PA, NP, MPH, MD/DO...

[UMSTUDENT]

I'm looking for some input from former paramedics who have continued their medical education at the graduate level. Specifically, I'd like to hear from paramedics who became nurse practitioners, physician assistants, or physicians. Individuals who sought other paths are welcome too.

What influenced you to choose the profession? How long were you a paramedic before?

You don't have to have been a paramedic, but I'd like to hear from people with prehospital experience.

[Ridryder 911]

I am currently enrolled in a NP program. I was in a PA program previously, but due to personal and financial reasons (not being able to work >12 hrs a week) I chose the route of NP. Nothing wrong with either program, except in some states a NP does not have to be "attached" to a physician to practice, where as the downside is a NP usually specializes (neonate, acute, geriatric, etc..) whereas a PA-C is more broad based.

I had been accepted to medical school (two of them MD & DO) on my 40'th birthday, but after discussing with several friends that were physicians, I took their advice and did not enter. Partly due to the amount of student loans, the time I was able to due residency, etc.. I only met one physician that described they would actually do it all over again.

I have been a Paramedic for > 30 yrs, an RN for 18 and have a total of four collegiate degrees, and still drive an ambulance ....

Personally, I only looked at MPH when I worked in Trauma Research and was closely linked to the State Department of Health. After reviewing the curriculum, did not have the interest in pursuing it. There are plenty of MPH out there.

My suggestion is if you are considering PA route to work in a clinic/urgent care area or ER, and be exposed to general medical care. For the NP route, many programs require 3-5 years as an active RN.

Good luck,

R/r 911

[UMSTUDENT]

...

Good luck,

R/r 911

Thanks Rid. I especially appreciate exactly how you came to make the decisions you did.

I love education, but I also want a career and family. I'm at a crossroads. There are so many things that I feel I would enjoy to do in life, but feel only prepared to continue in medicine. Some people have suggested I work for awhile, but I fear that I may never be capable (financially and family-wise) to return to make an extensive full-time commitment as student.

A lot of people are like, "Be a paramedic for a while," but if my education has taught me anything it is that this field is hugely fragmented, mostly unstructured, and lacks little-if-any upward mobility. Plus the pay generally sucks.

[Doczilla]

I made the decision to go to med school right around the end of my paramedic training (though I spent another few years in the field before making the leap). I knew that medicine was what I liked to do. I wanted to understand more, do more, and accomplish more than I could as a medic. I like seeing the "big picture" from the seat as the MD. I also felt I needed to cut my teeth in the field before moving up. I had been in EMS for a total of 7 years (2 basic, 5 medic) when I entered med school. One day, after a night shift, I was getting a bite of breakfast at a diner by myself, and I had an epiphany: I had come as far as I wanted to come as a medic, and it was time to move on.

I largely changed over because the field is hugely fragmented, mostly unstructured, and lacks little-if-any upward mobility. Plus the pay generally sucks. :wink:

Becoming a physician is a long and difficult road, but each step is another step. If you don't keep telling yourself that you could do something else easier, then it's easy enough. Good family support is crucial; if your spouse doesn't believe completely in what you are doing, then it will be an unhappy ride at home, and one of two things will end: your marriage or your medical education. It is an adjustment to go back to being a poor student after you've stretched your wings a little bit and earned a salary. If you have a REALISTIC picture of what awaits you at the other end, you can endure this bit of difficulty.

None of my med school classmates dropped out for financial reasons. Though the numbers are frightening, none have any worries about being able to pay off their financial aid (barring unforseen catastrophe). Most I know have it paid off within 5 years of finishing residency, and not by starving.

I hear plenty of folks say, "I thought about being a doctor, but the schooling was too expensive/hard/long/trying on the family for me to do it." I have never heard any of my colleagues say, "I should have stayed a medic/RN/PA because this was a waste of time." Physicians who are flirting with burnout occasionally do say that they regret going into medicine. A lot of that has to do with recent changes in the work environment for physicians, who remember easier times with less liability and lower insurance and better call days and higher salaries. It's still the best job anywhere.

