# The big question is...MD/DO, PA or NP?



## Handsome Robb (Dec 14, 2013)

I've been doing quite a bit of thinking and I'm pretty sure that I have come to the conclusion that I want to go further.

Background behind me: I'm 24 years old, single, no kids. 

I love my job, I don't want that ever to be called into question. If something drastic changed (read: tiered system third service, station based with guidelines rather than protocols and a livable salary) I'll gladly spend my days as a medic. I want more than ever to fly rotorwing for a while as well. Fixed wing would be cool too.

Ultimately, if EMS doesn't progress and continues to stagnate I refuse to sit on street corners for the rest of my life.

Now the real question is MD/DO, PA or NP?

I'm leaning towards PA. I'd love to be a PA in a surgical environment. Maybe Ortho. 

I don't know if I would be happy working as a nurse. The only way I think it could have a chance would be PICU, ER, CVICU, or TICU. I don't want to go into primary care though which seems like where NP is going...CRNA is pretty tempting.

Finally, med school. If I did it I'd be inclined to either do CC, EM or maybe a surgery specialty of some type. I really like trauma but that seems like it is going to the wayside.

What are your thoughts?

I'm getting ready to start my general education because either way I'm going to have to finish my BS.


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## VFlutter (Dec 14, 2013)

I am right there with you. It is a tough decision to make. 

I think I may end up going PA and specializing in critcal care. Or waiting a few years and going CRNA or ACNP. General NP does not appeal to me. 

Medical school is still very tempting but I am a little discouraged that many of the MDs I work with tell me that if they had to do it all again they are not sure they would. Nor would they encourage their kids to follow their footsteps. 

If I do decide to go CRNA it will likely be through the Army.


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## Handsome Robb (Dec 14, 2013)

I always forget about ACNP. That's definitely something is be interested in as well. Again, doesn't seem like they're utilized much though...

I will say nursing does open up the flight careers a little better so that's tempting but as a PA I can keep my medic valid and work PRN flight if I wanted to. As an MD/DO that option goes out the window unless you get with a program that flys docs.

If I went the med school route I'd be very interested in being an EMS Medical Director. Be the one that shows up on scenes, helps out crews and what not.


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## STXmedic (Dec 14, 2013)

PA in Critical Care has always stood out as somewhere I would like to be. I hate that it's essentially a shortcut into being where I'd really want to be (MD in CC/Pulm), but it seems a lot more feasible right now.


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## STXmedic (Dec 14, 2013)

Robb said:


> If I went the med school route I'd be very interested in being an EMS Medical Director. Be the one that shows up on scenes, helps out crews and what not.


I couldn't be a medical director... Knowing how the majority of medics are, I would take away _everything_. As much as I hate that protocols tend to be tailored to the lowest common denominator, I completely understand why the medical directors do so.


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## DesertMedic66 (Dec 14, 2013)

STXmedic said:


> I couldn't be a medical director... Knowing how the majority of medics are, I would take away _everything_. As much as I hate that protocols tend to be tailored to the lowest common denominator, I completely understand why the medical directors do so.



But you could change the standards and re-educate the sub standard providers.


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## VFlutter (Dec 14, 2013)

Robb said:


> I always forget about ACNP. That's definitely something is be interested in as well. Again, doesn't seem like they're utilized much though...



Around here ACNPs are common in ICUs are pretty much utilized the same as Critical Care PAs. Our CVICU is staffed with all ACNPs and MDs. Most of them even assist in surgical procedures and scrub in on CABGs. We also have a couple ACNPs that work with our EP docs and assist with pacemakers and EP studies. I would say that PAs are still more common in my hospital. Our CC department will hire ACNPs but not NPs. So far it is all PAs.


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## STXmedic (Dec 14, 2013)

DesertEMT66 said:


> But you could change the standards and re-educate the sub standard providers.



It depends on where you work. I couldn't do that where I currently work. Between the already engrained mentality, the budget, the politics, and the Union, it is very unlikely to make any significant change. Our last MD (who recently stepped down) tried relentlessly to make changes and make a stand-out EMS system. He was constantly derailed by the aforementioned barriers. While we're much better than before he got there, once a certain point was reached most improvement was brought into a stalemate.

I think where the best luck would be at would be somewhere in a medium-sized (or smaller) non-fire department that has a decent budget; somewhere like Williamson County, or Wake and its surrounding counties. The larger departments have so many barriers that it makes even the smallest change an uphill battle. I would much rather focus my time on doing what I will have gone through medical school for- practicing medicine.


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## Chris07 (Dec 14, 2013)

How much are you willing to invest?

Medical School is the most expensive in terms of money and more importantly time. Do you have an undergraduate degree? If you decided to go to medical school and you haven't done your sciences yet or even have a bachelors, your going to have about 3-4 years just to begin the process in either direction.
As a doctor you have your own license and are at the top of the food chain, but at the same time, you have to remember "mo' money...mo' problems". 

I considered PA myself but decided that medical school was what I really wanted. I really wanted to have my own license and decision making power without having to work "under" someone. I'm sort of the "Go big or go home" type person


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## MrJones (Dec 14, 2013)

My thoughts? I think that EMS will never progress as long as the good ones continue to bail out rather than do the hard work of driving change from within the system.

Remember - you asked.


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## Handsome Robb (Dec 15, 2013)

MrJones said:


> My thoughts? I think that EMS will never progress as long as the good ones continue to bail out rather than do the hard work of driving change from within the system.
> 
> Remember - you asked.



I did ask and I appreciate your opinion. 

If I'm interpreting what you said correctly I answer with; I don't know what to do to push to get those changes. I've got no idea where to even start.


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## Wheel (Dec 15, 2013)

Robb said:


> I did ask and I appreciate your opinion.
> 
> If I'm interpreting what you said correctly I answer with; I don't know what to do to push to get those changes. I've got no idea where to even start.



I'm having this problem as well.


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## Anonymous (Dec 15, 2013)

I would suggest shadowing PAs in a surgical environment, especially ortho. From my experience most of them are not happy with where they are at and are having similar feelings to what your experiencing now.


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## MrJones (Dec 15, 2013)

Robb said:


> I did ask and I appreciate your opinion.
> 
> If I'm interpreting what you said correctly I answer with; I don't know what to do to push to get those changes. I've got no idea where to even start.



You did interpret correctly, and I'll answer your answer by suggesting that you strive for supervisory responsibilities, and use that platform to push for positive change in your organization (the journey of a thousand steps and all). You develop a reputation as an EMS advocate through participation in, and accepting leadership roles in, organizations that, with the right people involved, could actually do something to improve our lot in life (I'm talking to you, NAEMT ). You become known as someone who should be listened to by writing for industry publications and making presentations at industry events. You become an instructor and help mold the EMTs and Paramedics who are our future. You network with like-minded individuals nation-wide.

In other words, you start by becoming more than just being an outstanding medic on the street. It's not always easy, it's not always fun, it doesn't happen overnight and it doesn't guarantee success, but that's how we will drive change in our industry


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## Carlos Danger (Dec 15, 2013)

Just about every paramedic I've ever known had to ask himself this same question at some point, usually pretty early in his career.

When I reached this juncture it was a fairly easy decision, because at that point I never planned on doing anything other than fly, and perhaps work part time in an ED or ICU. However, at that time and even at points after, I also considered RRT, PA, and MD/DO.

I ended up doing nursing obviously, and I couldn't be happier with my career choice. Even though I personally didn't like bedside nursing much (but many people who don't expect to like it find that they do), to me the advantages of a nursing career far outweigh the disadvantages. I've had a great career as a flight nurse, learned and experienced a ton in some high-acuity ICU's, and am now really enjoying anesthesia school and looking forward to the many options that await me when I graduate. One of the cool things about nursing is that you can go right through AAS-->BSN-->NP or CNS with no break in full-time employment. You can go on to midlevel practice (NP/CNS), administration, teaching (either nursing or paramedicine, or both), or bedside. You can work as a CCT or flight nurse, and generally make significantly more $$ than your flight paramedic colleagues. You can work 8-5 in an office or 12 hour shifts in a hospital. You can easily stay involved in EMS. No healthcare career path offers you more "bang for the buck" or more flexibility than nursing, IMO.

PA/NP. For all practical purposes, these two are synonymous and interchangeable, with the main difference just being the path you take to get there. Obviously PA school is modeled more like medical school whereas NP school is set up as kind of an "add-on" to your basic nursing experience and education. So they are very different educational models but both pathways are intended to produce generalists who rely primarily on OJT to learn their specialty, though fellowships are popping up here and there. NP school is relatively easy to do while you are working full time; I think most PA programs are not. If you know you want to do midlevel practice then go straight to PA school. If you'd like to do as much of your schooling as you can while working full time and don't mind taking a more circuitous career path (say, ASN --> ICU/BSN --> HEMS --> NP) in order to have some other experiences along the way, then that's a great option....it's pretty much what I did. The future looks very, very good for both NP's and PA's.

