Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions.

Is a PA Emergency Medicine Fellowship What You Need?

4/12/2017 11:47:30 AM | 4 comments

empa fellowship cep americaIt was working as an EMT that convinced me to become an EMPA. I had chosen that pathway in order to log the necessary hours to get into PA school. But, I was so impressed by the knowledge and skills of the paramedics I worked with that I decided emergency medicine was where I wanted to specialize.
Once I was in PA school, however, I started looking at the job market; all the EMPA jobs required years of experience. Which makes sense, since emergency medicine has such a steep learning curve. Indeed, PAs in the ED have to work quickly while managing multiple patients and performing a range of challenging procedures (difficult airways, to name just one).
Still, I was stumped: how could I get a job to get the required experience if I had no experience?
The answer, it turned out, was CEP America’s Emergency Medicine Physician Assistant (EMPA) Fellowship Program.


EMPAs: High Demand, Unique Skills, Small Talent Pool

Sixty percent of hospitals are actively recruiting PAs, according to the 2016 Survey of PA Recruiting and Employment Trends conducted by Merritt Hawkins in cooperation with the American Academy of Physician Assistants (AAPA). That number jumps to 87 percent in hospitals with more than 200 beds.
While we don't have specific numbers for EMPAs, it's likely that competition to hire them is even stiffer. That’s largely because breaking into emergency medicine is hard; it requires some pretty unique skills that are difficult to master in a single clinical rotation.
While PA students typically complete an emergency medicine rotation that lasts between four and six weeks (and sometimes an additional elective rotation in the specialty), more often than not such rotations don’t reflect the realities of practice.
For example, a practicing EMPA often has to manage 12 to 15 complicated ED patients at a time, whereas students generally focus on just one.
That’s why CEP America’s EMPA Fellowship was just perfect. It enabled me to put in the hours and do the higher-level procedures in a supportive environment while gradually taking on more responsibility.  

14 Months to Mastery

The CEP America EMPA Fellowship Program is offered in two California hospitals: Kaweah Delta Medical Center in Visalia and Arrowhead Regional Medical Center in Colton.
I did mine at Arrowhead, where my most influential mentors included Dennis Tankersley, MS, PA-C, who is the Advanced Provider Site Lead and Director of the EMPA Fellowship, and Heather Morse, PA-C.
But it’s not easy to get in. They look at your GPA, they look at what you did in undergrad, they take into consideration what type of person you are, and they even take into account the hands-on clinical hours you did to get into PA school.
Once you’re accepted (but before the program kicks off), you have to complete a series of online emergency medicine modules. Doing so gives the incoming cohort a common baseline from which to start.
The program, which is a mix of hands-on clinical training and weekly classroom instruction, starts in November of each year and runs for 14 months. One benefit of this schedule is that it allows the second-years to act as guides to the incoming fellow. So, everyone starts off as an EMPA newbie and leaves as an EMPA mentor.
You’ll have senior providers mentoring you throughout the length of the program, of course. But, they will hold your hand only for the first three months or so. After that you’ll be running pods on your own, caring for sicker, higher-acuity patients, coming up with the differentials, and ultimately making dispositions.
You will be supported, but you will quickly be doing the brunt of the work in order to maximize the amount of hands-on clinical experience you get. After all, that hands-on clinical experience — the pressure that’s on you and the volume that you have to see — is what’s going to make you effective in the ED (and ultimately get you hired).
It’s also going to make you a better EMPA. For example, in my current job as Assistant Lead Advanced Provider at Memorial Medical Center - Modesto (Calif.), I feel like I’m able to keep pace with the seasoned advanced providers, even though I’m just a few years out of school.

Taking It Further: The CAQ

The mentors in the EMPA Fellowship can have a positive influence beyond the clinical realm.
For example, when I was a fellow, our director Dennis Tanskersley had recently received the Certificate of Added Qualifications (CAQ) in emergency medicine.
The CAQ is a credential given by the National Commission on Certification of Physician Assistants (NCCPA). It’s somewhat elite; fewer than 50 PAs in the entire state of California hold a CAQ in emergency medicine. But it really proves to your employers that you can go the extra mile to provide that quality of care for your patients.
So I followed Tankersley's lead and pursued the CAQ as well. I was able to get it pretty quickly, because I had performed many of the required procedures (e.g., incision and drainage, laceration repairs, LPs) routinely during my fellowship. All I had to do was log my experience hours, procedures, and cases, have them verified by my clinical supervisor, and take the credentialing exam.
Another key thing I learned through the mentorship I received was the degree to which CEP America values its advanced providers. It is wholly dedicated to providing a great workplace for them.
Indeed, that dedication combined with CEP America’s culture of caring is why I went from being a CEP America fellow to a CEP America PA.

Is the EMPA Fellowship Right For You?

An EMPA fellowship is a great way to jumpstart your emergency medicine career. But that doesn't mean it's the right choice for everyone.
You'll need deep inner drive and passion to see you through these challenging 14 months. It’s hard to put into words the kind of volume you’ll see and the pressure you'll sometimes feel.
Being a good communicator will make a world of difference. It's not enough to convey information and get along with your coworkers. You also need to know how to lead and take initiative when necessary.
Having a strong support system also helps. Supportive friends and family  are invaluable when you're switching from day shifts to nights or working with difficult personalities.
Sure, the fellowship is intense. But being an EMPA is intense, so the program has to be, too.
Which is why if your heart is set on being an EMPA like mine was, there is simply no better way to start your career than with a CEP America EMPA Fellowship.

To learn more about our EMPA fellowship, visit the CEP America website.

Theresa, great article and great message. "Back in the old days" I applied for EM jobs and could not get one as a new grad as they all required experience. When I did land my first EM job, after practicing primary care, I realized I was woefully underprepared, despite my prior experience as an EMT and trauma center volunteer. Those experiences helped me realize emergency medicine was the field I wanted to practice in and so I paid more attention to that in my PA training, but the training fell far short of the reality. I would have LOVED a fellowship! I'm so glad CEP has opportunities for new grads like this and I, too, can attest to the very fine quality of Fellows turned out by the program.
If you are about to graduate PA school and want to get into EM and wish you had a residency like our physician colleagues do, then definitely look into a fellowship program.
4/13/2017 2:22:10 PM

Jon Brummond
I have been fortunate enough to work with many of the Fellows and I agree with Cyndy, they are absolutely amazing! The program does so well to augment professionalism, efficiency, clinical expertise, procedural competence, confidence and the precious secret recipe: CEP Culture! If you ever are fortunate enough to have a Fellow on your team, you understand...If you haven't, trust want to!
4/13/2017 12:18:45 PM

David Carter
Theresa, thanks! Great article. What a fantastic experience and appreciate the perspective that comes from this 14 month, very well-rounded, Fellowship Program. Dennis Tankersly and Rod Borger, thanks for your vision in establishing this program. Truly a great model and some excellent clinicians/leaders like Theresa born out of it.
4/13/2017 10:49:59 AM

Cyndy Flores
We are very fortunate as an organization to have such a training program within CEP. Kudos to Dennis and Dr. Borger for having the faith, knowledge and gumption to get this program started and turning it into an amazing program. I am lucky enough to work at a site that has hired 3 of the past Fellows and they are all amazing and have brought so much to our site. They bring clinical knowledge, great skills, a love of teaching and the CEP work ethic and culture.
4/13/2017 8:07:23 AM