Applying for EM: renew or don't renew EMT certification?

[Belleza156]

I was an EMT before med school. I'm an MSIII, interested in EM. I let my EMT certification expire while in med school. Didn't see the need for it, since I'm not using it. Is there any benefit to having it not be expired when applying for residency?

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[RafaTech]

Nope. I was an EMT prior to med school and let mine expire. It does you no good to renew for med school or residency unless you plan on working in the field during that time.

 

[fiznat]

I'm keeping my paramedic certifications up through med school, principally because I want to be able to work a shift or two here and there, but also because I am interested in working with EMS as an attending and I think it would be good to have an active certification. It really isn't that much of an investment to keep these certs up, so I figure why not do it.

 

[coralis]

I'm keeping my paramedic certifications up through med school, principally because I want to be able to work a shift or two here and there, but also because I am interested in working with EMS as an attending and I think it would be good to have an active certification. It really isn't that much of an investment to keep these certs up, so I figure why not do it.

When u're working EMS as an attending you won't need an EMT certification, you'll be waaaaaay beyond that.

But the keeping up a shift or two here and there does sounds like a solid plan.

 

[fiznat]

I'm not talking so much working on the ambulance (although that sounds fun!), but rather in a medical direction type role. I think it would be good to still hold the certs as a "street cred" bonus and also just as a means of keeping up to date with what's happening in the field.

I'm getting ahead of myself anyways... only a 2nd year.

 

[Siggy]

I'm not talking so much working on the ambulance (although that sounds fun!), but rather in a medical direction type role. I think it would be good to still hold the certs as a "street cred" bonus and also just as a means of keeping up to date with what's happening in the field.

I'm getting ahead of myself anyways... only a 2nd year.

The least useful thing I can think of for "keeping up to date" are those useless 24 hour refresher courses required for recertification.

 

[fiznat]

The least useful thing I can think of for "keeping up to date" are those useless 24 hour refresher courses required for recertification.

You don't have to do a refresher, you can maintain your national registry by re-taking the written test. I never took one of those refresher classes in 10 years of EMS-- I agree they are a waste of time.

Even less effort, many states allow you to maintain a state license (even if you don't hold national registry) if you just pay the renewal fee every year.

 

[Belleza156]

You don't have to do a refresher, you can maintain your national registry by re-taking the written test. I never took one of those refresher classes in 10 years of EMS-- I agree they are a waste of time.

Even less effort, many states allow you to maintain a state license (even if you don't hold national registry) if you just pay the renewal fee every year.

I'll have to check the requirement in Arizona, but all I ever heard about was the refresher course.

So is the end consensus that it looks better to apply to EM residency with a current certification?

 

[sylvanthus]

I let mine lapse and don't think it is particularly important to keep up. It will show up under your "experiences" section of your residency application. So, PDs will know you were an EMT. It won't do you any good in medical school, though, so don't sweat the recert.

 

[jendc08]

I really don't think EM residencies care if you have a current emt license. If you want it for your own use that's fine. But really, why do you think they would care? You won't be working as an emt once you are a resident.

 

[jbar]

The reason to keep the cert is if you want to work with it. I kept my EMT certification and am on a volunteer fire department during residency. (Yeah, I'm crazy. But the time requirement isn't too bad.)

I disagree with what some others have said, that you don't need the certification if you want to work on the ambulance. At least here in New York state, what matters is your prehospital certification. So you can't say "hey, I'm a doctor, I want to do EMT/paramedic shifts." You need an EMT card or a medic card to work.

Note that I'm talking about working as an EMT. I don't think it matters much for applying to residency.

 

[DeadCactus]

I get the impression some of the EMS folks like it the same way some of the US folks like RDMS. Serves as "street cred" and the extra letters help communicate your sub-specialty until the fellowship comes with some letters of its own. Just my observation...

 

[Belleza156]

The reason to keep the cert is if you want to work with it. I kept my EMT certification and am on a volunteer fire department during residency. (Yeah, I'm crazy. But the time requirement isn't too bad.)

