 a good fellowship, I think, beats a year of experience. Some fellowships are just straight up money grabs. I'm just going to be honest. They pay you way less than a PA working in that specialty, even a new PA working in that specialty. A lot of the more desirable, more high paying position assistant, inter-practitioner fields like emergency medicine, dermatology, trauma, surgery, I've seen certain cases of surgery, and also like urgent care, the one that I'm completing right now, those kinds of fields tend to have some fellowships. Helping others is a calling. It's not a job. Like fellowships after PA school, right? I don't know if it's something you're considering. Oh man, I am, I looked into it because I really want to get into trauma and I know there's trauma fellowships, but I've been hearing a lot of mixed reviews from everyone. A lot of people at my old work, a lot of PA said like they don't really appreciate it because they think you're getting shipped out of your money. But some people like saw, I recently saw a graduate panel with PA, so they graduated from my program and they said that, oh yeah, we love fellowships. For me personally, having a little one and a wife that I'm going to have to take care of when she's in med school, I don't know if I can afford a fellowship because we have so much loans from undergrad. So in an ideal world, if I didn't have my son, if I didn't have my wife depending on me, yeah, I would consider a fellowship. But my plan is just to really kick butt in my trauma rotations and hopefully land a job because from what I hear, fellowships, yes, are more structured, but you get paid a lot less, right? Yeah. Well, the answer as always is it depends, but not every fellowship is created equally. So some fellowships are just straight up money grabs, I'm just going to be honest. They pay you way less than a PA working in that specialty, even a new PA working in that specialty would have, and they might make it sort of seem like it's worthwhile by giving you some didactic stuff, some extra training, some NYC, but basically you're a licensed physician assistant, you have to be, or a nurse practitioner to even get into this fellowship. So they're getting work out of you, you're billing, you're working as a PA, they might even be getting a ton of hours out of you, and they're giving you extra work, so it's some didactic and they might give you a certificate at the end, and then you may or may not be guaranteed or be more competitive for a job after that fellowship in that particular field. So a lot of them legitimately are just money grabs and they're just like getting all this work out of you, making tons and tons of money off your license and paying you very little and at the end of which all you get as a fellowship on your resume, but some of them are excellent. So the best way to kind of distinguish the two is to ask people who have been through them. Do you feel like this was worth it? And also your own situation, the ideal situation for someone like Elijah who wants to work in trauma, at least right now, is get a job in trauma and learn on the job and get paid way more than he would in fellowship and not have all the structured didactic stuff. He can just look stuff up that he's interested in or that he needs to know as you go along. So that would be the ideal situation. If that ideal situation is not possible, a fellowship, especially one with a good reputation would be a good second choice. Does that make sense? Yeah. So you could do that. I've noticed that a lot of the like more desirable, more high paying position assistant and practitioner fields like emergency medicine, dermatology, trauma, and then I've even seen some other ones like surgery. I've seen certain cases three and also like urgent care, the one that I'm completing right now. Those kinds of fields tend to have some fellowships. Like I said, they're not all created equal. Some are very much worth it and you'll be very glad you did it. Some are just basically a money grab and you're not any better off. So yeah, it's nuanced. It's complicated, but see if it works for you and if it's a good fellowship with a good reputation. I think the hospital that's affiliated with my school has like you said in their ER, they have like a fellowship for advanced practice providers and I was actually, I was looking into it with my classmate because I sat on his screen and he was sitting right next to me. I was like, Oh, are you going to do that? He's like, yeah, I'm thinking about it. I looked up and actually the pay for that one wasn't too bad. It was like $80,000 or $90,000 and I was like, wow, that's pretty good for a fellowship. What are the hours though? That I don't know. They didn't disclose that online. That's the thing is what are the hours? Because it's like, I mean, medical fellowships, like not fellowships, like residents in medicine after medical school, they get like 40 to 60, maybe even 70,000 a year, which isn't terrible. But when you, that they work 120 hours, it's like, well now I'm making less than a Taco Bell employee per hour. So it's like, you know, just make sure you get a whole picture of what you actually get done. Ideally, the ideal fellowship and there are really good ones out there in that one year and PA school fellowships are one year or not PA school physician assistant nurse practitioner fellowships are one year. In that one year, you get way more experience ideally than you would as just a new employee in that field. That's the whole reason to do it, you know, and then you're just way more competitive because then you have that fellowship on your resume, but also on your resume, you