MD/DO. These guys are obviously at the top of the healthcare food chain. The investment of time and money to get there far outstrips the other options. However, to me the career satisfaction does not seem commensurate to the investment. Competition to get into the "good" specialties is pretty intense and it is very hard to change specialties once you are fully qualified. I've heard quite a few MD's say if they had it to do over again, they wouldn't. There was a large survey of physicians done a year or so ago where *90%* said they would not recommend a career in medicine. Docs take the brunt of the politics and production pressure and ongoing billing and reimbursement fiascos and probably will face more challenges than other clinicians with all the coming changes in healthcare. I view medicine as more of a "lifestyle" vs. just a career. Obviously it's not all doom and gloom, of course; many docs have incredible jobs that you just can't do without MD or DO behind your name, and many love what they do. Neurointerventionalist? Sign me the hell up! For a young person who loves medicine and has no commitments holding them back, I'd say go for it, if it's what you want to do. You just need to be fully committed, which I've personally never wanted to do for any career.


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## ExpatMedic0 (Dec 15, 2013)

In addition to chatting with us, I would recommend  chatting with some folks on the PA forum  www.physicianassistantforum.com/

I think DO and MD are the best choice,  but its not always possible for people to dedicate the time and money(and lets face it, ambition) to those programs. With your age and family status its still feasible and worthy of further investigation for sure. 

In addition to that there are non-clinical higher degrees at the masters and PhD level which allow you to remain in EMS in research, professor at a university degree program, and policy making, to name a few. IMO it is those pathways which will change EMS, but there not as appealing or exciting as choosing a clinical path(PA,MD) for many who ended up in EMS in the first place. Flying a desk with a PhD and tie will save more lives over time than flying rotor wing wearing a nomex suit and BCCTPC merit badge. Its just not as glorious, probably gets less chicks to.

PS: I read a recent article in forbes about the best masters degrees,PA was number 3. Here is the article http://www.forbes.com/sites/jacquel...and-worst-masters-degrees-for-jobs-right-now/


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## ExpatMedic0 (Dec 15, 2013)

Also, if you wanna make some quick cash for college, you should consider expating overseas for a little while. You could save enough as an expat medic to complete whatever education you wanted and have zero debt.


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## TransportJockey (Dec 15, 2013)

ExpatMedic0 said:


> Also, if you wanna make some quick cash for college, you should consider expating overseas for a little while. You could save enough as an expat medic to complete whatever education you wanted and have zero debt.



This is one of the big reasons once I hit that magic three year mark I want to expat as a medic. 

Rob, you saw my response the other place you posted this question. I like the idea of goin to PA school.


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## ExpatMedic0 (Dec 15, 2013)

TransportJockey said:


> This is one of the big reasons once I hit that magic three year mark I want to expat as a medic.
> 
> Rob, you saw my response the other place you posted this question. I like the idea of goin to PA school.



Ya even I have considered it. Unfortunately international opportunities for PA's are limited, we don't use them in most of Europe excluding 2 small pilot programs, one in Holland and one in the UK. The UK has another mid level which is specifically pre-hospital called an Emergency Care Practitioner(ECP). This masters degree allows Paramedics to practice like a PA outside of the hospital and cover for doctors after hours. So if I plan on remaining in the EU, PA is not really a viable option. I believe South Africa and Australia uses PA's, but they also have mid-level pre-hospital providers like a PA which is better suited for Paramedics. Just some food for though from an international perspective.


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## TransportJockey (Dec 15, 2013)

ExpatMedic0 said:


> Ya even I have considered it. Unfortunately international opportunities for PA's are limited, we don't use them in most of Europe excluding 2 small pilot programs, one in Holland and one in the UK. The UK has another mid level which is specifically pre-hospital called an Emergency Care Practitioner(ECP). This masters degree allows Paramedics to practice like a PA outside of the hospital and cover for doctors after hours. So if I plan on remaining in the EU, PA is not really a viable option. I believe South Africa and Australia uses PA's, but they also have mid-level pre-hospital providers like a PA which is better suited for Paramedics. Just some food for though from an international perspective.



From your international perspective how hard would it be to go to school overseas for that master level prehospital provider? I would love to eventually just move overseas and call it good. Especially the uk or Australia


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## triemal04 (Dec 15, 2013)

My guess is that there will be a lot of offense will be taken while reading this, probably by several people, but oh well.  And the points I'm going to make are very valid; even if you are just considering your options, these are things you need to consider.

If EMS really is something that you want to do, and under better conditions see yourself spending a career in...why not do so?  Departments that have the things you want do exist, and in greater numbers than most people seem to believe.  The catch is that you have to have the qualities they want, and be willing to go to the job.  If EMS is truly what you want, why not simple start the process of becoming qualified and/or go to one of these places?  You said it yourself; you're 24; this is the time to do that.  While that may not work out, if this really is what you want...shouldn't you try?  And if all you lose is a couple more years...well...you're only 24.

Becoming a PA (or NP, or MD) is not an easy process.  I'd guess you are looking at a minimum of 5 years of schooling for a PA.  And that is just to get the initial license.  I have to ask...if you don't have the drive and willingness to make sacrifices and move your life to a new place for a job that you admittedly love...why do you think that you have the drive to do this?

This doesn't even touch on the fact that the job you end up with as a PA may very well not be what you think it is.  PA's in critical care are not common nationally.  PA's in ER's doing much more than fastrack work or working solo are not common nationally.  PA's working in a surgical environment as a true peer are not common nationally.  While there are exceptions to these, it still stands that they are the exception, not the rule.  And the people who fill those spots have often worked for years and in many different locations to reach that spot.  I have to ask...if you don't have the drive and willingness to make sacrifices and move now...why do you think that you might later when you are even more settled and potentially in debt?

If being a PA (or anything else) is something that you really are leaning towards, I'd suggest you start doing some extensive job shadowing and questioning.  Find out what the daily working life and limitations really are for the various specialties, and find out how people got to where they are, or what they would have to do to move on.

In a nutshell, make sure your eyes are wide open.


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## ExpatMedic0 (Dec 15, 2013)

TransportJockey said:


> From your international perspective how hard would it be to go to school overseas for that master level prehospital provider? I would love to eventually just move overseas and call it good. Especially the uk or Australia



I am going to university both in Denmark and online back in USA in Washington state. Its not very hard, tuition is cheaper in most of Europe even for international students.

We don't use mid levels really at all in most of europe that I am aware of. The UK is an exception to that with those newer programs like ECP and PA. Holland and I think maybe also Germany have PA pilot programs, but its not a main stream or accepted thing yet. In Denmark, if I remain here, I can become a Paramedic with a higher degree, a Doctor or a nurse, that is it, no mid-levels, kind of sucks.

Regarding the UK, check out this http://www.paramedicpractitioner.com/ and this http://www.uea.ac.uk/study/postgrad...msc-advanced-practitioner-paramedic-part-time and http://www.uea.ac.uk/study/postgrad...itioner-emergency-care-practitioner-part-time

as for Australia http://www.hwa.gov.au/work-programs...practice-project/extending-role-of-paramedics http://www.ecu.edu.au/future-students/postgraduate/our-courses/overview?id=I58

The hardest part is your want to remain there as a resident and not just a temp expat. Aquiring a work visa can be hard but is possible for Paramedics, most likely easier for a mid level. I know Australia grants them for Paramedics with degree's from the USA because they have a shortage of medics in various areas. The UK is harder but here is some info maybe could help http://www.ambulanceworld.com/ems-in-the-uk-jobs-are-available/

the easiest way into the EU is marrying someone, but sometimes higher education will qualify you to apply for a work visa if the job is in demand.

Becoming a pre-hospital mid level in a foreign country as an American is only something I have researched online, so I can't say for sure if that would allow you to remain and practice as a mid level after graduation, depends on every countries work visa and residency rules. In Denmark we use a points system, if you speak English and have a masters degree, you can apply for temp residency and a greencard in most cases.


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## Ewok Jerky (Dec 15, 2013)

Unfortunately, in the eyes of most medical practitioners, politicians, and the general public, Pre-Hospital Medicine is not really a branch of actual medicine.  I am not saying I agree just telling it like it is.  I don't think any one in the trenches will be able to change that.  Certainly there are great medics out there, and they get recognized as such by hospital staff, but that just it, these exceptional pre-hosptital clinicians stand out against the backdrop of the average, poorly educated medic waiting for a fire job.  For EMS to change will take MDs and medical directors who see the true potential of high performing EMS systems, as well as hospital administrators/EMS CEOs/and insurance providers who are willing to pay the cash for better educated and better equipped providers.  We need more education up front, more CEs, more integration with hospitals after we drop off patients, and the ability to transfer somewhere other than the ED.  EMS as it stands to day is in the delivery industry, not the medical industry.  That makes us delivery people, not clinicians.  If you want to be a good pre-hospital clinician, it takes effort, time and money on your part to learn beyond what is required for certification and job maintenance.   I think everyone here is making the effort to be a better provider, but you can only do so much with out the compensation, respect, and ability to practice medicine that you deserve.  And now you have a choice, put on a white shirt or go to nursing/PA/DO/MD school?