I disagree with what some others have said, that you don't need the certification if you want to work on the ambulance. At least here in New York state, what matters is your prehospital certification. So you can't say "hey, I'm a doctor, I want to do EMT/paramedic shifts." You need an EMT card or a medic card to work.

Note that I'm talking about working as an EMT. I don't think it matters much for applying to residency.

That's odd that you need a medic card to work in EMS if you have an MD. The ambulance company I worked for before med school had nurse ambulances (so they could charge a s**tload for transport), and as far as I know they didn't have any medic certification. Must be a new York thing.

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[fiznat]

That's odd that you need a medic card to work in EMS if you have an MD. The ambulance company I worked for before med school had nurse ambulances (so they could charge a s**tload for transport), and as far as I know they didn't have any medic certification. Must be a new York thing.

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There is more to EMS than the medicine. Those nurse ambulances probably had some sort of EMS-certified individual on board, or perhaps they only did interfacility transports? In CT you need to have at least one EMT (or better) on board to make a legal crew.

 

[Belleza156]

You are right there was always an EMT or paramedic driver.

The nurse ambulances were the nicest ambulances I'd ever seen. Everything was hydrolic or electronic in there. Prob the only ambulances that weren't large scale petri dishes.....mine was. Shiny on the outside, oh so not sterile on the inside.

Are there doctor ambulances? What does an MD do in EMS? If u were to treat anyone, you would be liable as a physician not as a medic, right?


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[fiznat]

There are some systems where physicians (usually the medical director or residents) will ride around in fly cars and show up on calls. Sounds pretty bad ass to me, even though I'm not sure what role a physician really has in the field other than maybe on extended transports, major calls, entrapments, etc etc.

 

[jbar]

There are some systems where physicians (usually the medical director or residents) will ride around in fly cars and show up on calls. Sounds pretty bad ass to me, even though I'm not sure what role a physician really has in the field other than maybe on extended transports, major calls, entrapments, etc etc.

A lot of what you are doing in the field is giving feedback to the medics, doing teaching, seeing what protocols and equipment work and what don't. You can sit in an office all day and write how medics should treat patients trapped in car after a crash, but until you are on scene for a few you don't really know what you are writing about.

A MD can't do much more than a medic on scene because most of the things that are in our scope of practice in the hospital we either don't have the tools to do in the field or can wait until the hospital.

 

[jbar]

Are there doctor ambulances? What does an MD do in EMS? If u were to treat anyone, you would be liable as a physician not as a medic, right?


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This depends on the state, and the truth is a lot of places don't have specific laws relating to this since there are so few physicians working in the field. It's important to note the different between responding as medical control physician, where the medics are already operating under your license and you are already liable, and working as a medic. It gets tricky when you say "I have an MD, but I'm just working as an EMT/medic today." I know that medics work as EMTs a fair amount, they may be on a BLS ambulance for the day and they operate at the BLS level (since that ambulance won't be carrying ALS equipment.

Since the legal aspects are so murky, it would be wise to have some additional, personal liability/ malpractice insurance since if you are an attending the hospital that you work for probably doesn't cover you for working off duty, and the ambulance service may not cover you if you are held to a higher standard than a medic in court.

Note that none of this applies to residents doing ride alongs as part of their residency. You are covered by your residency malpractice as part of that (though in truth you aren't really going to be doing independent decision making, you are assisting the medics so you would have to mess up pretty egregiously to be sued.)

Like I said, I'm in New York State, here I can only practice under my prehospital certification (EMT). If you are thinking of working as a medic or EMT I strongly suggesting calling the sate department of EMS where you are going to be working and talking to them.

 

[Belleza156]

This depends on the state, and the truth is a lot of places don't have specific laws relating to this since there are so few physicians working in the field. It's important to note the different between responding as medical control physician, where the medics are already operating under your license and you are already liable, and working as a medic. It gets tricky when you say "I have an MD, but I'm just working as an EMT/medic today." I know that medics work as EMTs a fair amount, they may be on a BLS ambulance for the day and they operate at the BLS level (since that ambulance won't be carrying ALS equipment.