can have did this many of these procedures, saw patients per day with this kind of like level of satisfaction, NPS, whatever, recommendation letters, relationships with physicians and physician assistants, like you can get a lot out of a fellowship that you may not out of just being an employee ideally. And from my understanding, you don't have to work at that same hospital, right? Like you could use that fellowship and apply to a different job afterwards. Yeah, I don't think they can force you to take a contract, you know, as a not an attending, but as an actual physician assistant, they can't force you. No, it's just a fellowship at standalone. They definitely get their money out of you. They get a lot of labor out of you, but you can definitely take your talents and your fellowship education and go elsewhere. I definitely see how that could play an important factor in getting hired to like having that fellowship versus someone who's a new grad who doesn't have any experience in that specialty, especially if you want to specialize in something, right? Like if you want to be strictly emergency medicine and you want to do a fellowship like that, it looks good on the resume for when you actually apply for a job or if you want to stay at that job, if they hire you. Very much so. That's why I was saying, ideally, you get way more experience in that fellowship and you're much more competitive. So like, let's say, first off, ER jobs straight out of PA school are pretty tough to find, especially in like bigger, more desirable cities. So let's say you end up getting one and they keep you on the fast track and they have the physicians doing the actual ER stuff. So you spend a year before you know what a year goes by and all you've done is fast track. So it essentially works urgent care. You've never done one chest tube. You haven't resuscitated anyone. You haven't really put in like a trach or what do you call it? You haven't intubated anybody. You haven't done anything crazy. ER, you've just basically been treating sniffles and broken ankles and then sending them to the ER if it's anything serious. So you've essentially been working urgent care, not ER. However, in this fellowship, they probably have checkboxes for you. You have to do a chest tube or five chest tubes. You have to do X, Y, and Z. You have to do certain type of lacerations, small to big. You have to do all this stuff to complete the fellowship and then you can show on your resume, I've done all this stuff. Whereas someone who hasn't a year of ER experience, but hasn't done really anything except for just very low level stuff, you both have a year of ER experience, but you having completed the fellowship stuff that they promised experience that you would get are vastly more competitive or an ER position than even someone who's worked in the ER, but didn't get all those checkboxes. That makes sense. So if you find a fellowship and you get through it and you've done all this stuff that they promised to teach you, that's very, very good. Even if you happen to get paid less for that one year. I didn't realize that. I know that PAs and the ER do work fast track where the main ED, but I didn't realize that the fellowship would probably give you an edge because you're more well-rounded in the trade aspect. Yeah. It's a good fellowship and they actually deliver what they promised to deliver. Yeah. 100%. Right. Because you could just get a fellowship, but then they did still sticky on the fast track, right? Yeah. Let's say you're doing an emergency medicine fellowship and they're advertising, like you'll be able to do all this stuff by the end of it and you're a quarter of the way through or halfway through and you're like, your guys are just literally using me as a fast track person and not doing anything. You can quit that fellowship. You don't have to. It's just another job. They can't force you to work the rest of the fellowship. No, you won't get your certificate, but who cares? You're still a PA. That's true. This isn't working out. Thanks for my little bit of experience you gave me and my little paychecks and okay, I'm out of here. I'm going to do something else. They can't keep you on the fellowship and you don't need it. You're not like a physician who stuck because they need their residency and their fellowship to do what they want. You're a physician assistant. You can do whatever the heck you want. That's also why physician assistant fellowship pay is a lot higher than MD than doctor fellowship and residency pay because you can do whatever you want as a PA. You can still get a job making 90, 100, 120, 150K a year. You don't need this fellowship. You're choosing to do it. That's another thing. You're not stuck if the fellowship sucks. At the end of the day, if there was a trauma fellowship that came across my plate and I felt like at the time I wasn't ready yet or if I still had some doubts, I definitely would take it. That's just my opinion, I guess, as a student that I wouldn't do one now, but it depends on how things progress, how my education progresses. In the future, I may be like, oh, I definitely don't feel ready. I would prefer to do a fellowship. I never know. Yeah. It's more experience. It's more experience per month or year of practice in a structured training program. If it's a good one, then you would get just figuring it out and being sent into the wild as an employee. Perfect example. Let's compare me to somebody I know in my APA school class who started in ER. Let's call her, I don't know, pick a female name, Elijah. I'm not going to use the person's real name. Oh, god. Kelly? I guess that's a good one. I don't think we