For me, PA school was a no brainer.  Its the shortest path to where I want to be.  I am 30 years old, engaged, bachelors degree, no savings.  I do not want to be a nurse, and frankly I don't want to be an MD/DO.  I want to work my scheduled hours, go home, have time for my family, and be able to pay off my loans without having to work 80 hours/week.  I also get bored pretty quickly and get the desire to mix it up every 4-5 years.  As a PA trained as a general practitioner, I am free to work in any specialty that will hire me.  I will be practicing medicine as part a team after 2 years of school, building on the skills I learned on the street and the science background I got in college.  And I won't have insane loans.  I am hoping to be able to stay active in EMS education, at the very least giving/receiving reports from the EMS folks who deliver/pick up my patients every day.


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## TransportJockey (Dec 15, 2013)

^^^^
For the most part I agree with you. But we did get a boost when the academy of emergency physicians added ems as a sub specialty


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## ExpatMedic0 (Dec 15, 2013)

Ya I have a soft spot for PA's. In the U.S. it is one of the best choices for those in EMS who want to leave prehospital care and was basically created for medics historically correct?


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## wanderingmedic (Dec 15, 2013)

ExpatMedic0 said:


> Ya I have a soft spot for PA's. In the U.S. it is one of the best choices for those in EMS who want to leave prehospital care and was basically created for medics historically correct?



Yes, the PA was the brainchild of a Dr. Eugene (?) in the late 50's early 60's at Duke University. In my understanding PA programs were created to fill a primary care provider gap by giving military medics advanced education to serve the civilian public after they came home. 

The details are a little fuzzy for me, but I wrote a paper on this last semester.


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## wanderingmedic (Dec 15, 2013)

If you are a history nerd like me..interesting video. 


http://youtu.be/iuxUNDW7wBg


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## Ewok Jerky (Dec 15, 2013)

azemtb255 said:


> Yes, the PA was the brainchild of a Dr. Eugene (?) in the late 50's early 60's at Duke University. In my understanding PA programs were created to fill a primary care provider gap by giving military medics advanced education to serve the civilian public after they came home.
> 
> The details are a little fuzzy for me, but I wrote a paper on this last semester.



Eugene Stead. Created the idea of a highly trained former army medic to serve the role as a "physician extender" to practice primary care in underserved areas.


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## Wheel (Dec 15, 2013)

MrJones said:


> You did interpret correctly, and I'll answer your answer by suggesting that you strive for supervisory responsibilities, and use that platform to push for positive change in your organization (the journey of a thousand steps and all). You develop a reputation as an EMS advocate through participation in, and accepting leadership roles in, organizations that, with the right people involved, could actually do something to improve our lot in life (I'm talking to you, NAEMT ). You become known as someone who should be listened to by writing for industry publications and making presentations at industry events. You become an instructor and help mold the EMTs and Paramedics who are our future. You network with like-minded individuals nation-wide.
> 
> In other words, you start by becoming more than just being an outstanding medic on the street. It's not always easy, it's not always fun, it doesn't happen overnight and it doesn't guarantee success, but that's how we will drive change in our industry



Thanks for this. It's something I've been struggling with lately. I have been looking at getting involved in education soon.


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## xrsm002 (Dec 15, 2013)

Actually in Texas as of 2015 people wanting to become P.A.'s will be required to have at minimum a bachelors degree, the PA programs ate typically Masters degrees


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## xrsm002 (Dec 15, 2013)

NPs in
Texas have Masters also


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## STXmedic (Dec 15, 2013)

xrsm002 said:


> Actually in Texas as of 2015 people wanting to become P.A.'s will be required to have at minimum a bachelors degree, the PA programs ate typically Masters degrees



I can't think of any program in Texas that a Bachelors is not already a requirement...


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## Handsome Robb (Dec 16, 2013)

triemal04 said:


> My guess is that there will be a lot of offense will be taken while reading this, probably by several people, but oh well.  And the points I'm going to make are very valid; even if you are just considering your options, these are things you need to consider.
> 
> If EMS really is something that you want to do, and under better conditions see yourself spending a career in...why not do so?  Departments that have the things you want do exist, and in greater numbers than most people seem to believe.  The catch is that you have to have the qualities they want, and be willing to go to the job.  If EMS is truly what you want, why not simple start the process of becoming qualified and/or go to one of these places?  You said it yourself; you're 24; this is the time to do that.  While that may not work out, if this really is what you want...shouldn't you try?  And if all you lose is a couple more years...well...you're only 24.
> 
> ...



No offense is taken in the least. I come off like a real :censored::censored::censored::censored::censored::censored::censored: but when I ask for help I'm not going to bite the hand that feeds me. You make very, very valid points. 

I am a firm believer that you should not base where you live off of your job, unless that's all you do is your job and you have no life. I have a multitude of things that I do outside of work that a refuse to give up. There are plenty amazing EMS services out there however me moving to them and having the "dream job" results in me living in an area of the country that doesn't allow me to do the things that I love to do. Now I've taken myself from a location that I love and company that I dislike and replaced it with a place I dislike but a company that I love. Have I really improved my situation at all?

I'm very aware that whichever pathway I choose is going to be a long road and have sacrifices as part of it, even if I choose to stay in EMS if I want to have any possibility of making any changes whatsoever I'm going to need to finish my degree. At least an undergrad if not more than that. 

I plan on shadowing as many PAs as I can, I've already networked with a few, all in surgical or AC/CC settings that said they'd be willing to let me follow them around. 

ER isn't really a spot I'd be looking to end up as a PA for the exact reason you cited. 

I have zero problem moving to another place for school, but I ultimately want to end up back in this general part of the United States. I think that is a very reasonable plan of action. Like I said above, if I hate where I live but love my job I'm not in any better place than I was hating my job but loving where I live.


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## Handsome Robb (Dec 16, 2013)

Also, Thanks for the link, expat. I registered over there and am going to start asking questions. 

There are actually quite a few high end PA schools in the neighboring states as well as CC/Surgical/Trauma PA Residencies.


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## VFlutter (Dec 16, 2013)

Here is a link to Vanderbilt's ACNP - Intensivist program. Sounds like a really good program. 

http://www.nursing.vanderbilt.edu/msn/acnp_intensivist.html

I am really interested in combined ACNP/CRNA. Do Anethesia a few days a week and cover in ICUs PRN. Best of both worlds.


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## Handsome Robb (Dec 16, 2013)

Chase said:


> Here is a link to Vanderbilt's ACNP - Intensivist program. Sounds like a really good program.
> 
> 
> 
> ...




See now there's a plan I could get on board with.

ACNP and CRNA have been in my mind for a long time, y'all can make fun but MedicRob really hooked me on the idea. My old partner just finished her BSN and is planning IO go CRNA and her talking about it didn't help.

Then you have Mr.Jones that makes an argument that not only is flattering but difficult to argue with.

The more I look at PA and read that forum the more it seems like you've got to be damn lucky to get the residency(ies) and job(s) I want but I'd also assume the same for ACNPs/CRNAs.


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## ExpatMedic0 (Dec 16, 2013)

Robb said:


> See now there's a plan I could get on board with.
> 
> 
> The more I look at PA and read that forum the more it seems like you've got to be damn lucky to get the residency(ies) and job(s) I want but I'd also assume the same for ACNPs/CRNAs.



Really? I find that surprising. Did you read the article from Forbes I posted on here? PA was #3 out of 50 for best masters degrees to obtain right now. They are saying median earnings of almost 100k and expected job growth of over %30. Mind you I have no idea and would not base my career choices on one article, but it really surprises me. Advanced nursing degrees where not mentioned on the list(from what I remember), and also it may cost you extra time and money going to nursing school and learning a whole other holistic model on patient care, versus continuing on from medic, following the medical model with PA school, use your Paramedic degree instead of wasting more time and money on a nursing degree. The whole PA thing in my opinion is and was setup for medics and always has been. Its competitive yes, but I think if your not going to medical school, and your not already going down the nurse path, PA makes the most since IMO.

Forgot to mention, you can also bridge from PA to DO later if you want, this is not possible for nurses. http://lecom.edu/college-medicine.php/Accelerated-Physician-Assistant-Pathway-APAP/49/2205/612/2395


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## Carlos Danger (Dec 16, 2013)

Chase said:


> Here is a link to Vanderbilt's ACNP - Intensivist program. Sounds like a really good program.
> 
> http://www.nursing.vanderbilt.edu/msn/acnp_intensivist.html
> 
> I am really interested in combined ACNP/CRNA. Do Anethesia a few days a week and cover in ICUs PRN. Best of both worlds.




