Reply to “For EMS’ers, Is PA School Just the Next Thing to Do?”

Bob Sullivan at EMS Patient Perspective posted on one of my favorite topics today; brain drain in EMS.  What happens to great paramedics who get bored doing “vitals, oxygen, monitor, IV, transport” to the Nth degree for a few years?  They leave EMS!

If you haven’t read the original post, go check out “For EMS’ers, Is PA School Just the Next Thing to Do?”  Leave a comment or “Recommend” the post, then hurry on back here.  I’ll leave the light on for you.

Already back?  Good!

First, I agree that PA is a great goal for EMS providers, but it might be a pipe dream for the average paramedic with 5 years of street experience at McAmbulance. Here’s where I see obstacles for most:

1. Many will get tripped-up with the PA school entrance requirement of having a 4-year degree. It’s a damn costly endeavor. I’m still paying off mine, and will be for a while. Few McAmbulance operations are giving tuition reimbursement for employees to pursue a degree beyond the Associate’s degree they probably already earned with their paramedic courses.

2. Even if your employer pays for your 4-year degree, it will be a benefit to full-time employment only.  Ever try keeping your full-time job, family, and personal health together for several years while maintaining an “A” or “B” in Organic Chemistry and a handful of other prerequisite courses?  It’s something I’ve seen done, but only by a few high performers.  And I mean truly gifted people.

All that being said…
Going from paramedic to PA is entirely possible.
I’ve watched others do it.
They are very happy now.
You can do it, but it will be very challenging.
Here are a few tips. 

Second, there’s a bigger issue that needs to be addressed here.  That issue is our collective lack of career development.  As Skip Kirkwood so often points out in his writing, our law enforcement and fire/rescue peers have a dozen different career paths to take within their departments.  Since 2008, he’s been preaching that we need to develop career breadth for medics whose aspirations may not involve supervision.

Too many talented people leave EMS because we give them a job (something to do for a while) but fail to offer them a profession (something to pursue for decades).  As Bob Sullivan suggests, maybe they leave to become PA’s. Perhaps they depart to become RN’s or MD’s.  Regardless, they’re leaving and we need to address that.

Comments

  1. The last paragraph hits TOO close to home. It’s true! I love prehospital work, but am constantly defending my choice to family and friends. I hear, “You could be doing so much more,” or, ” When are you going to get a real job?” and, “What a waste of your education and talent.” (I hold several degrees) I am doing what I love to do, and you know what? I don’t have the super hero complex. I know I don’t save lives (all that often) but that I just keep a patient “going” until I can deliver them into the hands of an Emergency Department Doc. But that is an important “link in the chain,” and I’m happy doing it. It would be nice if it were viewed more as a profession instead of a stepping stone to a “real” job in the medical field. Thanks for the insight.
    PS. I’ve been doing this for about 20 years now, with a brief break after 9/11…I couldn’t stay away.

    • I heard the same things from my peers for a long time. Finally in 2008, I went back to school for a few prerequisites in preparation for the MCAT and a medical school application process. Over the course of two full-load semesters of pre-med studies, I learned three things:

      1. I’m not nearly as good of a student as I thought I was.
      2. We all have callings in life, and we are behooved to follow them.
      3. My calling is to be a husband, father, and EMS provider. Anything beyond that is just my ego looking for ways to make me feel important.

      Thanks for the comment. It’s good to hear from a talented individual who chooses to stay in EMS!

  2. This is why I’m going back to school; there is no future for me in EMS. I’m ambitious with zero desire to drive a desk, I feel like I’ve reached a plateau where I am no longer being challenged, and I don’t really want to destroy my back before I hit 40. As far as I can tell, my only option is to go back to school to do something else, and becoming a PA seems like a logical next step- expanded scope of practice, better versatility, better career track. Until something like advanced practice paramedics come along, guys like me will keep leaving EMS when we hit this point.

    • Knowing you as I do, Rick, that’s understandable. You have the talent to keep going as far as you choose. I will miss your smart-ass unique incident reports when you go, though!

  3. I decided about a year ago to return to school to pursue the PA track. It is extremly difficult to manage however it is managaeable. I decided to return to school because our industry has failed us. Private EMS has become to greedy. Just look at the number of memos or verbal threats you will recieve about billing information compared to patient care related items. The Fire Service is not any better. EMS is a different kind of monster to manage. Most Fire Chiefs lack the skills necessary to be successful. Just look at the whole 24 hour shift schedule in high volume areas. Wonder how many patients and providers have died because of sleep deprivation? I can only comment about my area however the abuse by the citizens and the lack of my department to care about EMS lead me directly to the front door of school. It’s better to get out while you can or become the next patient after hitting a tree at 0200 am after falling asleep while traveling to another senseless post.