NPs and PAs, though they often fill similar roles, come up in vastly different training environments. PA school is essentially an abbreviated, intense version of MD training. The mindset is the same, and they generally do well in physician-extender roles. NPs come up through the nursing ranks, so the mindset needs to switch. I work with several extremely smart and competent NPs who do a fine job as physician extenders, but I don't imagine it's something that all NPs are able to do. Since Rid has been borne up the ranks of EMS, and is used to a certain amount of autonomy, it is probably easier for him.

There is nothing wrong with being a medic for a while, but to avoid losing too much ground, start working toward med school or nursing school immediately. Finish your prerequisites, explore financial aid, start looking at programs to see what you like. Visit some schools, talk to the students, get the guides to med school (AAMC and AAOMC put out publications yearly with profiles of MD and DO schools, and there are many others available at Barnes and Noble) and imagine what it would be like to be there.

'zilla

[medic_texas]

Doc,

I disagree with your statement about NP's "mindset needs to switch". Nursing has it's own approach towards medicine. True, the nursing approach is different than traditional medicine (MD, PA) it is still effective and has purpose. I think to fully understand nursing you must be a nurse. Example: a lot of nurses don't understand why medics do certain things and vice versa. It's not a knock against nursing, PAs, or medics, just explaining that it is different. I'm sure you have encountered some incompetent people while working, doc.

I do agree that nurses with an EMS background are better nurses as nursing does lack in some areas. I think the "nursing theory" is a lot of common sense to medics but I think this "theory" is mainly to get away from officially diagnosing patients (medical diagnosis) but still addressing their problem.

We left out CRNA.

I think FNPs have an advantage over PAs simply because they have experience in the medical field. As with every area of medicine, we have our bad apples (the morons) and we have the good apples (the ones who do a great job), so I'm sure our personal opinions reflect some of our experiences with each area (MD, PA, RN, medics).

I've been a paramedic for 6 years and I will graduate RN school in May. I'm like doc, I really felt like I achieved everything I could as a medic. I felt like I could do more and better myself; but to continue to support myself and my family for the next several years, I chose nursing. 2 1/2 years to get my RN and make about double what I make now seemed like an easy choice. I also have other reasons like: Working with an RN for a flight service, I do the exact same job as they do. The difference is they make twice as much as me. Why do the same exact job for half as much money? Also, nursing opens many doors to me (PA, FNP, CRNA, or management). PA or MD would be very limited for me and I tend to get bored easily, I feel like nursing will give me an opportunity to change if I needed a change.

There is a PA program that I'm looking into that is designed for nurses. FNP programs in my area are mostly online. And CRNA school is tough and would be similar to medschool, only shorter in time (similar because I wouldn't be able to work and I would live off loans). I'll make up my mind as soon as I figure out where my life is going to go after I graduate.

Congrats to anyone who has or is looking get an education and advance their career! Sorry if my grammar is poor, I worked last night and I'm about to hit the hay! Be safe!

[UMSTUDENT]

I made the decision to go to med school right around the end of my paramedic training...

'zilla

How did you finish your prereqs for medical school? I'm about to finish my B.S., but still need to finish Organic Chemistry (8 credits) and Physics (8 Credits). I also may need to take another semester of English if I decide to pursue the DO route.

When I finish school, I'll probably start working a bit. I've heard that finishing at a university or enrolling in a formal post-bac program is what medical schools would like to see, but the local community colleges (who offer everything I need to take) are VERY cheap. Whats your take on this? I'm a good student, but money is an issue. One of my professors, who is an MD, states that medical schools don't care where they were taken so long as you did well. However, he did mention that the need for a composite letter of recommendation from your school pre-health committee is hard to acquire from community colleges.

Oh and thanks for the advice. It means a lot.

[JPINFV]

However, he did mention that the need for a composite letter of recommendation from your school pre-health committee is hard to acquire from community colleges.

Oh and thanks for the advice. It means a lot.

I wouldn't worry about getting a composite letter provided you can get letters of rec from your professors (2 science, 1 non-science seems to be the common advice. DO schools generally want a LOR from a DO as well). There are a lot of major universities that do not offer composite LORs.

