EMT-B with a strong desire for emergency medicine, torn between becoming a physician or Paramedic?

[Geomamaearth]

About me: 25 years old male. I'm an EMT-B, where I work IFT transport part time, and as a medical assistant in an urgent care. I have my bachelor's in Exercise Science, and absolutely 0 student debt.

I'm very drawn towards Emergency Medicine. I really like the idea of becoming a doctor, especially after working in the urgent care. Initially I wanted to become a PA, but I learned that their scope of practice in the ER is very limited compared to the The scope of practice, the depth of clinical knowledge, the autonomy, job security and salary of a doctor. I don't necessarily feel as though I need to be "The boss", and I know health care is a team effort. And I'm a bit concerned about the long road ahead to become a physician (I'm looking to be around 35-37 by the time I finish residency training, assuming no fellowship).

I would need to finish up my pre-reqs for medical school (2 semesters worth), take the MCAT, and I will be eligable to apply in 2018. Ideally, I would begin in 2019 (at 26-27 years old).

But I also love the idea of working rescue. There is a nice scope of practice that paramedics have, and I know there are obvious perks to being a medic in terms of lifestyle (1 on, 2 off, Kelly days, plenty of time for overtime). I recently met a Lt. In the county that I am in, and he pulls over six figures with overtime included (Yes, money is playing a big role in my decision. I need to take care of my family, and have a financial plan for my own future). He assured me that the area of south florida that I am in is hiring paramedics/firefighters. His enthusiasm for the job rubbed off onto me, as I recalled the handful of times that I actually ran urgent/ER transfer calls doing IFT. I would need to finish paramedic and become firefighter certified, which would take about a year and a half If I begin this summer (I can begin applying to jobs at 26-27).

I am torn between deciding what to do. I love the acuity of the patients that I can care for. I love the invasive clinical skills that EM has to offer, and I'm well aware that most patients are "non urgent", (I see a ton of them in the urgent care setting).

I don't know how to continue. I love the idea of the adrenaline rush, being one of the first people to meet and treat someone, the camaraderie and team effort, and clinical medicine. Several doctors have told me, "If you can see yourself being anything else other than a doctor, DO IT". And now here I am, full of doubt and anxiety about my future, afraid of regret and hating my professional life. Please offer some wisdom.

What are things that I should consider when deciding?

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[star.buck]

You sound much more enthused about paramedic/firefighter than doctor. Don't go the MD/DO route unless that's what you want without a doubt. It's time and life consuming, and extremely difficult. You have to have that drive and desire to be a doc to get through it.

 

[Geomamaearth]

You sound much more enthused about paramedic/firefighter than doctor. Don't go the MD/DO route unless that's what you want without a doubt. It's time and life consuming, and extremely difficult. You have to have that drive and desire to be a doc to get through it.

There is a part of me that wants the in depth clinical knowledge that a physician has, especially in pertaining to emergency medicine. I know that this knowledge far exceeds anything I could learn in paramedic school, and is one of the driving forces behind becoming a doctor. Yet, I can't help but wonder if that depth of knowledge is worth the time commitment.

 

[MusicDOc124]

Well you have a couple options, but one in particular I'll mention: PAs usually have a decent amount of autonomy in the ER - they just don't always get the most severe cases (depends on the individual/attending/location/etc, though). Think about PA school because it's shorter than medical school and will give you more autonomy than as a paramedic without the debt or length of training to be a physician. THEN utilize your PA license and apply for a paramedic license (ensure you keep your EMT-B current throughout PA school). This differs state to state, but in many states, if you have an active EMT-B and are a PA-C, you can get a paramedic license by being allowed to challenge the exam. PA school is only a little longer than paramedic school, and you get a 2 for 1 essentially. This way you have the best of both worlds without really feeling like you settled or like you spent too much time/money in school/residency.

Keep in mind, you can do this as a physician as well, but you will have more autonomy period, and there is more consistency state-to-state with challenging the exam. Some states (though I may be mistaken, so look this up), will grant a physician a paramedic license/simply allow the physician to be aboard ambulance and such without having to take the exam. Not sure if that is 100% accurate, or if you have to be an EM-residency-trained physician for that to happen. There are also fellowships for physicians after EM residency for EMS (though this is more in a managerial/FEMA type fellowship though I believe - again, clarify this).

 

[aformerstudent]

"If you can see yourself being anything else other than a doctor, DO IT"

Take that advice and run with it.

Medical school is about passing a lot of exams. All the interesting clinical scenarios happen once you have proven your test-taking skills and it's not easy no matter where you go. If you're grades and MCAT are good then pursue medicine.

It took me a long time to realize that becoming a doctor is a lot more than what I had been "observing."

 

[Nasrudin]

It was 2002. When I faced the exact same decision.

Look... here's a real thing. You want to be a 45 year old paramedic. With back, shoulder, and knee problems. From hoisting fatties of out tight spaces and into a meat wagon.

Become a doctor. You have the ability. Most people do not.

