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

Handsome Robb

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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.
 

VFlutter

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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

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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.
 

STXmedic

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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.
 

STXmedic

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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.
 

DesertMedic66

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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.
 

VFlutter

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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

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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.
 

Chris07

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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 :p
 
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MrJones

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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

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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.
 

Wheel

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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.
 

Anonymous

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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.
 

MrJones

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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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Remi

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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.
 

ExpatMedic0

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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/jacquelynsmith/2013/06/07/the-best-and-worst-masters-degrees-for-jobs-right-now/
 
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ExpatMedic0

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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.
 

TransportJockey

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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.
 

ExpatMedic0

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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

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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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