Also, University of South Alabama (which is much more affordable than Vanderbilt) has an "Emergency NP" program. It is a combined ACNP/FNP program with a focus on emergency care. The didactics are online and clinical hours are arranged at a hospital where you live. Perfect for the paramedic-turned-RN who wants to do advanced practice and stay involved in the emergency setting. 

Before I enrolled in CRNA school, I almost did this program. I still might......


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## Fire51 (Dec 16, 2013)

Robb, you have some hard decision to make and ultimately it's what you want and what you can see yourself being happy doing. Let's just say you decide to go one way and end up not likening it, you can always change ways and if that brings u back to being a medic then you'll know. You are going through a decision that a lot of medics go through, I have seen it a lot and I saw my father go through it, he knew there wasn't much advancement in EMS. He was a supervisor and had many other titles (teacher, FTO, ect..). He decided to stay in EMS because of his love and passion for it. My father was a paramedic for 25 years and in EMS for a total of 32 years, but ultimately he ended up with a career ending back injury. But till this day if you asked him if he regreded his decision of staying in EMS, his answer is no way. He loved what he did and had fun, he also hopes to go back and be a teacher for a paramedic program.     So the question is what do you see yourself doing? If you don't know like you said, do your schooling and try something new and see if it's what you want, if not change and do something else. Best of luck bud, I hope you find your answers and that you find joy with whatever you decide to do.


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## Handsome Robb (Dec 16, 2013)

That's something I never realized. I'm sure you wouldn't be able to do much with a Medic -> PA-C -> DO would get you much respect in the medical field or any big AC/CC/EM/Surg job though.


Seems it would be looked at as a short cut.


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## VFlutter (Dec 16, 2013)

Halothane said:


> Also, University of South Alabama (which is much more affordable than Vanderbilt) has an "Emergency NP" program. It is a combined ACNP/FNP program with a focus on emergency care. The didactics are online and clinical hours are arranged at a hospital where you live. Perfect for the paramedic-turned-RN who wants to do advanced practice and stay involved in the emergency setting.
> 
> Before I enrolled in CRNA school, I almost did this program. I still might......



I have an aversion for online MSN programs. I would probably do it for ACNP or FNP after I went to CRNA school but I do not like the idea for your first MSN.


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## Christopher (Dec 17, 2013)

Robb said:


> Now the real question is MD/DO, PA or NP?



Perhaps working more than full time in a field outside of medicine for the last 10+ years colors my view on this...do whatever makes you happy.

All three will make you enough money to alleviate the potential headaches of the positions.

Try and figure out what drives you, what motivates you, and what you want to do tomorrow.

If working your *** off to become an MD/DO is your thing, get it. I'll be getting it sometime in 2016/2017 (thanks to the US DOS making visas have income requirements keeping me from becoming a full time student for a few years). I'm attracted to the long hours, intense educational requirements, and opportunity to challenge myself. Perhaps I'm just masochistic, but I would be crazy happy to be in the brunt of med school right now. So. Much. Fun. (I have a problem)

PA school is attractive in that you can see fairly immediate successes! 24 months later you're treating and streeting. This field has probably the highest rate of return on your investment, both financially and personally. You can pretty much do what you want as a PA, in any area of medicine too. This is a wonderful option for anybody who wants more out of medicine.

RN/NP is attractive in that you can work anywhere and do anything. I think Halothane already mentioned it, but you practically write your own ticket here if you're any good. Set your own hours? Yup. Great income? Yup. Educational opportunities? Yup. Advancement? Yup. Being a nurse is a wonderful option if you want flexibility. This will be a longer road, but no less fulfilling.

Lastly, staying a paramedic is also attractive. I really enjoy working the truck ("frequent fliers" and all). For the effort, the money is fine. Extracurricular activities are plentiful. Literally nobody (this phrase is used figuratively) is researching better ways of doing EMS, so you have an open road ahead to make changes. Working in software, I believe in change which attracts followers rather than trying to make converts. Affect change by having the "better product" because content is king. Some departments are better for allowing change, some are not. But that is no different regardless of your title or job. Trust me. 

So, what would you want to do tomorrow if you could make the switch immediately?


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## Rialaigh (Dec 17, 2013)

Robb said:


> That's something I never realized. I'm sure you wouldn't be able to do much with a Medic -> PA-C -> DO would get you much respect in the medical field or any big AC/CC/EM/Surg job though.
> 
> 
> Seems it would be looked at as a short cut.




It actually takes a good bit longer. PA school is a solid 24 months of pretty intense learning, and clinicals, and then it only cuts off 12 months of medical school. I would venture people that take a PA -> DO route are much more complete well rounded providers than those that attend DO school straight out of college (at the age of 22 or so). You might not get as much respect from people that don't know you but I would venture you would actually get preference in hiring for jobs based on previous experience.


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## ExpatMedic0 (Dec 17, 2013)

Some good points, also as some of the others have mentioned. There is nothing wrong with remaining in EMS, even with a higher degree. If your willing to relocate you will qualify for more competitive and higher paying EMS jobs like flight and municipal agencies,  in addition to field provider positions other slots in EMS require a higher degree such as chief, director, researcher,  educator at a university, and policy maker/advocate.


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## Carlos Danger (Dec 17, 2013)

Chase said:


> I have an aversion for online MSN programs. I would probably do it for ACNP or FNP after I went to CRNA school but I do not like the idea for your first MSN.



As long as they have a solid lab component (which I believe USA does; you have to travel there for exams and labs) and it is easy to communicate with the instructors with questions, then it just comes down to personal preference. I understand why some people don't like an online formate, but personally I have a very self-directed learning style and end up teaching myself most things anyway, because I just don't absorb much in a classroom setting.

I would have done just as well - better, perhaps - if my anesthesia program courses were online and then I just went in once a week or so for simulation and skills practice.


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## FLdoc2011 (Dec 17, 2013)

Rialaigh said:


> It actually takes a good bit longer. PA school is a solid 24 months of pretty intense learning, and clinicals, and then it only cuts off 12 months of medical school. I would venture people that take a PA -> DO route are much more complete well rounded providers than those that attend DO school straight out of college (at the age of 22 or so). You might not get as much respect from people that don't know you but I would venture you would actually get preference in hiring for jobs based on previous experience.




I'm not sure,  in my experience and opinion, med school has a way of knocking everyone on a level playing field.

In my class we had people from pretty much every professional background,  from a PhD in chemistry,  to a PA, business owners, nurses, all the way to someone straight out of undergrad.   There were definitely differences clinically and each person obviously came in strong in their particular area,  but if saw within just a few months your background didn't really matter anymore.    

And while I respect and work daily with PAs,  PA school is not just a shorter version of med school.  The breadth and depth of knowledge overall just isn't the same, and it's not meant to be.  

During the clinical years of med school (3 & 4) at some rotation sites there were PA students who rotated with us and there was a noticeable difference clinically and on a basic knowledge level.  

That said,  of course there are horrible physicians that I'm sure some PAs could run circles around but I'm just speaking in general here. 

Also, I don't think previously being an EMT/medic or PA prior to med school will have any bearing at all on job prospects as a physician once your done with residency. 

All that said,  I also seriously considered PA school.   Ultimately I decided I wanted to be a physician with all that entails and personally would regret not going "all the way" so to speak.  

I really think it's a great field though.  I've known several PAs who have completely changed specialties and groups easily. As a physician, it's basically not feasible to change specialities once you're done with training and out in practice unless you're ok with giving up several years of time/effort and salary for more training.    And even then the system is biased against those who already completed training doing an additional residency.


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## WTEngel (Dec 17, 2013)

The EMT-P to PA to DO route is definitely not a shortcut. In fact, it is more like the scenic route...except with more debt.

Also, I think the PA to DO bridge that is offered is only for people interested in entering primary care. So if you are interested in EM, surgery, gas, etc. throw those ideas out the window. 

NP is not a bad choice, but be aware you have to specialize as an NP. You will have to go through with NP school and then essentially get boarded as an FNP, ACNP, PNP, etc. Nurse Prac doesn't have the flexibility that PA does, IMHO. 

As a PA, you can choose to do a residency, and it seems like more and more groups are giving preference to PAs who have done a residency in whatever specialty they are seeking to pursue, however, it is still rare to see a PA position posted where part of the minimum requirements includes a residency. As FLDoc said, it isn't uncommon to see PAs change groups, or even specialties. NPs can change groups fairly easily, but changing specialty is a whole other matter, at least in Texas. It may be different elsewhere.

