EMT-P to PA-C

[Brandon O]

I am a 10 year ca-EMT-P wanting to make the move to PA but need help and guidance. Is there anyone out here that can help with advise

I'm a Basic who's starting at a PA program in... well, about a month. Happy to answer questions if you've got 'em.

 

[eprex]

At what point is it simply best to go to med school?

It depends what you want in life and several factors, in my opinion. Physician you're looking at 4 years of medical school and a minimum of 3 years residency (I believe). Although I would personally specialize as a PA, it's still less schooling and smaller debt. Ideally you're looking at more "normal" work weeks as well. This isn't always true however.

A friend of mine and I were both premed in college and often talked about pursuing medicine. She had mentioned that she wanted a family sooner in life rather than later. It's because of that need to be stable in a closer point in time that she's now pursuing PA.

I on the other hand have no interest in getting married any time soon and particularly no interest in having a child until at least after marriage. I also have no problem being a student for the next decade or so. I have nothing holding me back from the commitment. I'd be perfectly happy as a PA, but why not shoot for the stars? If I'm going to do it, I want to be a doctor.

The lines get a bit blurred however when you talk to people who work as PAs and RNs in various places. Some absolutely love it and would never do it over. In fact I spoke to an RN who at the age of 23 owns her own home and is overjoyed she didn't pursue MD/DO. There are however quite a few PAs and RNs who have complained of A) working as much as the doctors and being treated as one which is exactly why they didn't pursue MD/DO and B) not getting respect from colleagues or patients and their families.

The bonus is that a PA school is relatively easier to get into than MD/DO (GRE anyone?) and paramedics have a leg up with their clinical experience.

If you want to be a doctor, then be a doctor. If you want to work in healthcare then become a nurse or PA and work your way up.

 

[eprex]

DO = Doctor of Osteopathy, or Osteopath, as opposed to and Alopath or MD. Osteopaths endure the same core curriculum of an MD program and add OMT = Osteopathic Manipulative Therapy, muskuloskelatal manipulation for purposes of treatment.

DO's take the same USMLE (US Medical Licensing Exam) 1-3 that MD's do before graduating and moving on to a residency program. There are several programs throughout the nation now and many of them have PA programs associated with as do several MD programs. I am certain that you will see DO's in just about every specialty in medicine now. I have worked with several in the ED and have seen others in many other practices.

DO's can practice any specialty of medicine, but they have a more difficult time landing the harder stuff like neuro, derm, etc. It's also slightly easier to get into DO school but that's quickly changing.

 

[Brandon O]

If you want to be a doctor, then be a doctor. If you want to work in healthcare then become a nurse or PA and work your way up.

I somewhat disagree with a few of your other points, and I do disagree about "working your way up." Med schools want to mold you from scratch and mostly don't care about, or are wary of, your prior professional experience; plus there's a long enough on-ramp without adding more years to the front end. If you want to be a doctor, don't try to "stepping stone" there (a la EMT to paramedic).

I do agree, however, that if you want to take care of patients, there are a number of options available. If you want to be a doctor, be a doctor. There are perhaps other differences, but the MD is the really insurmountable one that seems to end up being the crux for most people when they're honest.

 

[eprex]

I somewhat disagree with a few of your other points, and I do disagree about "working your way up." Med schools want to mold you from scratch and mostly don't care about, or are wary of, your prior professional experience; plus there's a long enough on-ramp without adding more years to the front end. If you want to be a doctor, don't try to "stepping stone" there (a la EMT to paramedic).

I do agree, however, that if you want to take care of patients, there are a number of options available. If you want to be a doctor, be a doctor. There are perhaps other differences, but the MD is the really insurmountable one that seems to end up being the crux for most people when they're honest.

I was referring to PA school! Most Pa schools require a certain amount of clinical hours in the field, at least the last time I checked. Some schools I looked at required several hundred hours but I was looking at the top tier schools. The requirements are also different. Most PA schools require Anatomy, Micro, and Physio with labs. Most med schools do not.

