

I know that I'm making a difference right now.

I will say that I think if for all of the pre PAs who are thinking to themselves, oh my God, I don't want to do this, I don't want to do this.

Like, the chances of something like this happening again are probably low.

But with that being said, if you're having doubts, you should look into those doubts a little bit more and maybe try and get some more hands on experience and see whether or not you actually like medicine.

Because medicine is not for everybody.

I think that's a good point.

A lot of people think that this is like a glamorous field, not just emergency medicine, but like being a PA in general.

Like it's very trendy right now.

It's very like Instagram is hot with PAs.

Like they're everywhere.

They're on frickin TikTok.

And I think a lot of people go into it and then they're like, oh, this is not what I expected.

So it's very important to shadow and like know what the role is and not just for being a pa, but like medicine in general.

I think a lot of people start college as a impressionable 18 year old and they're told that like doctors and PAs and nurses, like, we're always going to be needed.

And they're like, all right, that's a stable career, but you have to make sure that you actually like it too, right?

And so I think if you're having doubts, explore your doubts.

Don't shove them in a closet.

In terms of emergency medicine, would I do emergency medicine again?

Ultimately, the answer is yes.

I think, like, Jamie, I go through raves, okay?

So there are some days where I think about it and I feel super overwhelmed and I feel super stressed, and, you know, I've even, like, cried about the thought of going to work.

And then there are other days where I'm like, no, this is fine.

Like, this is life.

This is what I signed up for.

I knew exactly what I was getting when I got into emergency medicine.

I knew that it was going to be hard.

I knew that I was going to have to think.

I knew that no patient was going to present the same way and that I was constantly going to be learning and constantly going to be challenging myself, and I am ready for this challenge.

And then there are other days where I'm just, like, kind of numb to it, and I don't have any thoughts, good or bad, and I feel like those thoughts kind of, like go in like.

Like a cycle.

Like, it repeats over and over.

I am the opposite of Jamie in the fact that when I'm off, I actually feel worse about it because I'm thinking about it and I'm thinking, oh, my God, I don't want to go back to work.

And this is scary.

And then when I'm actually at work, I'm like, no, this is fine.

Like, I can handle this.

I'm prepared.

Like, being in the moment, being in the, quote, trenches, you know, makes me feel better about my decision.

So I've definitely had days at home, though, where I feel the same as you, where I'm like, man, this really, really sucks.

Especially, like, going to the grocery store is, like, very sobering for me.

Yeah, I usually don't wear anything protective equipment to the grocery store, but I, like, I posted to my Instagram.

I don't know if any of my followers listen to this podcast, but if so, I'm sorry for repeating this story, but this lady, like, spit at me in the deli line.

She didn't literally spit.

She was yelling at me for something unrelated, but she was standing too close to me and she was, like, making aized droplets with her freaking anger.

And I just wanted to be like, do you not understand, like, what this social distancing is supposed to be for, like, back away from me.

And when I'm home, I, like, look out and, like, see my neighbors, like, standing six feet apart and stuff.

And I'm like, this is real.

Like, at work, it just kind of feels like work.

Like, I dress the same way when I see a CDF patient.

Okay, that's an exaggeration.

I obviously don't wear an N95 or a capper for a C Diff patient.

But, like, the.

I mean, I'm wearing the right equipment.

I feel like I'm in control when I'm at work.

And then it's really easy at home to just be like, all right, this is not as in control as we thought it was because you see all the other things that are going on.

But I try really hard to stay away from, like, all of the social media and news and, like, podcasts and radio stations.

Like, I try not to digest that when I'm off because otherwise, like, I do get really overwhelmed too.

Yeah.

And that's what I've had to do.

So I no longer listen to, like, the radio stations because they're all talking about it, and it just makes me stressed.

I also am in a little bit different of a position than Jamie.

I live at home with my mom.

My mom is obviously older because she's my mother.

She's super healthy.

She's in much better shape than I am.

But it is something that I think about.

About the fact that, am I bringing this home to her?

Is something going to happen to her?

She's in that age group where maybe she would have a bad outcome from it.

And that.

That is very, very sobering.

And then originally, like, when it first came out and we didn't know anything about it and there was thoughts that we could transmit it to our pets, I was really concerned about my cats.

I was really, really concerned about my cats.

So my priorities are really in line.

My friend had to put her cats cat down on Monday, and I literally was like, did he have coronavirus?

Like, that was my first thought.

And he didn't.

He had something otherwise horrible happen to him.

But I was just like, holy crap.

Like.

And shortly after that, my sister, who was a vet student, sent me an article that, like, there is a cat who was confirmed positive with COVID and had a cough.

And I was like, why are you telling me this?

Because that cat did fine.

Both the owner and the pet recovered.

But she was like, just FYI, they think that dogs can't transmit it, but cats potentially can.

And I Was like, what?

So, okay, so that's super stressful.

Me, more stress in my life.

There's only one cat in the entire world that tested positive, though.

And for all we know, this mob was contaminated because he lived with the owner.

Like, maybe he licked his owner and it just happened to be in his.

You're right.

It was probably contaminated.

It was probably.

They've tested a lot of animals.

They are actually studying this because they want to know, like, how.

How did it get to humans?

Like, what is it transmitting from?

Should we be worried about our pets?

Because, like, how many people have an outdoor cat that, like, frolics inside just to eat?

So, yeah, there.

It's.

If the fact that there's literally only one and there's, like, literally hundreds of thousands of humans, I think you're doing pretty good.

They'll be fine.

So my cat actually really, really enjoys the scent of Lysol.

Good.

And anytime I, like, spray it to clean.

This is fat ginger.

I don't know, like Jamie said, I don't know how many of my followers listen to this.

You know, I sound so fancy when I say that, but so fat ginger really, really likes the smell of Lysol.

And if you spray anything with.

With Lysol, she'll come up, and she'll lay down on the spot.

Sounds like my child.

So I had one more thought that I was gonna say.

Oh.

In terms of patients, I am not as much in the thick of it as Jamie, and I have not had a ton of patients who have it have had it.

And so I am still, like, figuring out my clinical gestalt as to who I think has it and who I think don't have it.

Like Jamie said, you know, kidney stones.

Absolutely.

They come in.

There is a look, there's a story.

I'm like, you 100% have a kidney stone.

Like, I'm good at getting it, and I'm sure at some point I'll get good at figuring out who has Covid and who doesn't.

But until I, like, figure that out, it's kind of stressful thinking to myself.

You know, my thoughts at this point is I'm thinking that every single patient has it.

When I go into.

Yeah, for months, we've been having patients, though, that are flu negative.

They clinically look like a flu, and then we end up sending them home because we otherwise would have.

And once Covid started getting bigger, we started thinking a little bit harder about, like, does this patient need to go home or does this patient need to stay?

Like, their flu is negative.

They probably have coronavirus, but the, like, the CDC is not recommending testing them.

So we definitely have had our fair share of people that we were just like, this person probably has it, but we can't test them.

And like, that is scary to me because how many people did we send home like, that ended up having a bad outcome because we sent them home?

But our protocol is pretty much like, if you're not hypoxic and you're not, like, really, really working to breathe, you don't stay.

You go home, even if you feel short of breath.

And I feel horrible about that.

Thank goodness they suspended our patient satisfaction score.

So we can't, like, have people telling, like, the world how terrible we are.

But they are like, if they're short of breath, but objectively, by, like, vital signs and by clinical appearance looking okay, we're sending these people home.

Yeah, that's kind of what's happening here, too.

Well, thanks, guys, for your input,.

Sa.