The last thing I will say about the NP route is that I have never really held NPs who went straight through nursing school and immediately entered an NP program in very high regard. I always felt like a nurse should do at least a few years at the bedside before he or she pursued NP school. That's just a personal pet peeve of mine...for whatever reason.

None of the routes are easy, and they all have drawbacks. I have had more than a few physicians tell me that they would have chosen a different route if they could turn back the clock. I attribute a lot of that to the fact that times are changing. Some people view this as a bad thing...I look at it more from the perspective of being able to actually get in on the ground floor of the changing face of healthcare, and hopefully contribute in a positive manner. 

My father in law is a physician, and has been for over 30 years. He does seem pretty miserable right now, but it is a result of multiple things happening at once. He is not very tech savvy, and let's face it, in today's world, if you can't work a computer well, your day is just going to suck. He has been set in his ways for a very long time, and the changes are coming faster and faster.

This rationalization may just be my way of fooling myself into thinking it will be different for me when I am done with medical school, but I certainly hope not. Many of the complaints that the physicians have the mid levels still have to deal with. 

I will also say that I have seen more than one physician who would not change what they do for all the whiskey in Ireland, and their level of satisfaction overflows into their patient care. They are some of the happiest and most amazing people I have ever met (probably because they are out of medical school...)

My last word of caution would be to remain mindful of how you come to terms with things in your head. Going into PA school thinking that it is the most expedient way to get to the level of practice you want, without the difficulty and commitment that medical school requires opens you to the possibility of disappointment. It may happen that you find yourself in 6 years as a PA, relatively happy, but wishing you could do more. This might not occur to you now because there is so much more you can do as a PA than as a paramedic, but remember, the most independence will always be found at the physician level. I don't say that to start a pi**ing contest with the mid levels, but the fact remains, it will be a long time (if ever) before we find the org chart with midlevel above or lateral to physician. They may work hand in hand, but the hierarchy remains intact.

Best of luck in whatever decision you make. I began by pursuing the PA route, only to find that the pre-reqs were very nearly the same, and in the back of my head I always knew I would constantly be considering if I had truly made the right decision. Ultimately I decided on DO school...so far I have zero regrets.


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## Handsome Robb (Dec 17, 2013)

WTEngel said:


> The EMT-P to PA to DO route is definitely not a shortcut. In fact, it is more like the scenic route...except with more debt.
> 
> Also, I think the PA to DO bridge that is offered is only for people interested in entering primary care. So if you are interested in EM, surgery, gas, etc. throw those ideas out the window.
> 
> ...




I was hoping you would chime in. 

I noticed that the prereqs are basically identical as well. The MCAT scares the living piss out of me. 

My question is, can I still play as a paramedic once an MD? I don't think they'd let that fly. I'd have to get somewhere that uses docs on the flight service or something. 

I'm going to start knocking out prereqs, I've got a while before having to decide.


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## Gastudent (Dec 17, 2013)

Robb said:


> I was hoping you would chime in.
> 
> I noticed that the prereqs are basically identical as well. The MCAT scares the living piss out of me.
> 
> ...



Just wanted to chime in about the MCAT. A friend of mine, he is an AEMT as well. He just finished his BS in Biology, and got accepted to some Med school in the Caribbean without having to bother with the MCAT. 

Also a doc I know in the ER didn't take the MCAT and got into a DO school in Tennessee. He was a pa before he went to Med school 15 years ago, so it might not be the same today. 

Just thought I would let you know about these two guys, so maybe you shouldn't be that scared of the MCAT.


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## rescue1 (Dec 18, 2013)

I believe all osteopathic schools require the MCAT (which changes in January, yay) as of now.

I think a big test of whether you want to be a doctor is taking the required undergrad classes and excelling--organic chem and biochem are not easy except for the talented few, and they require a fairly decent time commitment, but for all that, med school requires even more studying and time. 

You mentioned wanting to stay in the area--with the competitive nature of med school and residency these (and all) days, I wouldn't bank on being able to stay local for many years unless you live in a city jam packed with schools and hospitals like Philadelphia or New York. You're in Reno, as I recall, which has exactly one medical (MD) school with a small class size, and California med schools are notorious about being difficult for non-residents to get in to. 

Not trying to talk you out of being a doctor, but it's something to consider when you make your choice.


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## WTEngel (Dec 18, 2013)

If you do medical school in the US, you're going to have to take the MCAT...go ahead and accept that fact. Both the allopathic and osteopathic app services require your MCAT scores in order to complete the application for submission. So does TMDSAS and the other state app services.

The MCAT isn't that bad. Don't let it get to you. It's a small hump in the road towards med school that ultimately won't make any difference in your life once you've done it and gotten accepted. The best advice I could give you is shell out the cash for a prep course and go that route. My score went up 6 points from my first test to my second, and my knowledge didn't increase really, it was the prep course helping me navigate the test.

The MCAT is undergoing a major overhaul starting in 2015. I'm not sure exactly what it will look like, but it is supposed to have more psychosocial type questions in addition to the traditional sections.

Some people luck out and hit a home run on the MCAT out of the gate. The rest of us schlubs have to pay to get the tips on how to succeed. 

MCAT scores have been steadily creeping higher in recent years. I personally believe this is a result of the test prep companies "cracking the code" so to speak, and prepping students so well for the exam that the content doesn't really matter anymore. I don't think students are getting smarter.

Bottom line, the MCAT is a hoop you have to jump through, but rarely is it the end all be all, and it is only one aspect of the overall application. I know more than a few people from my masters program that had exceptionally high MCAT scores (35+) and didn't get accepted. I also know a guy with a fairly low GPA, mediocre to low MCAT score (26), and a good bit of personal charm, who did get in. PM me sometime and I'll let you talk to him. 

SDN and to a large degree many other online forums for PAs, NPs, etc. give the impression that only the cream of the cream get into these programs. Take most of the advice for what it's worth (not much) and weed out the BS.

I'm a firm believer that very nearly ANYONE who is willing to work hard enough, apply broadly, and relocate to wherever necessary can get into med school. It isn't as exclusive as some would like to have you believe.


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## ExpatMedic0 (Dec 18, 2013)

Robb said:


> I was hoping you would chime in.



Careful Rob,  I use to work with WT, he could sell snow to an Eskimo. I am actually surprised hes not going to law school.


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## FLdoc2011 (Dec 18, 2013)

I agree with with WTE said. 

MCAT is just one hurdle but it's still a standardized test and one that you can and need to prepare for mainly from understanding how and what type of questions will be asked.   

There are numerous review courses, videos and books available.   

In general,  medically school material is not technically difficult,  the main thing in my opinion is the shear amount of material you have to get through.   I had undergrad courses that I thought were much harder based on the actual material than any in med school.  

So yea,  if you're intelligent enough to handle usual college courses then I think you're intelligent enough to handle med school as long as your devoted enough and put in the required amount of significant time to study.


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## WTEngel (Dec 18, 2013)

ExpatMedic0 said:


> Careful Rob,  I use to work with WT, he could sell snow to an Eskimo. I am actually surprised hes not going to law school.



Thank you?

While I have never actually sold snow to an Eskimo, I have been accused (but not found guilty of) making a profit from the distribution of sand and other useless commodities to Saudi nationals. How I made money off that deal I'll never know!


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## Summit (Dec 18, 2013)

Chase said:


> I have an aversion for online MSN programs. I would probably do it for ACNP or FNP after I went to CRNA school but I do not like the idea for your first MSN.



If you are going to do both CRNA and ACNP, why not do medical school?


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## NomadicMedic (Dec 18, 2013)

I ran into a former medic on my last night shift. He's now a PA at one of our EDs and he asked me point blank, "so how much longer are you gonna do this paramedic thing? It time to join the dark side."

He's got me seriously thinking about becoming a PA. What happened to me?


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## chaz90 (Dec 18, 2013)

DEmedic said:


> He's got me seriously thinking about becoming a PA. What happened to me?



Haha, growing up I suppose?


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## Carlos Danger (Dec 18, 2013)

WTEngel said:


> NP is not a bad choice, but be aware you have to specialize as an NP. You will have to go through with NP school and then essentially get boarded as an FNP, ACNP, PNP, etc. Nurse Prac doesn't have the flexibility that PA does, IMHO.



Except that many NP programs provide eligibility to sit for both ACNP and FNP boards. There is little one couldn't do with both ACNP and FNP certifications.


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## Summit (Dec 18, 2013)

I come from a family with several physicians, including my father. They told me don't do it. I would love to be a physician (in certain specialties) if I could snap my fingers and also not have to work 80 hour weeks plus call.

However, I do not live to work. I work to live. Thus being a physician does not fit my life philosophy.

I really prefer the medical model of learning to the so called nursing model (which is effectively the medical model with a bunch of annoying obfuscation so that it can be called something else, but that is another thread). However, the way life has lead me, it makes little sense for me to down the PA path.



