PCP to ACP with no experience

[BEorP]

What are everyone's thoughts on going straight to ACP with no experience at the PCP level?

I know some of our American friends have said that there is no point in working as an EMT-B and have pointed out that other health professionals do not need to start at a BLS level. I am wondering if they feel the same way about this with PCPs and also what Ontario medics think about this. (It seems that our situation is at least a little different since PCPs can get fairly well paying jobs and at least do a bit of SR.)

I know it is an expensive thing to do, but with our 500 hours field experience during PCP school enough to go onto ACP training?

Will it make the job hunt easier than trying to find employment as a PCP?

What about EMS politics, will it be frowned upon by other medics if you are an ACP who spent no time as a PCP?

If money were no object, would you (an Ontario Paramedic) have gone straight to ACP?

[vs-eh?]

Well this basically wasn't even an option a couple of years ago so...And even still Durham College is the only CMA accredited (why you would go to a non-CMA ACP school I don't know) school that you can go to ACP with no autonomous practice in a provincial service.

I wouldn't be surprised if Durham starts to get flooded with applications within the next year or two, especially as PCP spots start to be scarce in the GTA.

The other colleges I bet will start to get an increase as well, even though they generally require 1-3 years PCP experience...

I know it is an expensive thing to do, but with our 500 hours field experience during PCP school enough to go onto ACP training?

Personally, I don't think so. I say a year in a service prior to ACP. This is even with me saying that the 2 didactics were quite similar. There is more to paramedicine than being book smart. I don't think 500 hours of preceptor experience as a PCP and 500+ as an ACP will offer enough to let you function well autonomously, than if you had a year under your belt as a PCP.

Will it make the job hunt easier than trying to find employment as a PCP?

As a PCP? I don't see what would change. People have degrees, ACLS, BTLS, PALS, NRP, Man of the Year, Nobel Prize, whatever... I don't think it really would change things if you wanted to be a PCP...

What about EMS politics, will it be frowned upon by other medics if you are an ACP who spent no time as a PCP?

Oh, I guarantee you that. But that will pass with time hopefully...People take a razzing if they have less than 5 years on here...

If money were no object, would you (an Ontario Paramedic) have gone straight to ACP?

Tough to say. I did well in school and stuff. Ummmm, I dunno. I did however do my ACP earlier and outside "the system". If money were no object and stuff I'd do flight ACP then CCP. I just looked though and ACP(f) requires 2000 hours as PCP so....Meh, whatever...

[Neesie]

I believe it is very important to work for a while after any education you receive before going on to the next level. This is the time that you perfect your skills. Just because you finished school and passed the exams as well as any provincial exam you may have to write to get your registration, doesn't make you "good" at what you do. You need the experiences you get while working to help you along with any further levels.

Practicums give you some experience, but I feel that you need more than that. If you do just one code, does that make you comfortable and knowledgeable for the next one? Probably not. If you do a lot of them then maybe. We have a lot of students that go through our service and for a lot of them they are only required to do 20 calls and then they are eligable to write the provincial exam. Some of them go straight on to paramedic school and a lot of them fail because they aren't prepared for it. All of our students are required (by our service) to be at the service for 21 days and do all calls and THEN if we feel they are prepared, comfortable and doing well, we will pass them.

It is while they are working that they develop the ability to talk to patients, to gain confidence and knowledge and the ability to perfect their assessments, skills and techniques.

This is just my opinion but I do strongly feel that you should work for atleast 6 months to a year before going on to further your education.

[Dustdevil]

I am trying to stay out of this because you specifically asked for an Ontario perspective. However, I just want to say that I pretty well agree with VS here. Ontario education is completely different from the so-called "education" in the US. And, because of that, I agree that some practise time is indeed very beneficial to a PCP before continuing to ACP school. I might even go so far as to require it, although I am not sure.

Again, Neesie, I am disappointed with your continued focus on skills. What "skills" did you learn in ACP school? How hard is it to splint somebody or stick a puffer in somebody's mouth? How much practise does one need to perfect that? And how often does a PCP even use any of that stuff anyhow?

• This is the practice of medicine. It is about scientific knowledge and understanding. The ability to examine a patient, evaluate the information, and arrive at a prudent clinical impression and plan of action is what it is all about. That is what you need a year or two to validate and sharpen with practise. And that is what a PCP receives a significant education in, whereas an EMT receives next to none.

[Neesie]

OK Dust. I appologize for using the word "skills". I used that word because in other posts I have been jumped on for saying that I pracitce medicine. They have said that I apparently don't know what I am doing because I have to practice. Anyway, It is easier to say that one needs to perfect their skills learned rather than saying that one needs to perfect their education they were taught.

I understand what you are saying Dust. Infact I agree with what you are saying. You just have the ability to say it better than I do. :roll: :?

[BEorP]

Thanks for your input, Dust. I didn't mean to exclude the Americans completely and it's good to get your input, especially since it's different than EMT-B to EMT-P.

As a PCP? I don't see what would change. People have degrees, ACLS, BTLS, PALS, NRP, Man of the Year, Nobel Prize, whatever... I don't think it really would change things if you wanted to be a PCP...

I mean is it easier to get a job as an ACP than a PCP?

Do you think 1-3 years of experience is worth it even if it is with a county service like Huron or Bruce where the call volume is extremely low?

