Value of Post-grad Fellowship

Specialties NP

Published

Is there value in doing a post-grad fellowship or residency? Let me expound, I see obvious benefit as far as knowledge expansion and skill enhancement. But I have just started reading about more of these begin available for NP's and PA's yet have not spoken to anyone who has completed one.

For example the Carilion Clinic in Virginia offers an Emergency Medicine fellowship for NP's https://www.carilionclinic.org/emergency-department/fellowship

Would completion make the post-grad a much more desirable candidate? Would there be a salary increase? Certainly scope of practice or role in the care team would be the same regardless. There are 20 some other's in multiple specialties that I read about. Some very specialized such as Hepatology.

Thoughts?

Just getting back here. So much good information and thoughts from everyone. I love the idea of a fellowship. It is unfortunate there are only about 30-35 that I have been able to find. I believe, like everyone else, that the training, experience, knowledge and confidence gained would make a tremendous difference moving forward into practice. The lack of fellowships offered and their geographic locations makes it a double edged sword… Completing one may not be the easiest thing to accomplish but those who do would really be set apart from their new grad peers.

Carlton, good info on Carillion.

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Specializes in Family and Psychiatric Nurse Practitioner.

Do yourself a HUGE, HUGE favor... forget about obsessing over a "residency" or "fellowship" for NPs. They largely don't exist, and many, many of them are questionable at best. Many of them are also focused on specialty care. Unless you are going to do a fellowship with a very big name (think Mayo Clinic or Mass Gen or Sloan Kettering, for example), there really is little value in many of the so-called fellowships for NPs. If you are interested in a specialty such as oncology, a good fellowship may be of some value. However, whether in a specialty or generalist "fellowship", you have no guarantee whatsoever that you will actually be in a learning, fostering environment. Many NPs and PAs in "fellowships" find themselves in situations in which they are learning very little, or learning too specialized a field, particularly as a new grad. You may even find yourself in a situation in which you are taken advantage of...cheap labor, with unrealistic expectations, all with the moniker of being a "fellow," meaning you'll take lower pay than your colleagues in non-fellowship positions. And, unfortunately, I have met and worked with some NPs who've been through specialized fellowships, and was less than impressed with their overall knowledge base outside of the very limited world in which they worked. As NPs, we just don't get enough education to jump right into a specialty, unless you don't particularly care if you have a solid medical/nursing foundation (like what to Rx for specific infections or how to start antihypertensives, etc., while waiting to ship the patient to yet another specialist... not to mention, knowing when emergent care is needed... those can be difficult calls to make your first year in practice.)

The best advice that I can give, from my experience and those I've known and met, is to find a position with a good collaborating physician, and request working directly with that physician for x number of hours (you can decide how much you think you need). (In Ohio, we have a minimum of 500 hours required working directly with a physician.) Even if you live in a state without the requirement of a collaborative agreement and/or "externship" hours, consider your first job as a learning experience or residency of a sort, regardless of the position or environment or specialty. As a new NP, you need a great mentor. Make sure you have clear expectations as to the physician's support to be provided to you, number of direct supervision hours, etc., and make darn sure you trust and respect his or her expertise and judgement. Knowing the reputation of the provider is important as well.

Another key to success in the first year is using your resources constantly and consistently while working, read voraciously, and give some of your income back into professional organizations and continuing education. I highly recommend AANP and AAFP (the journal only, as an "allied health professional"), and any specialty organizations as you wish.

A final word of advice is to think more generally for your first job, depending on your certification. As an FNP or ANP (outpatient), regardless of whether you want to eventually work in specialty, having the experience of working a generalist or family practice/internist position is highly useful. I treat extraordinarily sick patients in an outpatient setting, and regardless of whether or not I go into a specialty later, knowing how to manage uncontrolled hypertension/DMT2/med noncompliance/mental health disorders/etc. is extremely useful. For example, if you want to go into oncology, having experience managing CKD and ESRD patients is quite useful. And, if you want to go into acute care as an NP, having the work experience as an RN is, IMHO, absolutely necessary.