Halothane said:


> Also, University of South Alabama (which is much more affordable than Vanderbilt) has an "Emergency NP" program. It is a combined ACNP/FNP program with a focus on emergency care. The didactics are online and clinical hours are arranged at a hospital where you live. Perfect for the paramedic-turned-RN who wants to do advanced practice and stay involved in the emergency setting.
> 
> Before I enrolled in CRNA school, I almost did this program. I still might......



CRNA is most attractive for many reasons, but the job prospects around here are limited (I have a very limited arena to focus on). And there is only one program I could really do that would find placements locally without forcing me to uproot the female's successful and lucrative career to somewhere she doesn't want to be.

NP... I don't want to be limited to FNP. But I also don't want to be limited to the acute care environment as working long and weird hours might not work for me my whole life. However, all the state programs are FNP only except for one and it is too far to commute and it doesn't do distance learning. Wow... that South Alabama program is impressive looking. That's a good way to go. Get both, I learn well independently, and local clinicals!

FPMHNP also seems like a good way to go for me... although I need to look into what the state is good with.


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## hawkeyemorgan (Dec 28, 2013)

After fighting in an old system, I am applying for PA school next fall. I love my EMS experience, but in order to preserver and have a little more comfortable life, away I go.


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## Handsome Robb (Dec 30, 2013)

I'm about 99% sure it's going to be ADN to an online BSN then probably CRNA school, that's Vanderbilt program is super tempting though. 

I have a question, mostly directed at the nurses of the forum...halothane and summit...cough...but can you still work as an RN once you're a CRNA? I know we have a few flight nurses that are APNs. I just think it'd be sweet to fly. I'd love to do it full time for a while but I do want to move on to advanced practice. 

Seems like if I wanted to do flight full time though I'd have to put off CRNA school until way later in life when I have a family whereas I could knock all three programs out as consecutively as possible and be done with it then start really living my life. If I get really lucky I'll be able to get a PRN flight medic spot right around the time I finish nursing school, but that would be insanely lucky. Also, getting through it basically eliminates my worries about hating bedside nursing but those fears aren't as bad lately after talking to some unit nurses that friends have hooked me up with. 

I have no doubt in my mind that whatever I choose to do I can do but I'm thinking this is my choice. Funny since I started prerequisite for my BSN first semester after HS.


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## ExpatMedic0 (Dec 30, 2013)

Robb said:


> I'm about 99% sure it's going to be ADN to an online BSN then probably CRNA school, that's Vanderbilt program is super tempting though.


Goodluck on everything, I am curious though, why the Nurse CRNA route instead of the Medic PA route if you don't mind me asking?


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## mariat753 (Dec 30, 2013)

*PA, MD etc*

Hi! I check into this site once in a while still and thought I'd add my two cents...I was a career EMT (yeah, I know, never even became a medic) and decided to go back to school (I already had a bachelor's degree gathering dust) at age 33. I've been a PA for 8 years now. I personally had gotten to a point where I wanted to get to know my patients and so went into Internal Medicine rather than any emergency/critical care field. I absolutely love my job. I had gotten so frustrated, nasty and burned out towards the end of my EMS life, feeling like I wanted (and had) more knowledge than I could use (although, as you can tell by my being on this site, in the rosy glow of looking back I still miss it a little). If I was younger when I went back I might have gone MD, but I agree, a lot of MDs say they wouldn't do it again.
The one good thing about PA versus NP is that you can change fields. Although everyone wants to do Emerg/CC now, you might find in a decade your interests change or you finally want an 9-5 job. Incidentally, I don't usually tell my salary because that's rude, but since you guys are thinking about what direction to go in, I do make well into 6 figures. If you have questions, please ask.


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## ExpatMedic0 (Dec 30, 2013)

also I remember there was some international questions earlier. Here is a good simple abstract of what areas around the globe use PA's currently. http://www.paeaonline.org/index.php?ht=a/GetDocumentAction/i/75206


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## Carlos Danger (Dec 30, 2013)

Robb said:


> I have a question, mostly directed at the nurses of the forum...halothane and summit...cough...but *can you still work as an RN once you're a CRNA?* I know we have a few flight nurses that are APNs. I just think it'd be sweet to fly. I'd love to do it full time for a while but I do want to move on to advanced practice.



Sure you can. I plan to, but realistically I don't know how long it'll work out. I've known several other flight-nurse-turned CRNA's who intended on flying prn after school, but when straight time for a flight nurse is $30/hr and OT for a CRNA is $130/hr or more, money becomes a real factor. Protocol and liability and other practice issues could potentially be something you have to deal with to, but shouldn't be difficult to work out with the program medical director.


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## Happycoop (Dec 30, 2013)

I think you need to spend some time reflecting on what exactly you want to do with medicine. The idea that you'll forge ahead and become a CRNA or MD/DO and still have all this spare time to do flight medic on the side is not likely to come to fruition. 

PA's and NP's are great (and something I've considered seriously over the years), but they absolutely have their limitations. In particular, if you're thinking you like Ortho-surgery, you absolutely need to shadow some folks. As a PA you MAY be first assist (depending on the practice/doc you work with), and if you're ok with that then great...but know going into it that you'll likely never be more than first assist. I've spent a couple years working in the ER, and I've met a number of PA's and NP's that love what they do...but they all have been quick to mention what the limitations are. 

The MD/DO route is long and will test your limits, but is tremendously rewarding. Both will require you to take the MCAT, but if you can't pass the MCAT, you'd probably fail boards anyway so just buck up and get through it. The DO programs are easier to get into (they generally will accept folks with a lower MCAT compared to the MD programs). As a DO, you'll learn everything an MD learns, plus OMM (the manipulative medicine). The OMM is a nice bonus, but the reality is very few DO's actually use it in their practice. The downside of the DO route is that your residency choices are more difficult. My wife (a Urological Surgeon) took both the DO boards (COMLEX) and the MD boards (USMLE) in order to be able to apply to either a DO or MD residency. That being said, MD programs wanted her to have a higher USMLE score than the MD applicants (because they were dealing with a lesser well-known commodity in the DO student). 

The MD/DO route isn't as bad in terms of life as many of the posts have made it out to be. It's very specialty specific. I know surgeons who only operate 2-3 days a week and spend the rest of the time with their families. Sure, they don't make what a surgeon who operates 6-7 days a week does, but trust me, they aren't hurting for money (most of the Ortho guys I know make over $1mill/yr...even part time you're clearing several hundred thousand). A friend is one year out of his anesthesiology residency and he makes $275k/yr, plus the practice that recruited him paid off all his med school loans and pays his medical malpractice.

Sounds like I'm pushing for the MD/DO route, but really I just wanted to paint a nicer picture of that side. In the end, you've got to decide what you want out of your career. I am more attracted to PA school, but it took some personal reflection before I realized that. My wife loves being a surgeon and wouldn't trade it for anything. 

Best of luck in making your decision!


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## Brandon O (Dec 30, 2013)

Figure out what you specifically want. With no offense to anybody here, people with no experience in either pathway can't help you much, and people with experience will almost always justify their own choice. Human nature.

If you're interested in surgery, realize that's the only thing you will never be able to do as a midlevel. If doing procedures is your interest, there are other avenues (assisting, other things like placing lines, IR, etc), but not that. If your interest is diagnosis, there's a bigger set of options.

It is hard to argue that many MD/DOs currently are unhappy and wouldn't recommend their path. But it's also probably true that this won't always be the case (things can get better), and that people getting into it now may not feel the same as those who have witnessed the field changing over the past few decades. Plus, as mentioned, some of their headaches are present for midlevels too, although you're paying less blood and money for the pleasure, which seems to be part of the reason for their widespread disillusionment.

People have mentioned many of the considerations. A few others I'd emphasize is that most things available to physicians are available to midlevels, but in many cases not as easily. You can be a great diagnostician, but not as a minimum, so you'll have to become one. You can be highly respected, but you won't necessarily be as a matter of course, so you'll have to earn it each time you meet someone. You can work in most fields, but with many regions/facilities/affiliated docs you won't be able to do what you want, so it may take time and effort to find your sweet spot. And so forth.

Contrariwise, with med school and the associated necessities, you're giving a lot to get "the big degree," and it's not just fluff cost -- it hits people in different ways, and plenty are burned out before they ever see the benefits. If you have an honest, accurate expectation of what you want and how to get there, AND that balance is worth the candle for you, then you'll be happy. If you're fooling yourself about either side of the scale, at some point it'll hit you.

I suppose the other sad fact is that, depending on who you are, probably no option will be totally perfect. You'll have to put up with some things you don't want as the lesser evil. But again, make that decision now; don't get surprised by it.

You can probably work as a medic as a PA; I don't know about NPs and physicians and would be curious to hear from a forumgoer who's still doing so, or knows anyone that has. In the long run, there may be opportunities for licensed clinicians in community paramedicine as well.