 

[eprex]

I somewhat disagree with a few of your other points, and I do disagree about "working your way up." Med schools want to mold you from scratch and mostly don't care about, or are wary of, your prior professional experience; plus there's a long enough on-ramp without adding more years to the front end. If you want to be a doctor, don't try to "stepping stone" there (a la EMT to paramedic).

I do agree, however, that if you want to take care of patients, there are a number of options available. If you want to be a doctor, be a doctor. There are perhaps other differences, but the MD is the really insurmountable one that seems to end up being the crux for most people when they're honest.

You disagree with working your way up from Nursing and general PA? Are you opposed to becoming an NP, APRN, etc?

 

[Brandon O]

You disagree with working your way up from Nursing and general PA? Are you opposed to becoming an NP, APRN, etc?

Ah -- I figured you meant work up to MD.

If an RN wants to go that direction, then more power to them. Some don't and that's also great; the practitioner role is different from the nursing role and isn't necessarily for everyone.

As a PA you could of course specialize or build experience, but I'm not sure how many more letters you could add to your name. Of course, career growth doesn't necessarily mean "more letters" and outside of EMS (and perhaps nursing) that's more understood.

I suppose my point is that "working your way up" from something implies that it's just a stepping stone to what you really want. An RN might be this but certainly doesn't have to be, and a PA isn't at all. (Actually I'm a little perplexed that you're associating those two, since they're quite different in most respects.)

 

[eprex]

Ah -- I figured you meant work up to MD.

If an RN wants to go that direction, then more power to them. Some don't and that's also great; the practitioner role is different from the nursing role and isn't necessarily for everyone.

As a PA you could of course specialize or build experience, but I'm not sure how many more letters you could add to your name. Of course, career growth doesn't necessarily mean "more letters" and outside of EMS (and perhaps nursing) that's more understood.

I suppose my point is that "working your way up" from something implies that it's just a stepping stone to what you really want. An RN might be this but certainly doesn't have to be, and a PA isn't at all. (Actually I'm a little perplexed that you're associating those two, since they're quite different in most respects.)

I associate the two positions because they're of course not physicians and yet are both viable, well-paying careers that can offer a piece of what being a doctor is like without the doom and gloom of lower pay rates, increasing school debt, increasingly difficult entrance standards, and massive fear of malpractice. There's also still plenty of room for more nurses and pa's.

 

[Sublime]

(Actually I'm a little perplexed that you're associating those two, since they're quite different in most respects.)

I'm curious as to what you've found that makes them so different. I know the educational models are different, although I don't know much about the NP model of training. From what I've seen, read, and heard... they function basically the same once out of school, the only difference being that PAs are able to specialize in any area of medicine and NPs are trained for a specific field (such as acute care for family medicine).

I am thinking that at some point in the future, I will want to go one route or the other.. but I am still not sure which one. From reading the NP forums on allnurses, I got the impression that a lot of new NPs were not very confident practicing on their own once graduating school. Maybe that's just the few vocal ones on that forum, idk...

I like the idea that PA school is somewhat like a condensed version of med school, which includes gross anatomy... something that NPs school don't do (if I'm wrong let me know). I do however like the fact that NP school allows you to receive a doctorates degree. So I am still unsure what is the best option. The most important thing to me is getting the best medical education possible outside of going to med school.

 

[Brandon O]

I associate the two positions because they're of course not physicians and yet are both viable, well-paying careers that can offer a piece of what being a doctor is like without the doom and gloom of lower pay rates, increasing school debt, increasingly difficult entrance standards, and massive fear of malpractice. There's also still plenty of room for more nurses and pa's.

Well, that's fair, and I've heard a lot of my coworkers voice similar things. You know, "I don't know... I'm thinking maybe PA... or my RN... or RT... or those CRNAs make good money... or electrician..."

But aside from making more money with better career stability than EMS (which is like saying more sunny days than Seattle), they're different jobs, so if we're trying to find fulfilling careers, it probably behooves one to figure out what they want to actually do.

I'm curious as to what you've found that makes them so different. I know the educational models are different, although I don't know much about the NP model of training. From what I've seen, read, and heard... they function basically the same once out of school, the only difference being that PAs are able to specialize in any area of medicine and NPs are trained for a specific field (such as acute care for family medicine).

