Fellow ship (as in MD kind) good idea?

  1. I admit, that I may be the only person that didn't know that NP's can apply to some of the specialized Fellowships, like Emergency Medicine, Psych, GI, etc but then again, I really didn't know that much about how MD's did their training and lo and behold, I mainly work with MD"s now and several fellows in Rheumatology and totally get how doing a fellowship and really getting immersed into the field can be a huge boost to both ones knowledge and confidence inspiring.

    So my question is, would taking a paid 12 month fellowship in Emergency Medicine or psych be smart? Pro: 12 months of intense training in one field alongside MD's, with a likely guaranteed job at the end of it, and the Con: most stipends that I saw were in the mid $50k range during your training, but you can moonlight on off days to earn some extra cash, plus you are back in the training mode again, ugh.

    Honestly, I think that if I knew about the possibility and could have gotten into one, I would have loved to have the in-depth training that I think was lacking in my FNP program. I am continually humbled at my current position at the difference between what I know and what the fellows know, but I"m new and I'll catch up, but still.

    What do you all think?
  2. Visit Tony1790 profile page

    About Tony1790, BSN, MSN, RN, APRN, NP

    Joined: May '06; Posts: 206; Likes: 115
    FNP-BC; from US
    Specialty: Arthritis/Rheumatology

    14 Comments

  3. by   traumaRUs
    Hmm...residencies weren't really a thing when I graduated in 2006. However, in the nephrology practice I went to, I had a 4 month orientation that was split between didactic and time spent with MDs and experienced NPs.

    If you are an experienced NP, taking $50,000/year would definitely be a kick in the household budget I would think. However, I can see the pluses for new grads
  4. by   Jules A
    I do think that would be excellent especially if this would align us more with MD type training. I would advise anyone who plans to work in a specialty with a board certification, such as psych, to get that first. More states should be moving to require NPs be board certified in the areas they practice, imagine that?
  5. by   Oldmahubbard
    If there is any way you can swing it financially, I would recommend it.
  6. by   djmatte
    I'm half considering it in primary care. But it would require a move to another state and after 3 years of school, my wife might put the veto on a pay cut.
  7. by   BostonFNP
    I worked on a project for establishing an NP residency at a local tertiary center (in which NPs would work directly alongside the medical residents). In the beginning I thought it was a great idea: excellent/established formalized clinical training, a way for novice NPs to get real world experience, adds legitimacy to NP practice overall, etc. By the end of it, I had a whole new array of concerns. I think my biggest flaw from the beginning was assuming there was no downside.

    As I worked with the medical staff, admins, and academics on the project I started to develop some significant concerns about the motivations for establishing the program in the first place. It seemed from an academic side the motivation was to use the program as a selling point for their NP program; this I can understand. It seemed from the hospital admin side this was essentially a program to produce cheap labor; they were struggling with the residency hour cap changes and they were looking to replace that coverage with other cheap labor. From the medical side (and this could be a few bad apples spoiling the bunch) there was an overhanging aire of this being a control issue designed to get the best and brightest novice NPs to become established in a model of physician leadership. This went so far as to included discussion about presenting to the state BOM and BON with the goal of the BOM taking full control over NP practice.

    I once asked in a meeting if the hospital admins planned to hire these "post-residency" NPs and they said "of course", but when I asked if they would be paid the same as a new physician after residency they literally laughed (at this time, the new MDs were making about 3x what new NPs were in the hospital).
    Last edit by BostonFNP on Jan 15 : Reason: fixed some gramma'
  8. by   Jules A
    Quote from BostonFNP
    I worked on a project for establishing an NP residency at a local tertiary center (in which NPs would work directly alongside the medical residents). In the beginning I thought it was a great idea: excellent/establish formalized clinical training, a way for novice NPs to get real world experience, and adding legitimacy to NP practice overall. By the end of it, I had a whole new array of concerns. I think my biggest flaw from the beginning was assuming there was no downside.