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## Carlos Danger (Dec 30, 2013)

Brandon O said:


> You can probably work as a medic as a PA; I don't know about NPs and physicians and *would be curious to hear from a forumgoer who's still doing so, or knows anyone that has.* In the long run, there may be opportunities for licensed clinicians in community paramedicine as well.



Just a few years ago I worked with two trauma services ACNP's who flew part time while working full time in trauma. I also used to know a paramedic-turned-PA who was involved in EMS, even running calls occasionally. 

I think it is a little more difficult for CRNA's just because of money. The ones I've known who came from flight had every intention of flying again once they were CRNA's, but they were completely exhausted and broke when they graduated, and told themselves "I'll just take a little time to get used to my new role and get back on my feet financially before I start flying again". Before you know it another year or two has passed, and at this point they're starting to lose interest in transport and considering how much more money their time is worth doing anesthesia, they have a hard time basically donating their days off to fly.


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## Handsome Robb (Dec 30, 2013)

I'm going to try and address everything. If I miss anything please don't hesitate to yell and scream a little bit. 

Expat, I'm leaning towards RN/CRNA because of all the pathways it opens up between now and then. Being on short term disability I've got nothing but time so I've been doing a lot of reading and I could do my MSN in Anesthesia then do a Post-Masters from USF and get my ACNP or ACPNP. If I did that I'd honestly probably lean towards the ACPNP, at the same time though someone brought up a good point about you might as well go to med school if you're going to that much school. Then...it seems as if midlevels are moving towards requiring a Doctorate, so if that's the case I'd be looking at either DNP, DNAP or a PhD as well and would be basically at the point of med school as far as length, not including residencies and fellowships.

No matter where I go I'm going to have to specialize, so that isn't really weighing in to much on my mind. Also, I can do all the nursing pathway here where I'm established until I got to grad school then I'm going to have to relocate for a couple years unless UNR decides to start doing an NA program but I doubt that will happen. After grad school though I can do DNP here.

As far as moving, I've got no problem moving, I'd just prefer to stay here. I'm fully confident that by the time I get to the point of applying and interviewing to CRNA school that I will have a good chance at wherever I'd like to go provided I don't mess around in school. 

I would like to stay in Acute Care/Crtical Care. I absolutely loved the OR environment when I was doing clinicals for P school. I wanted to go back for more but they wouldn't let me. Anesthesia is fascinating to me. I'm huge on pain management and anesthesia is one of the services that provides analgesia for both in and out patients depending on where you work. I could never get over how cool it was to take a person who's walking (maybe) and talking, put them under, make sure they're comfortable, protect their airway, they get cut wide open, then wake them up send them to PACU and sometimes send them home all in the same day, sometimes over the course of a few hours. I'd love to be a surgeon but I know myself and I know what I want in life and I'm not willing to be in school, a residency or a fellowship until I'm well into my 40s. With this plan I've got now, provided everything goes like I like it to I could potentially be done with CRNA by the time I'm 31, probably realistically 33-34, and be out doing what I love, taking care of patients. 

Also, CRNA is appealing to me because of the shear amount of procedures you preform. Some might say that this isn't a good reason but I love working with my hands, I'd rather be with patients and be hands on with them than stand back and tell people what to do and write orders. 

That's a great point about pay for CRNA OT vs Flight RN pay Halothane...I want to fly, but I also want to further myself in healthcare to the midlevel level. I also don't want to get the 5 years of experience, hopefully get a flight job, do that until I get bored then decide I want to go back to school later. It seems like the more time you spend out of school the more difficult it is to get back after it, especially in a program as intense as these NA programs are from what I've read at allnurses.

We have more than one PA that works PRN for us as a medic, both started as medics and worked FT for a while before going to PA school.

I also want to be involved in EMS, somehow for the rest of my career. I'm wondering if I can get an emphasis in education concurrently with CRNA. I'd love to teach medic programs PRN. I wonder if there are any NPs out there as associate medical directors? I've always said I wanted to make changes in EMS. I know I've made little changes an impacts on the people I've trained but from the top down is where you can really make the big changes. I'd love to stay involved with TEMS after all of this is done, maybe not as an operator but in some form or another, as well but I'm thinking I'm going to have to let that dream go to do nursing school and work full time.


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## Handsome Robb (Dec 31, 2013)

Another question I have is regarding the transition to DNP. I've read quite a bit on it and it seems like it is still very much up in the air as to if and/or when/how it'll happen. 

I read the AACN "Essentials of Doctoral Education for Advanced Nursing Practice" statement and am having a difficult time understanding it. Are they wanting a DNP plus your specialty on top or is the specialty included in the DNP program?


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## Handsome Robb (Dec 31, 2013)

Another question I have is regarding the transition to DNP. I've read quite a bit on it and it seems like it is still very much up in the air as to if and/or when/how it'll happen. 

I read, admittedly skimmed some sections, the AACN "Essentials of Doctoral Education for Advanced Nursing Practice" statement and am having a difficult time understanding it. Are they wanting a DNP plus your specialty on top or is the specialty included in the DNP program?

Parts seem as though the specialty would be added on to the end of DNP however other parts indicate rather than a research paper or dissertation, since it's a practice degree rather than research, that your specialty would be your final project. 

The DNP seems like they're sitting at 3 years for a BSN to DNP degree full time, 12 months a year which only adds a year to most masters programs, less in some, so it's not like it's going to be a massive change in time requirements. Unless they add specialty school at the end rather than included. Then you're looking at another 1-2 years at least and at that point why not go to med school? Especially if I wanted a dual specialty such as CRNA and ACNP or ACPNP. 

http://www.aacn.nche.edu/publications/position/DNPEssentials.pdf


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## Brandon O (Dec 31, 2013)

For what it's worth, I don't know of any similar movement for the PA profession toward a doctoral requirement. Historically they've been fairly content in their role. Granting master's degrees seems like it's becoming ubiquitous, but that's more along the lines of "why not, the credits are there."

And while the concept of formal specialization via residency/fellowship is proliferating somewhat, it's far from clear that it'll ever become the norm for PAs. It's still considered a generalist's training.

I'd recommend some shadowing in anesthesia. I think the subject naturally appeals to many EMSers (essentially specializing in life support), but that doesn't mean you'd necessarily enjoy the day-to-day work. There is a lot of sitting and staring.


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## Carlos Danger (Jan 1, 2014)

Robb said:


> Another question I have is regarding the transition to DNP. I've read quite a bit on it and it seems like it is still very much up in the air as to if and/or when/how it'll happen.
> 
> I read, admittedly skimmed some sections, the AACN "Essentials of Doctoral Education for Advanced Nursing Practice" statement and am having a difficult time understanding it. *Are they wanting a DNP plus your specialty on top or is the specialty included in the DNP program?*
> 
> ...



The specialty is included in the DNP program. The doctoral part is basically just added on to the already-existing MSN programs. Generally speaking, the DNP is specifically intended to be a practice-oriented degree (as opposed to a PhD, which is research-oriented) so I would expect most DNP's do not require a dissertation. What I think you are seeing is programs describing the earning of board specialty eligibility _in lieu of_ the dissertation that is required of a traditional PhD program.

As for the second part that I highlighted......that is a good question. Very different pathways; probably more similarities than differences (but the differences are potentially very important) in the end. Only you can decide which is the better option for you.



Brandon O said:


> I'd recommend some shadowing in anesthesia. I think the subject naturally appeals to many EMSers (essentially specializing in life support), but that doesn't mean you'd necessarily enjoy the day-to-day work. There is a lot of sitting and staring.



I would recommend shadowing several members of ANY profession one is considering entering. Personally, I spend a lot less time sitting in the OR than I did sitting at the base when I worked in HEMS.


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## joshrunkle35 (Jan 2, 2014)

If you are interested in nursing, and already have a bachelor's other than nursing, you can do the Graduate Entry Option at OSU. It's a 3 year MSN program, where you get your RN and MSN in the 3 year program without needing an RN/BSN prior to entry into the masters program.

http://nursing.osu.edu/sections/aca...ram-overview/graduate-entry-introduction.html


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## TransportJockey (Jan 2, 2014)

joshrunkle35 said:


> If you are interested in nursing, and already have a bachelor's other than nursing, you can do the Graduate Entry Option at OSU. It's a 3 year MSN program, where you get your RN and MSN in the 3 year program without needing an RN/BSN prior to entry into the masters program.
> 
> http://nursing.osu.edu/sections/aca...ram-overview/graduate-entry-introduction.html




Hmm I like the sound of that program. Especially as I was planning on a BS in ems before I look at going on


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## SunshineCamo (Jan 2, 2014)

I'm tackling a similar question, although mine is a little more forward thinking.  I've still got one year of Medic classes, but even after a few months of working in EMS I know this is not something I would want to do forever.