My apologies, I probably wasn't clear. I meant PA vs. RN. PA vs. NP is a much closer comparison and commonly drawn.

It's usually described as coming from the medical model of education (diagnostic) vs. the nursing tradition (more holistic, preventative, caregiving). This difference seems to extent to the professional culture; I've never had a close relationship with the nursing world, but it's interesting to watch from outside, particularly how the professional bodies have kept pushing to change and develop their roles.

NPs can practice independently, whereas a PA is always affiliated with a physician in some respect at least (what this means varies greatly). PAs are starting to become more specialized as well, but lateral mobility is still common. And, of course, if you're already an RN, NP is a shorter route. But many times they're performing similar roles.

 

[MediMike]

After 10 years in EMS I've started PA school so I'll add a little input here...

First off, PAs don't truly "specialize". You're trained as a generalist, with the large majority of schools focusing mainly on primary care. With that being said, there are a growing number of residencies available after you pass the PANCE to help you land a job in a specialty/sub-speciality. NPs are trained in a specific specialty, be it Family Practice Acute Care etc.

The idea that PAs end up with a better work week than MDs is a definite myth from practicing folks I've talked to/shadowed/learned from, especially as you enter the realm of specialties (Ortho/Cardiology etc.) In many offices (not all by any means) PAs are hired to perform more of the pre-op/post-op duties, as well as take call during the times that the MDs don't want to. Primary Care offices will often hire PAs and allow them to develop their own patient panel. From what I've seen the duties of the PA will depend on their SPs idea of how the relationship should work. Could end up great, could end up bad!

In regards to the educational models of NP v. PA there is a large disparity. NPs are trained in the nursing model, more of a holistic approach, whereas PAs are trained in the medical model. Many PA programs are run by the school of medicine associated with whatever university they are at, classes are shared with MS1-4s, same faculty teach many classes etc. So there is a large difference in the didactic period. Clinically PA students (from what I've seen) are exposed to a greater number of hours as compared to NP students.

A large point of contention between the two educations has been the fact that there are several online-only, and direct entry NP programs. PAs have always been proud that there has historically been a large number of direct HCE hours required for admission to their programs, but that is starting to go away with the large number of newer programs opening up.

A large number of states allow NPs to operate independently, that has caused quite the schism between the AMA and the BON. And although the opportunity is there to operate independently, from what I've read it's a statistically negligible number of NPs who actually do. PAs will always be required to have an SP, although state laws vary on what the duties of the SP shall be. Some require the SP to perform a certain % of chart reviews, some want the SP on site, while others require that your SP be available by phone in the incident a consult is needed.

And on a last note, while the terminal degree of the NP profession is indeed a PhD, that is an academic doctorate, and (in my personal opinion) should not be used as a title in the clinical environment. I find it to be misleading to patients, and false advertising if you will. PAs have the opportunity to earn a PhD as well, although if you have attended a B.S. program rather than an M.S. you will of course have to achieve your master's degree prior to attending. If I recall correctly there is the Doctorate of Physician Assistant Studies and a Doctorate of Clinical Health Sciences.

This post was in no way intended to offend any NPs or future NPs here, just my simple attempt to explain some of the differences between the professions. And now after looking at my watch, I realize that I have successfully slaughtered a large chunk of my study time...

 

[MediMike]

Way to provide a much more succinct answer there Brandon...makin' me look all blabby...

 

[Sublime]

After 10 years in EMS I've started PA school so I'll add a little input here...

First off, PAs don't truly "specialize". You're trained as a generalist, with the large majority of schools focusing mainly on primary care. With that being said, there are a growing number of residencies available after you pass the PANCE to help you land a job in a specialty/sub-speciality. NPs are trained in a specific specialty, be it Family Practice Acute Care etc.

The idea that PAs end up with a better work week than MDs is a definite myth from practicing folks I've talked to/shadowed/learned from, especially as you enter the realm of specialties (Ortho/Cardiology etc.) In many offices (not all by any means) PAs are hired to perform more of the pre-op/post-op duties, as well as take call during the times that the MDs don't want to. Primary Care offices will often hire PAs and allow them to develop their own patient panel. From what I've seen the duties of the PA will depend on their SPs idea of how the relationship should work. Could end up great, could end up bad!