As far as post-bach programs, there are a wide variety of them. The current "flavor of the month" programs are the "Special Masters Program" (SMP). SMPs generally follow the first year medical school program and have their students take the same courses. How those courses are taught vary from school to school though. For example, Drexel simulcasts their medical school courses to their master students whereas Tufts University's program (new this year and the program that I'm in) has the professor teach the course at a different time to the master's students in most cases (for example, the medical students might have a biochemistry lecture at 8 am and the master students will have the lecture at 1pm. The exams in these courses are the same between the master and medical program and given at the same time. Some courses are simulcasted though). These programs generally have the same admissions requirements as medical school.

There are also programs out there (post bach and masters) for students wishing to apply to medical school who didn't complete the prereqs during their undergrad. I suggest hitting up the postbach forum on www.studentdoctor.net . Take any advice there, and especially anyone spitting out stats (GPA, MCAT) with a grain of salt. There are plenty of 4.0 and 45 trolls there.

[Dustdevil]

I disagree with your statement about NP's "mindset needs to switch". Nursing has it's own approach towards medicine. True, the nursing approach is different than traditional medicine (MD, PA) it is still effective and has purpose. I think to fully understand nursing you must be a nurse.

I admit that I stumbled over Zilla's words the first time through too. But I think you and I may have misread what he was saying. I don't think he was saying that the nursing mindset in general needs to change. I believe he meant that a nurse who enters primary care as, for instance, an FNP or a PA, needs to shift gears to a different mindset, and that is very true. That does not mean that he/she needs to lose those positive mental attributes that make nursing practice what it is. It just means that your overall focus does need to change. What he is saying is that, just like a medic must totally change his attitude in order to practise as a nurse, a nurse must totally change his attitude to practise as a primary care giver (physician/extender). As a person who has made both transitions, I would fully agree with that.

I would also agree with you that, if general primary care is where you want to go, that an FNP -- generally speaking -- has an edge over a PA, in that he has a much broader foundation to build upon, resulting in a little better attention to detail. However, as was already stated, FNP is the only post-grad nursing specialty that really compares to NP, as all others are very specificially focused specialties. Because of that, if you are exploring options, you have to determine for yourself if a narrow focus is what will make you happy. I have tried it and found that I am not happy for very long when working a specialty focus. I need variety. If that applies to you too, then CRNA or any of the other nursing specialties probably won't be for you.

[medic_texas]

If that was the meaning, then I agree with it. However when I read it (and yes, I was a little tired) I was like... uhh.. why do NP have to change their mindset?

I'm leaning towards PA or FNP honestly. I did love doing my intubations with an Anesthesiologist in the OR during medic class and in nursing school me and the Doc got along great (swapping ET stories, he was an old medic too). Plus, CRNA's BANK!

[Doczilla]

I disagree with your statement about NP's "mindset needs to switch". Nursing has it's own approach towards medicine. True, the nursing approach is different than traditional medicine (MD, PA) it is still effective and has purpose. I think to fully understand nursing you must be a nurse. Example: a lot of nurses don't understand why medics do certain things and vice versa. It's not a knock against nursing, PAs, or medics, just explaining that it is different. I'm sure you have encountered some incompetent people while working, doc.

I don't mean to say that NPs are less competent or poorly suited for the profession. As I said in my post, I have worked with many very competent NPs, and continue to do so on an ongoing basis. I respect their input and experience. What I meant to say was that the individual who has completed nursing school and gained valuable experience as a nurse must be trained in a different role, one not germane to the formative years of nursing education. This requires the change in mindset I was referring to.

Dustdevil, as always, is quite eloquent in his reply.

NP training is designed to build on the medical foundations of nursing education and utilize the experience of the practiced nurse to bridge the gap to a physician extender. Physician Assistant training trains the practitioner in the physician extender role from the ground up.

If you want to be a physician, go to medical school. If that's really what you want to be, then you will never feel fulfilled by any other profession.

If you want to be a physician extender, go to PA school. Why go through all the nursing school, master's degree, clinical practice, and NP school if you just want to be a physician extender? If you're already a nurse, then NP school is a viable option.

I can't think of anything more boring than being a CRNA. Yeah, they bank, but they sit for HOURS ON END doing nothing but checking little boxes. The difficult airways are managed by the anesthesiologist. And I don't know too many CRNA's who started out as nurses to be CRNA's. They become CRNA's because they like the money and the easy hours and it represents a slowed pace from most other nursing practices. I say that with respect, owing much of my initial airway training to CRNA's.

'zilla