    As I worked with the medical staff, admins, and academic on the project I started to develop some additional concerns about the motivations for establishing this program in the first place. It seemed from an academic side the motivation was to use the program as a selling point for their NP program; this I can understand. It seemed from the hospital admin side this was essentially a program to produce cheap labor; they were struggling with the residency hour cap changes and they were looking to replace that coverage with other cheap labor. From the medical side (and this could be a few bad apples spoiling the bunch) there was this overhang aire of this being a control issue designed to get the best and brightest novice NPs to become established in a model of physician leadership, including discussions about presenting to the state BOM and BON with the goal to have the BOM have full control over NP practice.

    I once asked in a meeting if the hospital admins planned to hire these "post-residency" NPs and they said of course, but when I asked if they would be paid the same as a new physician after residency they literally laughed (at this time, the new MDs were making about 3x what new NPs were in the hospital).
    Very interesting, thank you for sharing. I'm not sure I see the downsides as downsides. Even the BOM attempting to take over NPs, which will never happen, might not be a bad thing as far as aligning us with MDs. What I appreciate is not only the additional education for NPs but also bringing them in on par with residents. I wonder if a NP liaison or project overseer like it sounded you might be would have been able to corral the experience to avoid the NPs being pushed into a subservient position.

    You seriously didn't think they would pay NPs the same as physicians did you? I agree 100% that if they are only paying 1/3 that is egregious but even with as bottom-line oriented as I am, I have been very content making 2/3 of what the top earning psychiatrists in my area.

    I do have to wonder why NPs would stand for that, although suspect is it similar with what we see from one of the highbrow hospital-university systems in Baltimore. Some are deluded that their good name on your resume is payment enough.
  9. by   Tony1790
    Quote from Oldmahubbard
    If there is any way you can swing it financially, I would recommend it.
    I can definitely swing it, I'm currently doing a practice run, trying to live on my military retirement income, I almost can do it, but not quite, so I've been pocketing almost 100% of my take home check at my actual job, once I save up enough to pay cash for a house (goal of Dec 2018), then I could literally retire.
  10. by   Tony1790
    Quote from BostonFNP
    I think my biggest flaw from the beginning was assuming there was no downside.

    included discussion about presenting to the state BOM and BON with the goal of the BOM taking full control over NP practice.

    I once asked in a meeting if the hospital admins planned to hire these "post-residency" NPs and they said "of course", but when I asked if they would be paid the same as a new physician after residency they literally laughed (at this time, the new MDs were making about 3x what new NPs were in the hospital).
    Thanks for the reply, great info.

    There's always a downside (pro/con) to everything.

    As to the BON becoming subservient to the BOM, that's the case in some states currently, I was licenses in NC, but I could only have an active license if I had an MD that was over me, so If I didn't have an MD supervisor, then I was not able to have an active license, weird, that puts you in the position of having to find a job w/o a license, and then have the MD tell the BON that it is ok for you to have a license, and once I left the NC job, the MD promptly let the BON know that I was no longer employed there, therefore my license was no longer valid. Currently I'm licensed in TN, but working in a federal facility in WA, so I couldn't transfer my DEA card to my current employer, because the DEA card is dependent on your state rules. I now have a fee exempt DEA card to use here in WA but only valid on federal property.
  11. by   TuxnadoDO
    I think that you are mistaken about the nature of the programs you are talking about. Do you have a link to any of these programs? MD/DO fellowships require prior completion of specific ACGME or AOGME-accredited residency programs. GI fellowship, for example, is a highly competitive 3-year program that requires prior completion of a 3-year internal medicine residency. People usually apply during the last year of their residency program.