had a single Kelly, so that's a good name. All right. So me and Kelly, I know this person, I don't know what she's doing now, but she got a job at the emergency room here locally. Right out of PA school, it was her first job. I got a job in primary care and then moved on to this urgent care fellowship that I'm doing now. But let's just say I started doing the urgent care fellowship right out of PA school. Right. So comparing apples to apples, Mary or what's her name? Kelly. Kelly got a job at the emergency room and she's just an emergency room employee. They're using her as much as they can to make money and to see their patients and to do what's best for the ER. I got this urgent care fellowship and they are training me to be the best urgent care PA that I can be to hopefully work with this company or any urgent care. So Kelly goes to work and they're like, all right, what do you know, Kelly? She's like, well, I'm a new grad. They're like, do you know how to treat stuffy noses? Because that's all we can trust you to do right now. And she's like, yeah, I can treat some stuffy noses. So for like weeks and weeks, all she's doing is like, oh, stuffy noses. Okay, this is boring. Give it to Kelly. So all Kelly's doing for weeks is like stuffy noses. And then she might see some other stuff come through. And if she's got spare time, she can ask another provider like, oh, okay, can I sit in on that one? And then after a little while, they're like, all right, Kelly, you want to handle this one? And, you know, we'll look over your shoulder if we have time. And now she's doing not just stuffy noses, now she's doing like small lacerations, little one, two, three stitch lacerations. So now Kelly's getting a little bit of experience as she goes along. And, you know, if she's hungry and she wants to learn more and she makes of it what she does, Kelly eventually after a year, you know, sporadically gets little by little by little, more and more experience and is now vastly more knowledgeable and experienced and trustworthy than she was a year ago. Okay, but that's because she makes of it what she did. I have a legitimate curriculum that I have to complete. I have to see X, Y, and X number of these things. I have to do Y number of these things. And I have supervisors and experienced providers working with me hand in hand, at least in the early parts of the fellowship, especially the first few months, making absolute damn sure that I prevent, that I present every single case to them. They tell me what I could have done better. And it's like feedback constantly, constantly feedback. Some people are very nice about it. Some people are super mean about it. Some people are like, Oh, well, yeah, it's your choice. It's your license. But you know, I would probably do this. And some people are like, no, you're stupid, you should do that. But either way, it's constant feedback, constant feedback, and constantly just like learning, learning, learning and checking off boxes because I have to complete the fellowship. So mine is more structured. By the end of the year, I guarantee know these, you know, number of things and probably more. Whereas Kelly may or may not guarantee know a certain number of things. Like piecemeal learns more and more, but they're basically using her and learning is secondary. Whereas for me, learning is primary. So a good fellowship, I think, beats a year of experience. But it's not always like that. Well, I had no idea about this perspective. That definitely like makes me think about it a lot more. Yeah. Yeah. If you are sure that you like that field, or at least you're curious about it, and like you're not just that extra couple of $10,000 is gonna just make or break you for a year. I mean, obviously more training, more like guaranteed experience with experienced providers having to train you is worth a lot, I would say. I might consider it. I'll have to talk with the wife about it. Well, I mean, talk to some people who went through the fellowship first. You know, if they feel like they got a lot out of it, and more people are saying good things than the not, and you're sure that's what you want, I would say certainly go for it. I feel like the more common ones I do see are like what you said earlier, like ER fellowships. I feel like that's just a college game. Yeah. Dermatology, I feel like a lot of them aren't official fellowships, but like dermatology is kind of notorious for paying PAs very little at first, knowing that once they ramp up and get that client base, and if they like it, then they can make those insane paychecks 250,000 a year if they're like hustlers and they're good at dermatology. But at first, they kind of pay very little because you don't have that experience in client base. Which makes sense. Yeah, a little bit. I mean, it's kind of screwed up because you can literally just like treat sore throats and stuffy noses for 90K a year, or 100K a year, or 120K a year, but here you are doing dermatology with a very steep learning curve for like 70K a year and you're like, what the heck, the nurse is making more than me. But a year later, if you really hustle, then you're making like 180 and you're like, okay, this is okay. Oh, is that our ceiling? Like around that number? Oh, no, that's not the ceiling. I don't know. I mean, I don't have good numbers, but I know dermatology people can make insane money, like 300. What? Yeah. Dermatology PAs, if they work a lot, they do a lot of billable hours and they're good and they're fast and efficient and they have a lot of clients. Dude, insane money. Oh, wow. Insane. But I know that a lot of their contracts are kind of like commission based.