In order to have work be more of flow state of growth and learning... more often. There has to be pursuit. With achievable but difficult tasks.

That's not going to happen as a paramedic. Not for you. The knowledge base takes a a year or two, then the learning curve will flatten out... sure there might be things you do there to keep it a challenge. But... if you're curious and love to learn... you're going be moving on to something else at some point.

You can do whatever you want as a doc. Be the guy who works a helicopter EMS operation. And then starts his own company to do it. Or... a 1000 other possibilities.

 

[Matthew9Thirtyfive]

It was 2002. When I faced the exact same decision.

Look... here's a real thing. You want to be a 45 year old paramedic. With back, shoulder, and knee problems. From hoisting fatties of out tight spaces and into a meat wagon.

Become a doctor. You have the ability. Most people do not.

In order to have work be more of flow state of growth and learning... more often. There has to be pursuit. With achievable but difficult tasks.

That's not going to happen as a paramedic. Not for you. The knowledge base takes a a year or two, then the learning curve will flatten out... sure there might be things you do there to keep it a challenge. But... if you're curious and love to learn... you're going be moving on to something else at some point.

You can do whatever you want as a doc. Be the guy who works a helicopter EMS operation. And then starts his own company to do it. Or... a 1000 other possibilities.

Agreed.

@Geomamaearth If you are intellectually curious and crave the in-depth knowledge and challenge of medicine, being a paramedic will not satisfy you for long. There are many opportunities to do pre-hospital stuff as an EP. And being a paramedic is less about medicine and more about having more tools to stabilize and transport. They get more knowledge and a larger scope of practice, but it's still pre-hospital care. Vital, but not the same.

 

[Gurby]

Paramedic-to-medical student here.

This is a post I have bookmarked that was influential for me and relevant to your situation. Looking back on my 4 year EMS career, this is more true than ever:

This post is directed at the OP, but applies to traditional undergrads as well. Anyway,
I'm assuming you're an EMT-B already, since that is usually a mandatory pre-requisite to becoming a paramedic (though this might be different in other states). Great, you got a head start on your med school hopeful peers, you don't really know too much as an EMT-B so you still have a healthy appreciation that you don't know very much about medicine. Believe it or not this is a wonderful place to be. I strongly advise you to stop right there (at EMT-B) and devote yourself entirely to becoming a physician.

Here's why:
EMS is a bit of a trap, you can get all caught up in it, because you are enjoying what you are doing, helping others, taking care of emergencies, etc. It's a good high when things go really right. Then you meet a paramedic, and think to yourself: boy can this guy take care of business, I'd really love to be able to do all that great stuff too! But there is really not that much to being a paramedic. Unfortunately nobody really tells you this. IN your world, all these new skills are exciting and impressive, So then things start to take a turn in your life. Let me tell you a little about what I mean:

Paramedics are funny people, they are experts in a very, very, narrow slice of medicine. In fact, when it comes down to the business of prehospital emergency care, nobody does it like a medic. WOW, I think I want to do this medic thing, I'm going to go for it, atleast for now, until I go to med school next year. BUT, you can easily get all caught up in the ALS pre-hospital care scene. Because you are doing life saving interventions you may feel like you fast forwarded yourself to "doctor" or at least the preconceived notion you had of doctors before you ever got involved in medicine. So anyway, there you'll be doing all these great skills, and soon you'll start to think that gee-whiz look at all the great things that I can do as a medic (ha! nurses my ass, they can't do this stuff!). Heck, all that other stuff in medicine really is not as important as this stuff I'm doing right now (IVs, intubation and pacing oh my!), and that's when you start to make a very big mistake. All of a sudden you really stop caring about all the other things that medicine has to offer, so you stop learning about anything that doesn't have anything to do with the "important stuff". Now depending on how long this lasts you can piss away 4,5,6 years doing EMS work and be totally satisfied. But then something happens, it can be some job that went bad on you or you come across something you've never been prepared to deal with, or any other number of things that cause you to become reflective about yourself as a professional. So then you start to read again and you once again rediscover that there is a whole world of medical knowledge out there you weren't aware of as a medic. So now you're studying again and learning about the things you didn't know, but you are never able to do it in any coherent way. The sheer volume of the material is intimidating and you have no real way of knowing if you are making any progress. Plus you are surrounded by your peers, fellow paramedic professionals who tell you things like who the heck cares about temporal arteritis, that's not important and what the heck is so important about this pancreatic psuedocyst you speak of??? So now you start to get frustrated, and you look around at the people around you who are very content with being medics and knowing what medics know, and incorrectly equating their skill proficiency with medical knowledge. But not you. You start to remember that you wanted to be a doctor, and you look back and say, how the **** did I get here, this isn't what I wanted for myself professionally or personally. This whole medic thing was supposed to be a stepping stone to becoming a physician. You become, really frustrated, pissed off, burnt out and then to add insult to injury you start to realize that you are wildly underpaid for the work you are doing. Nurses don't have to put up with 1/2 the crap that I do and they get paid 3 times as much, plus I know a hell of alot more! That's the last straw, F-this you say, I'm going back to school. Only now you are well into your mid- late 20's, (in your case, mid-late 30's) maybe you got a mortgage, a big monthly car payment, who knows maybe a wife and kids in private school, your Golden Opportunity to become a physician is now well past you. You now must suffer in new and interesting ways to get to where you wanted to be in the first place. So sacrifices and painful choices are made and finally 7-8 years later you are back on track for the MD, older, a little more worn out, less enthusiastic, but hopefully a little wiser. Maybe.