So my question is NP or PA.  The decision kind of hinges on if I want to stay in the National Guard.  If I want to stay in, going RN to NP seems smarter.  I could finish my RN in time to still be young enough to get commissioned, and then continue on to NP.

However if I decide that I'm done with the military (which I'm very close to do as of late) then the PA route is a little more appealing.  I've got about a year before I really need to make a decision but it weighs on my mind.


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## Wheel (Jan 2, 2014)

SunshineCamo said:


> I'm tackling a similar question, although mine is a little more forward thinking.  I've still got one year of Medic classes, but even after a few months of working in EMS I know this is not something I would want to do forever.
> 
> So my question is NP or PA.  The decision kind of hinges on if I want to stay in the National Guard.  If I want to stay in, going RN to NP seems smarter.  I could finish my RN in time to still be young enough to get commissioned, and then continue on to NP.
> 
> However if I decide that I'm done with the military (which I'm very close to do as of late) then the PA route is a little more appealing.  I've got about a year before I really need to make a decision but it weighs on my mind.



If staying in as a PA is an option, look into applying for IPAP. It's pretty competitive, but they send you to school in exchange for a commitment contract. It might be a good option for you and it may not, but doing some research into it might be a good idea.


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## KellyBracket (Jan 3, 2014)

I'm late to the discussion, but I wanted to weigh in as a former paramedic, now emergency physician. 

TL;DR version - this is a great job!

Yeah, some doctors make a big stink about discouraging others from coming into the field. Yeah, the money is going down, paperwork is going up, and it ain't the good ol' days. There ain't no such thing as a free lunch... Some folks are just plain gloomy. (My theory is that a bunch of the old guard screwed up their retirement planning with real estate and Bernie Madhoff in 2008, and are unable to retire now, and they take out their frustration on the world!)

This job is amazing. Yes, the training chews up a good deal of your life, but it gives you opportunities you just don't get in other, shorter, training programs. A midlevel/advanced care practitioner can be quite well-accomplished in one area or field, but the breadth of that domain can often be somewhat circumscribed. 

It's true that PA or NP training takes less time, and you'll start working sooner. It's hard to argue against this economic perspective. Heck, it's hard to argue against staying a medic for the same reason.


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## VFlutter (Jan 3, 2014)

Something I have been strongly considering is the US Army CRNA program (USGPAN). One of the best CRNA programs in the country. It is a 3 year DNP program. School is paid for, get paid while going to school, and then have a 5 year commitment. 

http://www.northeastern.edu/bouve/nursing/add/armyprograman.html

https://www.sites.google.com/site/armynurseanesthesia/

Here is an awesome blog by an Army CRNA showing his deployment in a Forward Surgical Team. I do not think you could find a better Trauma Critical Care experience anywhere.
http://gotosleep2005.blogspot.com/


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## ExpatMedic0 (Jan 3, 2014)

3 years of school, 5 years of commitment, why not become a doctor? 



Chase said:


> Something I have been strongly considering is the US Army CRNA program (USGPAN). One of the best CRNA programs in the country. It is a 3 year DNP program. School is paid for, get paid while going to school, and then have a 5 year commitment.
> 
> http://www.northeastern.edu/bouve/nursing/add/armyprograman.html
> 
> ...


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## VFlutter (Jan 3, 2014)

ExpatMedic0 said:


> 3 years of school, 5 years of commitment, why not become a doctor?



MD/DO is not the answer for everyone and every situation. 

Getting paid while going to school, at no cost, for 3 years and then working for 5 years, again while getting full pay, is different than going $200k+ in debt spending ~8 years in school and residency. 

People can have a comfortable lifestyle, great job, and contribute to the medical field without having MD behind their name. 

Call me selfish, lazy, etc but I much rather have the quality of life and work being a CRNA over that of a Hospitalist. Even if the latter is a MD. 

That being said, I have no totally decided against MD.


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## Carlos Danger (Jan 3, 2014)

ExpatMedic0 said:


> 3 years of school, 5 years of commitment, why not become a doctor?



No loss of income and no SL debt?



Chase said:


> Something I have been strongly considering is the US Army CRNA program (USGPAN). One of the best CRNA programs in the country. It is a 3 year DNP program. School is paid for, get paid while going to school, and then have a 5 year commitment.



I have a good friend who joined the Navy because he wanted to become a CRNA but didn't want to lose income and go into debt. He went in as an O2, worked as an RN for a couple years, then they sent him to the USUHS program.


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## Handsome Robb (Jan 4, 2014)

I'm very confident I can continue to work full time and get through my ADN and BSN but from what I've read it doesn't seem even remotely possible to work even PRN during a CRNA program. Maybe people exaggerate the workload and intensity although I have no doubt it's a bear. 

The military program is really tempting, my question was how difficult would it be to get into school. I'd hate to go in and not be able to get in in those four years rather than be able to increase my odds by applying multiple places on the civilian side during them. How many applicants do they accept? Just seems like there's a lot of military nurses and only one military CRNA school if I'm not mistaken.

I wonder if you could work in a civilian hospital or surgery center PRN during your 5 year commitment?


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## VFlutter (Jan 4, 2014)

Robb said:


> I'm very confident I can continue to work full time and get through my ADN and BSN but from what I've read it doesn't seem even remotely possible to work even PRN during a CRNA program. Maybe people exaggerate the workload and intensity although I have no doubt it's a bear.
> 
> The military program is really tempting, my question was how difficult would it be to get into school. I'd hate to go in and not be able to get in in those four years rather than be able to increase my odds by applying multiple places on the civilian side during them. How many applicants do they accept? Just seems like there's a lot of military nurses and only one military CRNA school if I'm not mistaken.
> 
> I wonder if you could work in a civilian hospital or surgery center PRN during your 5 year commitment?



You can go for direct ascension meaning you apply for the USGPAN program first and then get direct commissioned into the Army once accepted. If commission first and then apply there is no guarantee and if you do not get accepted you will have work as a RN until you can apply again. 

There is USGPAN which takes Army, Air Force, and VA applicants and then USUHS for Navy. It is competitive but I have heard they have not filled every class lately. 

I think part, if not all, of that 5 year commitment must be active duty with the possibility of deployment. IRRC you are allowed to moonlight in civilian hospitals. 

Here is a good breakdown on pay. 
http://www.usagpan.org/how-much-will-i-make


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## Handsome Robb (Jan 4, 2014)

Chase said:


> You can go for direct ascension meaning you apply for the USGPAN program first and then get direct commissioned into the Army once accepted. If commission first and then apply there is no guarantee and if you do not get accepted you will have work as a RN until you can apply again.
> 
> There is USGPAN which takes Army, Air Force, and VA applicants and then USUHS for Navy. It is competitive but I have heard they have not filled every class lately.
> 
> ...




Wow that's really interesting. Pretty legit deal too. How easy would it be to find a consistent job with that few hours per month that to supplement your income? I guess when I was looking at jobs I was looking at full time. 

Is it automatically into the army or are you able to go into the other branches as well?


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## Handsome Robb (Jan 4, 2014)

Doesn't look like you can be commissioned into anything other than the Army unless you come in from that branch. Still not a bad deal at all. The Air Force would be legit as well just because they tend to have nicer living quarters. 

Lots of time to think about it. 

I'm going to this open house type deal at the nursing school next week, looking forward to that.


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## Summit (Jan 4, 2014)

As far as it is from everything else I've thrown my life at, Psychiatric NP is a specialty I'm really thinking about. There is a colossal shortage of psychiatric professionals and the physicians are are not interested enough in filling that gap. 55% of Psychiatrists are over the age of 55 because fewer and fewer MDs go that route because of lack of interst and lack of reimbursement vs other medical specialties. In 25 years on our current trajectory, MD psychiatrists will be primarily research, management, botique, and specialty practice. 

I think I'd be good at it. The pay is decent (only CRNA pays more). Set your own hours. The brain is fascinating.


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## ExpatMedic0 (Jan 4, 2014)

Summit said:


> As far as it is from everything else I've thrown my life at, Psychiatric NP is a specialty I'm really thinking about. There is a colossal shortage of psychiatric professionals and the physicians are are not interested enough in filling that gap.



Any opportunities like that down the PA path that you are aware of?


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## Brandon O (Jan 4, 2014)

ExpatMedic0 said:


> Any opportunities like that down the PA path that you are aware of?



There are PAs in psych.


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## Summit (Jan 4, 2014)

ExpatMedic0 said:


> Any opportunities like that down the PA path that you are aware of?



I'm sure PAs work in psych. 

I think psych is an atypical route for the more typical personality types found in EMS. I think the pace is at the opposite end of the spectrum, the diagnostic path is muddier, the patient interaction dynamic is quite different, and the measure of success is on a different scale than other parts of healthcare.


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