As some of y’all know, I completed a PA Residency in Emergency Medicine. I’ve gotten a TON of questions since announcing that I’m doing this, and I thought it might be easiest to do a frequently asked questions post to clear up some of the confusion.
I will be updating this post as I go (and get more questions asked).
**Disclaimer: For privacy reasons (both for myself and my program) I am choosing NOT to disclose which program I am attending. Thank you for respecting that decision.
Additionally, everything I share is based on my own opinions, experience, or research I have conducted.
These are not the opinions of my program, employer, hospital, nor anyone else associated with me.
I recommend you take all of this information with a grain of salt, and conduct your own research.
What is an PA residency?
You might have also heard these called “fellowship” or “internships”. Mine is technically called an APP Fellowship. Basically, no matter what its called, they’re all the same thing. An APP post-graduate training is a program that places an emphasis on continuing education for APPs (advance practice providers), and gives them a stronger base on which to build the rest of their careers on. You’re also working during this time period. They can be in all different sorts of specialities, but typically are the more acute care fields or those that are less common (for example, palliative care).
What happens in an PA residency/APP Fellowship?
This definitely varies by each individual program! In most, you are both seeing patients and having designated educational time. The educational time can be lectures put on by more experienced providers, online courses, labs, or even joining in on lectures for MD/DO residents. Additionally, a good APP Fellowship will give you rotations outside of the field you plan on entering. This allows you to have a better understanding of the different specialties of medicine that work together. For instance, my program sends us on a trauma surgery and orthopedics rotation since those are two of the big specialities that we work hand in hand with in the ED.
One of the easiest ways to think of a PA residency is to think of the residencies that physicians go through. Though it’s definitely shorter and not always as intense, and I am in no way belittling a physician residency, it is similar in the expectations and education set up!
Do you have to be a new grad?
I think its more common for new grads to complete these programs, but there are definitely more experienced PAs who do them. Typically that happens when someone is transitioning from one speciality to another, and especially when these fields are total opposites.
What separates a PA residency from a job in the same field?
APP Fellowships are also jobs – so you are treating patients and doing shifts like a regular provider. What makes them different is the emphasis they have placed on education. While you might be lucky enough to find a job that wants to teach you, this isn’t always the case. Often times you’ll have a few weeks on orientation before going off on your own and the continuing education you get is the education you make happen. A PA residency allows for a smoother transition into being a provider on your own, because there are people there guiding you. They are dedicated to making sure you continue to grow as a provider and they are dedicated to providing regular, planned, good education. That’s not saying that you can’t find a fantastic job that does all of these things! Hopefully a residency allows you to feel more confident that those are going to happen and you will succeed.
Why are you doing an APP Fellowship?
Here is a more detailed answer on this, but for right now, here is the short answer. I knew for a fact I wanted to do emergency medicine out of PA school, and I knew it was going to be incredibly challenging to find an ED job as a new grad in Florida. So there was a couple of options I could have done. I could have stayed in DC and worked in an ED there (that hires new grads) to get my 1-2 years of experience. I could have started out by working in urgent care and transitioned later to the ED. Or I could do a fellowship.
After a lot of consideration, I decided that doing an APP Fellowship was the best option for me. I knew that I would have emphasis placed on continuing my education and I knew that I would gain great experience from doing one. Plus I would then have my 1 year of experience when I was applying for regular jobs.
How long do these programs last?
This definitely varies by programs. I would say the most common length is 12 months. Some are as long as 18 months though!
Are these programs only in person or are there online ones too?
Ehh, yes there are online fellowships/residencies…I’m not exactly sure how I feel about them because I think the hands on training that you get is super important. I mean, the only way to learn a procedure is to do it in real life. On the other hand, the lectures for these programs are definitely on the more structured side and more like the lectures you got in school. So, you could do this online “fellowship” while also working in the field and that would provide you with a similar-ish feeling as to what I did.
Do you get paid in an APP Fellowship? How does it compare to a new grad salary?