    I think the programs you're talking about are specific one-year post graduate programs for APP's. More education is a great idea! While the program wouldn't give you totally equivalent training to a physician who did a residency/fellowship in that field, it seems definitely worthwhile. I'm all for more training and more education! During my residency program, there was a PA completing a 1 year post-grad program that we had for APP's (I don't know what they called it). She came to our grand rounds every week and got the same didactics those days, but her work schedule and training curriculum was totally separate from ours. We weren't in the "same" program and didn't really work alongside one another. I remember her saying she thought the program was very helpful and she felt much more prepared by the end of it.
    Last edit by TuxnadoDO on Jun 12 : Reason: Clarifying
  12. by   Neuro Guy NP
    DEFINITELY do it!! I did one in neurocrit /neuroendovascular surgery. Initially was going to be one year, but we agreed to redo the program and I ended up completing 21 months of fellowship training. And let me tell you it has made a world of difference,anything from the ability to handle and read neuroimaging, decision making, procedures, everything. It has also afforded me much higher salary given this training (I've been out of training a little more than a year now and just started a new clinical job aside from teaching).

    So long story short, if you can afford to put up with the lower salary (it's the same as a PGY-2 generally) the absolutely do it! It's worth the while as long as you make sure the program is quality.
  13. by   babyNP.
    My hospital system is doing something similar to this. As I recall, PNPs spend a few weeks to a month in each specialty area in pediatrics (these are acute care PNPs) and then decide/interview on a specialty. I'm not sure how pay structure works but I think they they get paid the same as they normally would on our pay scale. I believe the idea behind this is that the hospital recognizes that it needs PNPs to help staff its own and is willing to invest the $$ to make sure the training/mentoring is up to snuff. I met one of the surgical PNPs who does exclusive nights (gets paid a premium to dot his) to help offload some of the surgical MD resident workload.

    There is also a year long PA new graduate fellowship program. Their structure is a bit different- they get paid less than they would but if they complete the program and get hired, they get a bonus that I think helps makes up for the year long shortfall.
  14. by   juan de la cruz
    NP's are nurses and for that reason, our training programs will never be structured under the guidance of established physician training programs. Post-graduate training programs for NP's have adopted the word "fellowship" to refer to any type of structured educational offering fresh NP grads can avail of in order to sub-specialize or fill-in educational gaps not offered in any of the Consensus Model based tracks (FNP, AGPCNP, AGACNP, WHNP, NNP, PNP-AC, and PNP-PC).

    In my opinion, it doesn't make sense to have a fellowship program in General Psych for grads of PMHNP programs because that should already be the focus of PMHNP programs. However, a fellowship program in Psych may sell itself as having a focus on Psychotherapy training for instance which does add a layer of skill and specialization not offered as an intensive to the PMHNP track.

    I've also seen Primary Care fellowships for new FNP's and AGPCNP's and again, I feel that Primary Care is already the focus of those programs so I'm not sold on having another year of fellowships for the same skills that the NP training program should have already prepared the new provider for. However, some graduates do feel a need to have additional exposure to the same field in order to gain confidence as providers especially in some job markets where new grad on-the-job training does not exist and new NP's are expected to hit the ground running when they land their first job.

    I happen to work for an Academic Medical Center that offers a fellowship program for new AGACNP's in Critical Care and Surgery and I'm designated as one of the Preceptors for the Critical Care portions of the training. It is an additional layer of intensive training that AGACNP's don't all get in their program. Yes, the pay is much lower than the rate for NP's in the medical center, however, the position is not listed under the medical center but rather the School of Nursing which was able to secure funding for the program.

    Is it fair? maybe, maybe not. That fellow is a board certified NP and fully credentialed by the medical center to write orders, write notes, and perform procedures under supervision initially just like a new NP would be. Even with full university benefits, that does sound like cheap labor. But then it's also a two-way street because we are offering a service to the fellow and making sure they have structured rotations in various Critical Care and Surgical settings with seasoned NP's and physicians throughout the fellowship year.

    We've graduated 4 fellows since we started this program and all 4 have worked for us in various Critical Care and Surgical Specialties where their job applications were given priority over outside applicants. Typically, we get numerous resumes submitted when we have openings and they were considered before anyone else. In the end, I think it's a win win for both fellow and the medical center. Our program is currently applying for accreditation with ANCC which has become the equivalent of ACGME for nurses in terms of post-graduate training programs for nurses.

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