MD to EMT?

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medicdan

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I have a family member who graduated from medical school about five years ago, completed an internship and residency in Intensive Care. He is interested in moving to EMS/Paramedicine. He thinks that the money could be better, better job opportunities, more flexible shifts, etc.
He asked me what he would have to do. I wasnt sure and told him I would get back to him.
I assume that he would have to sit through a class (100% attendance), and pass a state test (or NREMT), is that correct? Are protocols that different? Do things change if there is an MD in the ambulance that follows the pt from scene to ER?

Thanks a lot!!
DES
 
not sure how it works out there but seriously medics dont get paid well at all vs. a doctor. EVEN if you are a doctor it dosent matter you have to be an emt-b or emt-p at your job. We have RN's on the squad but they cant do ivs or anything RN related. they only can do EMT-B scope of practice.
 
Around here, doctors who want to ride on ems vehicles have to take the required ems classes like everyone else.

If he thinks the money is better in ems then I truly feel sorry for him. I would give my first born child to have his job.
 
I can not think of a system in the US that still utilizes a doctor on EMS units full time since the 1980s. Some European systems still have physicians in their systems.

There are arrangements between EMS and the emergency departments in some regions to provide a doctor on scene in special circumstances such as extrication that may require amputation at the scene. Maryland EMS and Johns Hopkins Hospital (as do other major trauma systems) have a close relationship for quick dispatch of a physician if absolutely necessary.

Residents doing their rotation in Emergency Medicine do ride with Paramedics for the experience of the field but primarily as an observer.

Air Ambulance transport companies utilize physicians but most of them also have hospital jobs to maintain skills.

With the huge demand for Intensivists, an ICU trained physician can pretty much write his/her own contract with the right credentials.

Also, a new physician without ED experience/affiliation would be of little use to an EMS system as a Medical Director.
 
Good points Vent. As well the liability issues would be incomprehensible. There is something very fishy with someone finished medical school with residency ( I am guessing has a license to practice?) that wants to go into the field. Sorry, this is illogical.

The liability alone would be preventative. As a licensed physician, not performing at their license level they would be held negligible. Unlike, EMT's and medics, they are never "off duty" where they only can perform care "on duty", the only time they do not have a license to practice in the area. They cannot "go to a lesser level". As well, how is a medical director going to "cover" another physician.... this is ludicrous.

Sorry, he should had thought this out before medical school. As well, I am sure once exposed to the real world, a change in heart would suddenly occur. Especially, seeing the exposure of what we do, the poorly financial income.

As others have stated, there are residency programs for EMS. As well, very few states require Medical Directors to be board certified in either EMS or even Emergency Medicine, rather just to be a licensed physician.

I do not want to imply that if his interest is true to discourage him. We need as many interested physicians we can get. I highly suggest, he might contact NEMSP or ACEP and State EMS agencies, I am sure they would love to have his expertise.

R/r 911
 
Yeah, since the NREMT requires verification of course completion, I do not know how he could take the national registry without taking the courses. If he really wants to be in EMS, I guess he could try to find the shortest courses possible. Being an MD should make the courses fairly routine for him. Practical skills such as backboarding still require practice though.
 
Thank you for your responses. I thought this was a crazy idea at first, but didnt realize how crazy. The salary really is not comparable, and there is a shortage of MDs. I was not aware that anything was going on with him, I just thought this was an early mid-life crisis.
I will pass this information on to him.
Thanks a lot!
DES
 
Is he thinking of adding EMT or some sort of field emergency experience to his credentials? I know there are doc's who do that. It makes them a bit more attractive as an ER doc if they have some field experience.
 
My understanding is that Pittsburg EMS uses EMS residents as an on-shift medical presence at all large emergencies and anything that "sounds cool".. my understanding is that the doc can go and provide additional care, and some on-scene medical direction.

Also... your friend may want to consider an emergency medicine residency program... some areas even have EMS/Disaster Medicine fellowships.. I know Philly's got one or two.. if he is really intrested... PM me and I'll try to find the info.

Good luck.
 
Glorified said:
Yeah, since the NREMT requires verification of course completion, I do not know how he could take the national registry without taking the courses. If he really wants to be in EMS, I guess he could try to find the shortest courses possible. Being an MD should make the courses fairly routine for him. Practical skills such as backboarding still require practice though.
Click to expand...


Simple, NREMT will honor his education level and allow him to test out. Doctorate in medicine far supersedes any Paramedic certificate .. hmm 8 yrs of university and 4 years of residency in comparison to 3 months to 2 years associate degree? ATLS and other courses have skill stations that teach the fine points of backboarding, etc. Basic skills is not rocket science and the theory is all taught in general medicine. Remember EMS came from medicine, not the other way around.