Yes, you do get paid. However, it definitely is less than what you could be making as a new grad in a regular position. It varies from program to program, but you should expect something in the 50k-60k range. In the past couple of years this number has increased, and it is possible that this number could continue to increase. Some programs also will pay you a regular rate for shifts you do over your required amount! Programs should also provide you with benefits and CME money (please make sure to look for these things).
One thing to remember with any of these programs is that you can put your loans on deferment for the year that you’re completing them since its continued education. While your loans will continue to accrue interest, you’re able to make payments even with your loans in deferment – and this would allow you to make the payments that you can afford.
What is the application process like?
Pretty straight forward actually! Most programs will ask you to fill out some sort of application. It might include writing a personal statement (you should approach this similarly to how you approached the personal statement for PA school). But all of the programs will ask you to send in transcripts, a CV and letters of recommendation.
Once you’ve sent in all of this paperwork, you’ll hear back about interviews. Most programs understand that applicants are coming from all over and in the process of completing this clinical year, so the first interview will typically be a phone interview. If you pass that round, you’ll most likely have to go for an in person interview.
Interview questions will run super similar to most job interviews.
How difficult is it to get a PA residency?
Think back to how hard it was to get into PA school – nah, I’m kidding! Its hardish but no where near as difficult as getting a spot in school. PA residencies/fellowships typically take around 1-6 in their cohort and about 30-50 people apply. I do think that this number is changing and that with every year it is becoming more competitive to get in as more people are applying and wanting to complete one.
How do I find an PA residency?
Google or Networking! There are a few websites out there that list out all the different residencies, or at least the ones they know of. Programs will also contact PA schools and ask for their information to be sent out on the listserv. One of the easiest ways to find “good” programs is to look at places that have a larger amount of PAs working in the hospital and also have an MD/DO residency
**By good – I mean standardized and truly committed to growing you as a provider and not just using you as a source of cheaper labor.
Do I have to do an APP Fellowship/PA residency?
Absolutely not!!! And in all honesty, I never think that this will be a requirement to practice as a PA. My class had 63 graduates, and only 3 of us did a program. Do I think it helps? Yes. But its not the end of the world if you don’t do one, and you’ll still be successful as a PA.
How does doing a program help you as a PA?
These programs give you a confidence boost and more training than a typical new grad. Studies have shown that when you get done completing a program, you will most likely get paid more than a similar applicant with the same amount of experience, but the further you get in your career it becomes less likely that you will see a pay increase from having completed a program.
Are APP Fellowships for only PAs, or are there NP programs as well?
There are absolutely programs for NPs as well! My program is for both, so there are actually two NPs in my class.
How are these programs regulated?
Unfortunately, at this point in time there is no regulating body for these programs. That means that there definitely are some programs out there that are a little sketchy because anyone can call their program a “residency”. I’m hoping in the future we’ll see more regulation, but until then its incredibly important that you do your own research and form your own opinions about individual programs.
Programs CAN pay to be a member of the APPAP, and do have to fulfill some requirements to do that, but this isn’t a regulating body.
Are you thankful to have done a residency?
ABSOLUTELY. Every single shift I work I am happy that I did one. I truly would not feel as confident as I do now – roughly 18 months out – if I did not complete a residency
The only thing I would have changed is perhaps going to a more “intense” program. I got amazing education and experience at mine, but I also have some friends who do feel a little bit more confident in their complicated procedures (central lines, paracentesis, etc).
What are your thoughts on the comments from some of the physician boards on APP training programs?
So I think this is a touchy subject. At the end of the day, physician groups like to say that we are not well educated and should not be practicing medicine. And while I do definitely understand that in comparison PA education is less hours, I think that we are valuable members of the healthcare team. I am not in the practice of trying to replace physicians and this is not why I became a PA. I respect and value my physician colleagues. I work in a team to provide care to patients and improve access to care. Do I find it frustrating that physician groups tote our lesser education but then make comments on how we should not be able to do post-graduate training programs? Yes. I find this contradicting. But I am very happy I did a program, my colleagues are very happy I did one, and I will continue to advocate for these programs.
I’m going to be continually updating this post the further I get into my program since I’m sure I’ll get more questions from all y’all! Please don’t hesitant to reach out if you do have any questions not answered here!
**Updated April 14, 2021