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

[VFlutter]

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.

 

[Christopher]

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?

 

[Rialaigh]

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.

 

[ExpatMedic0]

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.

 

[Carlos Danger]

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.

 

[FLdoc2011]

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.

 

[WTEngel]

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.

 

[Handsome Robb]

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.

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.

 

[Gastudent]

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.

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.

 

[rescue1]

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.

 

[WTEngel]

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.

 

[ExpatMedic0]

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.

 

[FLdoc2011]

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.

 

[WTEngel]

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!

 

[Summit]

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?

 

[NomadicMedic]

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?

 

[chaz90]

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

Haha, growing up I suppose?

 

[Carlos Danger]

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.

 

[Summit]

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.

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.

 

[hawkeyemorgan]

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.