Even OB Doc's spend more time in ER internship than most EMS students. :o
 
well aware EMS came from medicine. I was not aware NREMT would honor his education level considering these things are usually a pain in the arse. But that is great for him, if he can test out. Interesting.
 
i still cant believe that there is actually a person on the planet that entertained the thought of moving from md to emt for a pay INCREASE. thats so ridiculous as to be laughable. take a look around the p-lot of your local rescue house. see a lot of bimmers, benz's or porches?
 
Jon said:
My understanding is that Pittsburg EMS uses EMS residents as an on-shift medical presence at all large emergencies and anything that "sounds cool".. my understanding is that the doc can go and provide additional care, and some on-scene medical direction.
Click to expand...

Emergency residents are required to do ride time as part of their training. However, their role is limited due to liability reasons to primarily observing. They can do some skills, the same as a student paramedic, under the guidance of the EMS medic. They are essentially still in training and the hospital/med university are responsible/liable for their actions. Many times their liability insurance will not extend beyond the walls of the hospital as a resident. Several times we were their baby sitters to keep them out of harm's way. Some had an enthusiasm for the field, but many saw it as just another requirement to get through their residency and move on.

When a physician is requested on scene for special procedures such as an amputation, a fellow or at least 4th year surgical resident (surgery usually has a 7 yr residency) or possibly an attending will go. Medical direction is usually limited to a Fellow or Attending. That is whose direction the residents are working under.

This is also the same when NICU residents ride along on transports. Their function is not to interfere with the protocols set forth by the attending and any deviation requires a call to the attending. A few programs do have residents on all NICU transports but that is a rarity now. If the nurses are not extended intubation privileges, NPs are not utilized and RTs are in short supply, then a physician might be used. Most specialty teams (RN/RT/EMTP) have advanced skills and are trained directly by the medical director.

At Rid mentioned, doctors can challenge the exams if they want the credentials or if they are in a teaching role for the paramedics to gain insight on the exam and skills.
 
I wont question it, I dont know anything about it, Im just assuming its for personal satisfaction. In that case I agree
 
My impression is that Pittsburgh is a bit unique in their MD response - the residents don't do "ride-alongs" per-se...they've got thier own pimped-out explorers that they can drive directly to the scene....they aren't just observing the medics.

from Field Termination of Unsuccessful Out-of-Hospital Cardiac Arrest Resuscitation: Acceptance by Family Members.
Annals of Emergency Medicine, Volume 27, Issue 5, Pages 649-654
T. Delbridge, D. Fosnocht, H. Garrison, T. Auble

I'd post a link but you need a subscription .

"In the Pittsburgh EMS system, a postgraduate year 2 or 3 emergency medicine resident physician responds in a specially equipped vehicle to critical EMS incidents.12 The emergency medicine residents have completed ACLS, Basic and Advanced Trauma Life Support, emergency vehicle operation, and base station physician courses and have been oriented to the Pittsburgh EMS system. These physicians provide on-scene medical direction for nearly all out-of-hospital cardiac arrest resuscitations. In approximately 60% of cases involving refractory cardiac arrests in a private residence, the EMS physician directs paramedics to terminate resuscitative efforts at the scene, and the dead patient is not transported to a hospital. No standard resuscitation termination criteria exist. An emergency medicine faculty physician supervises residents in the field by way of radio communication."
 
jrm818 said:
My impression is that Pittsburgh is a bit unique in their MD response - the residents don't do "ride-alongs" per-se...they've got thier own pimped-out explorers that they can drive directly to the scene....they aren't just observing the medics.
Click to expand...

They can drive and monitor everything instead of being on one rescue unit. They are experiencing this from a medical control point of view.

"An emergency medicine faculty physician supervises residents in the field by way of radio communication."
Click to expand...

The resident physicians are still in training and their teachers at the hospital are ultiminately responsible for them. They are reminded that they are in a field environment and not do anything that they can't finish or delay definitive care inside the hospital.

This is only one small part of their residency. They will have the opportunity to do this for maybe 1 month at the most and while rotating shifts with many other residents. They have many, many other rotations in other areas of medicine to complete in just 3 short years.

However, I couldn't imagine being a paramedic for a service that has someone always there "taking charge" on the scene. It will almost always be someone different each time with a different attitude for field authority, some great and some bad.
 
Glad I don't work there. Don't need a wanna be on the scene. Sorry, I am all in agreement of getting exposure to residents, but apparently the length of the tour is not enough to warrant true experience.

Personally, more than 4 people on a scene is too much....

R/r 911
 
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