Also, you said that ACP(f) requires 2000 hours as a PCP so if you got to ACP before then you're out of luck? (probably a stupid question...)

[vs-eh?]

I mean is it easier to get a job as an ACP than a PCP?

Easier to get a job? I dunno, maybe? Just considering numbers of new PCP's to new ACP's any given year in Ontario. ACP's would represent a fraction of PCP's...

Do you think 1-3 years of experience is worth it even if it is with a county service like Huron or Bruce where the call volume is extremely low?

I think it would. Personally, I would be bored to hell but you would be as an ACP too. Autonomous experience is autonomous experience.

Also, you said that ACP(f) requires 2000 hours as a PCP so if you got to ACP before then you're out of luck? (probably a stupid question...)

http://www.ontarioairambulance.com/education.html

Well, you wouldn't be out of luck persay. It is just that ACP(f) encompasses both land and air, so it would be redundant in many aspects to take both full courses. Therefore, they have a bridge course...

http://www.ontarioparamedic.ca/job_postings.html

Too bad, OAABHP just had some PCP spots in Moosonee. I am pretty sure that if you went up there they pay your way for education and you might be able to bypass some of the "experience" limitations that the program generally has. Lithium would be a better person to talk too about that though...

[Dustdevil]

Will it make the job hunt easier than trying to find employment as a PCP?

I think it *might* be a factor in your favour when applying for a position to already be an ACP. It sort of complicates matters though. If you apply as an ACP, you're probably not going to get hired by the big boys if you have no street experience. If you apply through centralised testing as a PCP, then the ACP creds may well be that little something extra that gets you hired over the next guy. But you'll still just be a PCP. And let me tell you, bro. Working below your educational level is an extremely frustrating experience that most people can't handle for very long. You'd be miserable.

On the other hand, you're one of the smartest guys in your class. You're going to come out of school with good marks, good understanding, and a high score on the AEMCA. You're more than likely going to find a PCP job pretty soon anyhow. Certainly sooner than you could finish ACP school. So, all the way around, you are probably much better off going straight to work after PCP school.

I mean is it easier to get a job as an ACP than a PCP?

Very dependent upon where you are looking. In the GTA, the application process is definitely a LOT easier for ACP's than PCP's. But beyond that point, the selection process probably isn't a lot easier. Especially with no experience. Look at it from the agency's point of view. They are going to have to invest just as much time and effort into training you as they would a new PCP, yet pay you more. Why would they want to do that? If you move out of the GTA to a service a little farther away from the glut of schools, then yes, you will probably find it easier to find an ACP job than a PCP job. But the short answer is, you probably won't find yourself a whole lot more marketable as an ACP with no experience than as a PCP with no experience.

Do you think 1-3 years of experience is worth it even if it is with a county service like Huron or Bruce where the call volume is extremely low?

In most cases, this theory is very overstated. The belief that rural medics are usually less experienced is one of the biggest myths in EMS. Do county services make fewer runs than urban services? Sure. But they also have proportionately fewer ambulances, and consequently, proportionately fewer medics. That means that things come very close to evening out, and you as a medic are still going to be making a good share of runs. You are also going to be caring for patients for much longer periods of time because of the increased transport times. Any difference in run volume is more than made up for by the length of patient contact and treatment times.

[BEorP]

Thanks for all the feedback.

Another question regarding non-in-house ACP training... how hard is it to get into? (even with experience)

What is it that they look at with admissions that you can be working on in your few years as a PCP before applying?

[northernmedic]

Hey BEP,

I can only offer you my experience from the west coast. I recently finished my ACP and I had 7 years experience when I was accepted into the course. Here you need a minimum of 3 years and 1000 911 patient contacts as well as doing a written exam, 4 OSCE's and an interview. I am a firm believer that experience will only help you. Education is very important but I think you really need the right combination of education, experience and maturity to be an excellent ALS provider. I worked in a variety of station all the way from downtown Vancouver with tons of resources down to the lone PCP unit with no backup for miles in a rural area. Working and developing your own practice and clinical judgement is very different on your own than with a preceptor. For me one of the hardest things to develop was the ability to defend my treatment plan for a pt. Experience gives you the confidence to do this, especially with hospital staff. Certain hospitals around here have notorious nurses that give you the gears about anything. Some things that I found that really helped me to prepare for ACP when I was a PCP:

1) Work lots, see lots of pts, preferably in a role where you are responsible for making decisions and developing a treatment plan and not being a glorified driver for an ACP.

2) Do rideouts with an ACP unit.

3) Follow up on all pts that you bring in, especially complex cardiac or respiratory pts. Talk to the ER doc, review the hospital ECG and the doc's diagnosis.

4) Do some prestudy. Not sure exactly what references you guys use but crack the books and review medical directives, ACP pharmacology and brush up on all your respiratory and cardiac patho. I found that when I revisted my patho a couple years after school I was able to really relate it to real life a lot more after seeing a few hundred more pts, rather than just learning in lectures/labs.

5) Forget physical skills for the time being. You will get lots of opportunity to practice IV's, intubation etc.

6) Become a leader. Most of the good ACP's I know are good leaders and role models. Think about mentoring young PCP students and be the type of paramedic where you are respected by everyone from the hose monkeys to the emerg docs.