Don't obsess (like I did as I was finishing my program) over trying to find a fellowship. You're just looking for a title, without a guarantee of a true learning experience. Focus on the job, collaboration, and benefits, as well as intellectual/emotional investment into yourself, and you will be fine! Experience is experience, and very few employers care whether or not, as an NP, you had a "fellowship" or "internship." Get a great job with lots of support for a new grad, and make your own fellowship. =) Good luck!

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Specializes in Vascular Neurology and Neurocritical Care.
Do yourself a HUGE, HUGE favor... forget about obsessing over a "residency" or "fellowship" for NPs. They largely don't exist, and many, many of them are questionable at best. Many of them are also focused on specialty care. Unless you are going to do a fellowship with a very big name (think Mayo Clinic or Mass Gen or Sloan Kettering, for example), there really is little value in many of the so-called fellowships for NPs. If you are interested in a specialty such as oncology, a good fellowship may be of some value. However, whether in a specialty or generalist "fellowship", you have no guarantee whatsoever that you will actually be in a learning, fostering environment. Many NPs and PAs in "fellowships" find themselves in situations in which they are learning very little, or learning too specialized a field, particularly as a new grad. You may even find yourself in a situation in which you are taken advantage of...cheap labor, with unrealistic expectations, all with the moniker of being a "fellow," meaning you'll take lower pay than your colleagues in non-fellowship positions. And, unfortunately, I have met and worked with some NPs who've been through specialized fellowships, and was less than impressed with their overall knowledge base outside of the very limited world in which they worked. As NPs, we just don't get enough education to jump right into a specialty, unless you don't particularly care if you have a solid medical/nursing foundation (like what to Rx for specific infections or how to start antihypertensives, etc., while waiting to ship the patient to yet another specialist... not to mention, knowing when emergent care is needed... those can be difficult calls to make your first year in practice.)

The best advice that I can give, from my experience and those I've known and met, is to find a position with a good collaborating physician, and request working directly with that physician for x number of hours (you can decide how much you think you need). (In Ohio, we have a minimum of 500 hours required working directly with a physician.) Even if you live in a state without the requirement of a collaborative agreement and/or "externship" hours, consider your first job as a learning experience or residency of a sort, regardless of the position or environment or specialty. As a new NP, you need a great mentor. Make sure you have clear expectations as to the physician's support to be provided to you, number of direct supervision hours, etc., and make darn sure you trust and respect his or her expertise and judgement. Knowing the reputation of the provider is important as well.

Another key to success in the first year is using your resources constantly and consistently while working, read voraciously, and give some of your income back into professional organizations and continuing education. I highly recommend AANP and AAFP (the journal only, as an "allied health professional"), and any specialty organizations as you wish.

A final word of advice is to think more generally for your first job, depending on your certification. As an FNP or ANP (outpatient), regardless of whether you want to eventually work in specialty, having the experience of working a generalist or family practice/internist position is highly useful. I treat extraordinarily sick patients in an outpatient setting, and regardless of whether or not I go into a specialty later, knowing how to manage uncontrolled hypertension/DMT2/med noncompliance/mental health disorders/etc. is extremely useful. For example, if you want to go into oncology, having experience managing CKD and ESRD patients is quite useful. And, if you want to go into acute care as an NP, having the work experience as an RN is, IMHO, absolutely necessary.

Don't obsess (like I did as I was finishing my program) over trying to find a fellowship. You're just looking for a title, without a guarantee of a true learning experience. Focus on the job, collaboration, and benefits, as well as intellectual/emotional investment into yourself, and you will be fine! Experience is experience, and very few employers care whether or not, as an NP, you had a "fellowship" or "internship." Get a great job with lots of support for a new grad, and make your own fellowship. =) Good luck!

Some good points are mentioned here, thigh i disagree with others. Fellowships or residencies can still be very valuable. I am in one myself

In fact my side job as a rapid response NP felt that my residency training could complement me well in their rule and they were impressed by the curriculum laid out for me in the residency. My advice is to seek it well established residency programs at reputable institutions.

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