In regards to the educational models of NP v. PA there is a large disparity. NPs are trained in the nursing model, more of a holistic approach, whereas PAs are trained in the medical model. Many PA programs are run by the school of medicine associated with whatever university they are at, classes are shared with MS1-4s, same faculty teach many classes etc. So there is a large difference in the didactic period. Clinically PA students (from what I've seen) are exposed to a greater number of hours as compared to NP students.

A large point of contention between the two educations has been the fact that there are several online-only, and direct entry NP programs. PAs have always been proud that there has historically been a large number of direct HCE hours required for admission to their programs, but that is starting to go away with the large number of newer programs opening up.

A large number of states allow NPs to operate independently, that has caused quite the schism between the AMA and the BON. And although the opportunity is there to operate independently, from what I've read it's a statistically negligible number of NPs who actually do. PAs will always be required to have an SP, although state laws vary on what the duties of the SP shall be. Some require the SP to perform a certain % of chart reviews, some want the SP on site, while others require that your SP be available by phone in the incident a consult is needed.

And on a last note, while the terminal degree of the NP profession is indeed a PhD, that is an academic doctorate, and (in my personal opinion) should not be used as a title in the clinical environment. I find it to be misleading to patients, and false advertising if you will. PAs have the opportunity to earn a PhD as well, although if you have attended a B.S. program rather than an M.S. you will of course have to achieve your master's degree prior to attending. If I recall correctly there is the Doctorate of Physician Assistant Studies and a Doctorate of Clinical Health Sciences.

This post was in no way intended to offend any NPs or future NPs here, just my simple attempt to explain some of the differences between the professions. And now after looking at my watch, I realize that I have successfully slaughtered a large chunk of my study time...

Thanks for the post. Last time I looked I thought that the only place offering a doctorates degree for PAs was the military though, perhaps I'm wrong on that though.

And I agree on not using the title in practice, it is misleading. I still would seek out that level of education anyhow just for personal goals and increased knowledge.

 

[MediMike]

Whoops! You are correct about only Baylor's offering of a Doctorate in EMed for PAs. I was mistaken, there are other doctorate level degrees available to PAs though!

 

[Brandon O]

Way to provide a much more succinct answer there Brandon...makin' me look all blabby...

Yeah, me, I'd never blab <_<

Not sure what I'd make of a PhD in PA studies, but then, I'm not sure what to make of a DNP either, so it is what it is.

Edit: Mike, are you at MEDEX?

 

[MediMike]

You could walk around telling people you're a doctor, garnering the respect of men and the desire of women...Of course since it's an academic doctorate you'd be able to wear a tweed jacket with leather patches on it's elbows, smoke a pipe without looking like an idiot, and perhaps wear more argyle??

 

[JPINFV]

You could walk around telling people you're a doctor, garnering the respect of men and the desire of women...Of course since it's an academic doctorate you'd be able to wear a tweed jacket with leather patches on it's elbows, smoke a pipe without looking like an idiot, and perhaps wear more argyle??

What's wrong with tweed? Tweed is cool!

 

[MediMike]

I forgot the damn bowtie didn't I...

 

[eprex]

After 10 years in EMS I've started PA school so I'll add a little input here...

First off, PAs don't truly "specialize". You're trained as a generalist, with the large majority of schools focusing mainly on primary care. With that being said, there are a growing number of residencies available after you pass the PANCE to help you land a job in a specialty/sub-speciality. NPs are trained in a specific specialty, be it Family Practice Acute Care etc.

.

I consider that to be specializing but maybe I'm ignorant to the true definition. For instance I've heard great things about becoming a surgical PA.

http://www.aaspa.com/page.asp?tid=99&name=Surgical-PA-Specialties&navid=22

 

[eprex]

While it's not the be all end all of medical information, I thoroughly enjoy the student doctor network. You can always ask questions there as well.

http://forums.studentdoctor.net/forumdisplay.php?f=113