Physicians on ambulances? As a career?

[Caduceus]

Recently after talking to my parents I got the idea of becoming a physician. But I don't want to work in a hospital.

I still want to be a firefighter and a paramedic, but what if I could work as a doctor on an ambulance? Would fire deptartments hire an emergency medicine physician who was also a firefighter, and had experience as a paramedic?

I want to work in EMS, preferably with some sort of ground ambulance service or FD, but I started thinking about this and wanted to know if it was a possibility.

[paramedicmike]

Not in the US. At least not in any US system I know of. There are places in Europe that use physicians on ambulances. It is a straight medicine job. To my knowledge it isn't mixed with the fire service like it is here in the States.

If you decide to pursue a career as a physician you have the option to apply to for emergency medicine residencies. Increasingly there are EMS fellowships available out there once your residency is complete. It would allow you the opportunity to be involved in EMS from a physician stand point. It might not allow you to run as a provider on the ambulance. But you'd be the boss as the medical director. There are always going to be trade offs.

[Caduceus]

I did a google search on it, and I realize that it's not a position fire depts. offer (at least not that I could find).

But is it even slightly possible that I could send in an application saying, "I'm a doctor and I want to do this." And they would let me? As a career?

Edited June 18, 2014 by Caduceus

[paramedicmike]

Their first, and probably most relevant question, would be, "Why do you want to do this?". You would be severely underemployed. They would be concerned that you'd up and leave once through with training for a better or better paying (or both) opportunity. With everything it would take to become a physician a FF salary wouldn't even come close to putting a dent in your student loans.

Besides, why go through the hassle of medical school to limit yourself as a paramedic?

[ERDoc]

You will not be able to afford to become a doctor on a FF salary. Why bother becoming a doctor if you want to work in the field as a medic/FF? There are opportunities for doctors to work in the field. Many medical directors still do field time. There are a few helicopter services that use doctors (but the pay sucks). No FD is going to care about your MD/DO unless you are going to sign off on their protocols. Otherwise it will be, "You went to medical school? Wow. Here's your hose, put the wet stuff on the hot stuff."

[triemal04]

Some medical directors can respond on some calls, though it's not on a regular basis. In St. Louis (I think) one of the EM residency programs lets third year residents fly on their helicopter. That's really going to be about all you'll find here.

Beyond asking what you really want to do with your life, a better question that you need to ask is, "how effectively could you work as a doctor in a prehospital setting in todays environment?"

Beyond doctors themselves, the equipment that they would need (ultrasound, possibly echo, lab capabilties [i-stats and the various cartridges aren't cheap when used all the time] plus a larger and more comprehensive stock of medications and routine equipment) isn't cheap. When you add in the fact that some patients need at least a couple hours of observation for repeat labs before discharge, and that many things would still require a visit to the ER (fractures, anything that needed a CT, anything that requires cultures, anything that needs more than a brief workup, anything that requires an x-ray and so forth)...and you further add in the nature of our legal system and how people will sue at the drop of a hat...what doctor do you think would be willing to spend all their time seeing patients in a setting where they would only be able to take care of the most minimal problems without a massive potential for a lawsuit if anything went wrong?

Add that to the question of, what department would be willing to spend all that money on equipment and supplies, wages for the doctor, a large and robust malpractise insurance plan for them, and then get very minimal return; how many people do you think could see on a daily basis in that role? How many could you really keep from going to the ER, bearing in mind that YOU are doing all the work that is usually done by ancillary staff? How many people do you think you could see and effectively treat in the field with limited equipment in a way that was safe for both the patient, and for YOUR continued practice?

Whenever some bozo brings up the fact that other countries use doctors as field providers, you have to keep in mind that those doctors are not being used in the same role as the average paramedic or even EMT; they are more limited in supply and don't respond to every call. They are paid very differently than doctors in the US (and due to differences in schooling often have different financial needs) with some of them still being residents. Those countries also have a very different legal setup when it comes to tort law and malpractice.

Food for thought.

[ERDoc]

You will also be held to the standard of care for a physician, not a FF/medic.

[Caduceus]

Good to see a lot of answers for me here, but I'm a little down in the mouth that most of them are negative. Not down on you guys at all, I need to hear it like it is. Thanks for taking the time to hash this out with me.

You will not be able to afford to become a doctor on a FF salary. Why bother becoming a doctor if you want to work in the field as a medic/FF? There are opportunities for doctors to work in the field. Many medical directors still do field time. There are a few helicopter services that use doctors (but the pay sucks). No FD is going to care about your MD/DO unless you are going to sign off on their protocols. Otherwise it will be, "You went to medical school? Wow. Here's your hose, put the wet stuff on the hot stuff."

What does it mean when you said, 'sign off on their protocols'? Not follow them, and work within an MD's scope of practice?

Triemal makes a good point with the cost to the dept. to equip an ambulance with all the equipment a physician would need/use. I considered the salary issues a department might have but not that. Thanks for pointing that out. The whole 'medical director' thing sounds cool, but if I can't work directly (ha) in EMS then I'd rather not do it.

ParamedicMike also made some good points that I appreciate; I guess what I was specifically looking for was whether I could work within the scope of practice of a physician on an ambulance, and even though I didn't really state that in a way I feel was clear enough you've all given me solid answers.

[ERDoc]

The protocols that prehospital providers work with are created by physicians. As a physician, you don't have protocols, you work under your license but I doubt you will find a department that is going to hire a physician to be a field provider, except in the cases of medical directors or the one or two HEMS services that use them. Another consideration to working in the field for a department is malpractice.

[Caduceus]

Another consideration to working in the field for a department is malpractice.

Yes as I was researching this myself I heard that the reason a lot of Emergency med physicians don't work on ambulances more often is because their malpractice insurance doesn't cover prehospital care.