Since the legal aspects are so murky, it would be wise to have some additional, personal liability/ malpractice insurance since if you are an attending the hospital that you work for probably doesn't cover you for working off duty, and the ambulance service may not cover you if you are held to a higher standard than a medic in court.

Note that none of this applies to residents doing ride alongs as part of their residency. You are covered by your residency malpractice as part of that (though in truth you aren't really going to be doing independent decision making, you are assisting the medics so you would have to mess up pretty egregiously to be sued.)

Like I said, I'm in New York State, here I can only practice under my prehospital certification (EMT). If you are thinking of working as a medic or EMT I strongly suggesting calling the sate department of EMS where you are going to be working and talking to them.

Ride alongs for residency? Never thought about that for EM. I actually didn't know that EM is more than a physician in the emergency room. Going through these threads is definitely helping to expand upon my preconceived notions of EM. I went through and found theres subspecialties in EM...definitely didn't know that. When you discuss all this EMS related action w EM, are you talking about an EM physician who is subspecializing?

I'm going to have to research more about EM, it's good to know there's options besides just working at a hospital for the next 20-30 years.

 

[fiznat]

When you discuss all this EMS related action w EM, are you talking about an EM physician who is subspecializing?

EMS works directly underneath the licences of Emergency Physicians, so ideally the relationship between the EP and EMS should be pretty tight. Still, it was only recently that the relationship is becoming formalized through an EMS fellowship available to EPs. As I understand it, eventually EPs will probably need to to have EMS specialization before they can serve as a medical director, but things are in transition right now and there is a lot of grandfathering/exceptions/overlaps/etc for the time being. It is likely to be a good long while before all of this stuff trickles down and becomes the norm-- especially in rural areas.

 

[jbar]

I believe EMS is a required component of EM residency. Most programs do about 2 weeks worth of ride alongs to get to know what the EMTs/medics deal with on the street.

In terms of what I'm talking about, there are 2 ways in which EM attendings would be responding to calls in the street. One is by being a medical director/EMS faculty where you do training for the medics, provide oversight, and go to some serious scene calls. The other is people who on their own time do something that involves treating patients in the field, not as part of their attending job. Not many attendings want to ride on the ambulance at the EMT level. But there are a decent number who are doing things like search and rescue, ski patrol, SWAT, volunteer firefighting etc. In some situations they may be able to do this under their own medical license. In some they are going to have to be under some other certification (paramedic, OEC etc)

 

[Apollyon]

As I understand it, eventually EPs will probably need to to have EMS specialization before they can serve as a medical director, but things are in transition right now and there is a lot of grandfathering/exceptions/overlaps/etc for the time being.

Think about it, though - what if they don't? Who is going to say what to whom? I mean, who has oversight? Who is going to tell a region that the medical director has to be fellowship-trained/boarded? If a region doesn't have one, then the implication is that whomever is stating that one is needed would then have to provide one. I find it quite, quite unlikely that a state would shoot themselves in the foot by removing a medical director lacking this qualification, if there wasn't another to step right in. And, what if it was NAEMSP? So what? They have no teeth and no authority.

 

[fiznat]

Think about it, though - what if they don't? Who is going to say what to whom? I mean, who has oversight? Who is going to tell a region that the medical director has to be fellowship-trained/boarded? If a region doesn't have one, then the implication is that whomever is stating that one is needed would then have to provide one. I find it quite, quite unlikely that a state would shoot themselves in the foot by removing a medical director lacking this qualification, if there wasn't another to step right in. And, what if it was NAEMSP? So what? They have no teeth and no authority.

Absolutely. The only real mechanism I can think of is if there were an insurance/liability incentive for hospitals and ambulance services to insist (or at least strongly prefer) EMS-boarded EPs as medical directors. But you're right, there would first need to be a pretty deep supply candidates- and I can't see that happening unless there is some strong motivation for EPs to pursue that kind of fellowship training...

It's interesting what's happening with all this. I think standardized training for medical directors and increased EMS consciousness among EPs could be a really good thing, but I'm not sure how it will eventually come about. Establishment of an EMS fellowship certainly is a good start though.