    • Valid points across the board, Mike. I’m glad you took the initiative to further your education, but it’s unfortunate that we lost a great EMS provider. Best of luck with PA school!

  4. I salute those who want to further their education and move on. But I’m not going anywhere. I have a four-year degree, and it does nothing but collect dust in a box.

    I’m a paramedic. That’s who and what I am.

    And I am going to be the best paramedic I can be.

  5. Thanks for the reply, and great points made by all. Perhaps I’m naive, but I believe that EMS in the US can be a worthwhile career that people can stay in for a long time.

    Mike, you mentioned that the profession has failed us. I used to agree, but have accepted that WE ARE the profession. It’s us to make it better. We have models in other countries. The UK, Australia, and Canada have much better organized systems that people stay in for a long time. There are diamonds buried in the country too, but you have to get away from the McAmbulances.

    • Mike Morris says

      The profession has indeed failed us. Maybe one day it will be different and you will be able to make it a career. I have been a Paramedic for 20 years. We are no closer today than when I first started in defining who we are. In my area EMS has not been successful in being adopted by the fire department and ran into the ground by money starving private corporations. I do not work for a “McAmbulance” service. I work for a large county fire department just outside of Atlanta, Ga. I don’t want to name my employer for the perception that I am bashing. I do believe your statement about it is up to us. I’ve heard it before. The problem is that to many of us will accept riding around in a ambulance with 300’000 miles that has an exhaust leak or falling asleep at 200am at a red light because your on a 24 hour shift in a high volume area. We put up with it because we have little choice if we expect to support our family. I met with a CEO of a large private ambulance service certainly not a “McAmbulance” and when faced with the sleep deprivation studies and all of the other complaints that I had for him he stated to me that its about money. Even if litigation is involved its all accounted for by the “bean counters” probably the same bean counters that developed SSM but anyway how do you fight something like that? I appreciate his honesty that day. I was not going to meet with him as an angry employee just wanted some answers. That’s when I knew that we were in trouble. I will occasionally here someone say it will take “the right person to die before anything changes” meaning that someone will have to pay the ultimate sacrifice for lack of training or delayed responses due to a poorly managed system. Unfortunately as this statement is, it would not make a difference. The public, government officials, and most Fire Chiefs have no clue what a good EMS system looks like. Good luck to you I hope it will change and that you will be able to make a career out of EMS. Let me know how it works out for you when your the last available ambulance at 200 am with a patient complaining of a tooth ache or boils who wants to be transported to a hospital that bypasses 3 others and during your road trip you hear on the radio that a cardiac arrest is holding “no units available”. A couple days latter you get a verbal warning because you forgot to record the patients social security number on your billing form. Good luck if you can manage to make a career out of this you have my respect.

      • Mike, I’m sorry about your experience and current situation with the profession. I am frustrated by the same things you write about. I’ve seen lots of important people die in communities with broken systems and nothing changed after. Still, I’ve been at this for 12 years now, and early on I learned early on that SSM, 24’s, and the fire service weren’t for me. I landed somewhere that doesn’t do those things and still enjoy the work.

        So the question is whether EMS right now is as good as it gets, or whether we can change to make it better. I’ve decided to try to change it. That’s why I started my blog focusing on how to provide better patient care. You mentioned that your bosses don’t know what a good EMS system is. I have an article scheduled to appear in February in one of the big magazines about that very topic, and includes ways to measure how good a system is. As far as the system abusers, we can keep complaining about them call or or find a better way to manage them.

        I am optomistic, perhaps naive, that the profession will get better. I believe that the key is education. In the 1970’s nurses got organized, embraced formal education, and made their profession harder to get into. Now they have almost unlimited career opportunities and are well compensated. Another example is law enforcement. Police departments take pride in reducing and solving crimes, but we continue to tolerate single digit cardiac arrest resusication rates. Both nurses and cops are organized groups that politicians are afriad of. We don’t have that yet, but getting involved with a group like NAEMT is somewhere to start.

  6. Mike Morris says

    I will look forward to reading your article. I admire your passion for change but I believe in order to see real change it will take more than putting our faith in NAEMT. The NAEMT has been at it since 1975 and the only real thing that they are known for is producing the alphabet soup of certification. I believe this organization has lost it’s influence to establish real change in the industry. Maybe it’s time for a new party to appear that could really rally the troups and lead us to everything that you just mentioned. I have read some really good articles over the years high lighting everything you spoke about. I have unfortunately never seen anyone act on any of the ideas. There is always hope

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