Are you captivated by the adrenaline-filled environment of emergency medicine (EM)? You’re not alone. EM attracts 12.5% of PAs, making it a popular choice among advanced practice providers. But how do you get started in such a fast-paced, varied, and occasionally high-stakes practice environment?
Newly graduated PAs may find themselves at a crossroads, wondering how best to embark on a career in EM. Do you dive straight into the job market, eager to apply your freshly acquired knowledge and energy? Do you gain clinical experience in another field and then transition? Or do you opt for a more structured approach, seeking additional training through an Emergency Medicine Physician Assistant (EMPA) residency? EMPA residency is relatively new in medicine, and much has changed since the first program opened in 1991, but the same conundrum exists: Why go through this if I can just get a job?
Exploring the Value of Postgraduate Training Options in Emergency Medicine
EMPA residencies are designed to equip PAs—and, in some programs, NPs— with the skills and knowledge to effectively manage patients across a spectrum of severity, from minor cases to critical emergencies. Currently, over 50 EMPA programs are operational in the US, with top programs like the University of Iowa, St. Luke’s, and Gundersen maintaining accreditation through the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). These programs have undergone a formal accreditation process that verifies the quality and content of education, similar to physician residencies, although the accrediting body is different. The remaining programs offer quality EM education recognized by the Association of Postgraduate PA Programs (APPAP.)
Inside EMPA Residencies: Duration, Rotations, and Training Structure
EMPA training programs typically last 15 months (range 12–24 months), during which learners rotate through the ED and off-service disciplines such as trauma, anesthesiology, ultrasound, and orthopedics. Many programs offer opportunities to pursue elective rotations in specialized areas of interest, such as plastic surgery, burn care, or wilderness medicine.
Trainees find themselves in a dynamic learning environment, attending conferences and participating in overnight calls, mirroring the schedules of their physician-resident colleagues. It’s a challenging yet enriching pathway, with a median annual salary of $58,566 during EMPA training —modest compared to the annual starting salary of $110,000 for full-time EM PAs.
Why Pursue an EMPA Residency?
Why take on the long hours and reduced pay of an EMPA residency? Many choose PA training over medical school, partly to avoid spending four years in residency and being pigeonholed into one specialty. The decision warrants careful consideration.
While immediate job placement may offer the allure of earning a salary sooner, a residency provides an accelerated path to gaining comprehensive clinical and didactic knowledge, which would otherwise take years of on-the-job training. PAs can develop judgment and technical skills through a structured and supervised program, boosting their confidence and readiness. Participants gain exposure to a diverse caseload, receive mentorship from seasoned practitioners, and have the chance to refine their clinical judgment in a supportive environment.
Completing a residency may enhance marketability and lead to higher compensation. Employers may prioritize residency-trained PAs, recognizing the depth of training and expertise they bring. Additionally, for mid-career PAs seeking a new career path, residency programs provide an avenue to transition into a specialty practice. A 2022 SEMPA survey found that 65.0% of PAs who completed a PA residency or fellowship received a pay increase after completing the program.
The answer also depends on your professional goals and desired practice settings. If you prefer to see low acuity patients in an ED “fast track” or an urgent care center, the extra training might not be necessary. These are perfectly reasonable career paths and positions needed within the larger healthcare community. However, if you want to care for critical patients, practice emergency medicine in remote or solo coverage sites, or learn more in a shorter time frame, then perhaps an EMPA residency is a good choice.
Debunking Myths
Some worry that endorsing EMPA residencies could imply that all aspiring practitioners need residency training to succeed in emergency medicine. This isn’t the case.
My response to this question is nuanced. ER residencies for midlevel providers will not become mandatory for the foreseeable future. The number of available training programs pales compared to the many PAs already practicing in emergency medicine. Many EM positions do not require additional training, offering ample on-the-job learning and skill development opportunities. EMPA residencies serve as one pathway among many for midlevel providers entering the field. While completing a residency may enhance one's skills and marketability, it is by no means the only route to success in emergency medicine.
However, there's merit in considering that additional training may be necessary, particularly for those aspiring to care for critically ill patients, especially in resource-limited settings. The reality is that no one leaves PA school fully prepared to confront the challenges inherent in emergency medicine. The skills and knowledge acquired through a dedicated EMPA residency can equip practitioners to handle complex cases confidently and proficiently in such demanding environments.
Choosing the Right Path
Ultimately, whether or not to pursue a residency should align with your career goals and the type of emergency medicine environment you aspire to thrive in. While many institutions prioritize candidates with residency experience, particularly for roles requiring solo coverage or immediate care for critical patients, some employers are open to providing additional training to new hires.
Having worked in a rural ER setting, I've observed that both residency-trained and non-residency-trained PAs are considered for roles, but those with residency backgrounds tend to progress through the vetting process more quickly. However, regardless of residency status, individuals can still navigate the selection process, though it may be more challenging for those without residency training, especially when handling critical cases. For those driven to excel quickly in high-stakes settings, an EMPA residency can be a game-changer.
