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

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.
 
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
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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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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.
 
^^^^
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
 
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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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?
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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.
 
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.
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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.
 
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
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Thanks for this. It's something I've been struggling with lately. I have been looking at getting involved in education soon.
 
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
 
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
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I can't think of any program in Texas that a Bachelors is not already a requirement...
 
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.

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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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.
 
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.
 
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.
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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.
 
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.
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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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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.
Click to expand...


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......
 
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.
 
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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