So the question is, are you absolutely, positively sure that being a medic is what you want? Think long and hard about this, this is your life afterall. That being said, you gotta do what you gotta do, if you are supporting your whole family or you are on your own out there I can understand. But think about this seriously think about this. This is a long post, but I did not make all of this stuff up, I speak to you from my experience. There are alot of other things I can go into, all sorts of crazy stuff that you'll be banging your head against, but I think I'd be writing for days and days. Anyway best of luck, you can always drop me a PM if you have any specific questions.

 

[RocuROMANium]

I was watching the show "Trauma: Life in the E.R." and they actually followed an ED physician who, in his spare time, worked as a paramedic. It was really interesting but I don't know how that works or how realistic that is for a given ED doctor.

 

[Medic2MD4me]

I can reply to you giving my perspective, having been an emt/er tech (south florida too no less) having these same thoughts 8-10 years Ago.

I became a paramedic. Loved my job, had amazing patient care experience that started the foundation of my career. High volume, patient after patient. I took a set of skills, while being narrow in the grand scheme of medicine, that were highly valuable throughout PA school and in my emergency medicine career as a PA.

10 years later, I'm applying to medical school this summer. I don't regret my path despite it being the long way around. Id be happy to chat more abt it via pm but ultimately you'll do what feels right at the time... just know it may change as more experiences come your way.

 

[ROSC]

EMS is a trap

 

[Geomamaearth]

Thank you very much for the insightful replies. I truly and sincerely appreciate reading every comment. I will do some more soul searching and try to find what I want in my professional life. Reading that people shared the same anxiety inducing doubts as I have makes me feel less alone. Thank you all for taking the time to help me.

 

[drummermedic]

I started out as a firefighter/EMT thinking public safety was what I wanted to do for the rest of my life. I was a second generation firefighter and I knew the benefits and retirement could provide a good life for me and my family.

I promoted to Fire Engineer (driver/operator) early on and started paramedic school as part of my career advancement. I wasn't thinking Medicine in the slightest. It was in paramedic school I was introduced to the depth of knowledge physicians received. Unlike most of my classmates, I wasn't satisfied with just knowing protocols or recognizing SVT with aberrancy vs V-Tach and knowing which drug to give and how much. I wanted to know the underlying mechanisms of pathophysiology and pharmacology.

I took a long road to med school since I then had to complete paramedic training, complete my bachelor degree and then get into med school. Am I glad I did it, absolutely. I'm happier now in med school than I was working prehospital. Med school is difficult as it should be, but in the end, I will be able to experience all things in medicine without restrictions. I'm almost 34 now and will be starting my career as an attending much later, but as others have stated, prehospital takes a toll on your body. My dad is 61 and still actively working as a firefighter and has had bilateral knee replacements. He's had to work hard (physically) to enjoy the life he has and I just didn't want to do that to myself.

20 years from know, where do you want to be? 20 years are going to pass by regardless of which choice you make. Do you want to be 50 years old being woke up at 2:00 am for abdominal pain or do you want to be working in the ED on a preplanned shift when you knew ahead of time you'd be awake for the whole 8-10 hour shift? Do you really want to work overtime just to make 6 figures? On average you'll work 10 shifts a month as a prehospital provider just to make base wage and probably max out around $60-70K if you're lucky. You'll need to more than likely work at least 5 extra shifts to make it close to $100K, and that's even if overtime is available. Overtime is not guaranteed.


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[medngame]

To add another perspective, I became an EMT-B after I did not get into the ONE SMP I applied to the winter after undergrad. At the time I didn't know of other programs or SDN for that matter. So I thought "well you aren't good enough to be a doctor, try another sector of the medical field". My program was wonderful, we pretty much had to shadow every type of EMT service offered in my area from emergency room to fire department to private. While I enjoyed my teachers, colleagues and professionals I shadowed at every run I lingered. While most EMTs and paramedics would go to the EMS room for snacks or to socialize, I would hover over the various doctors watching and savoring the moments till I was needed back at the rig. I realized after I finished my final that this was great work, but it wasn't enough. Like posters above have said, there's so much knowledge available in medicine and Paramedics/EMTs have a niche of stabilization and transport that just wasn't satisfying. And now as I prepare to enter a post bacc for gpa repair, I will say that I would not be anywhere near as confident as I am now had I not gone through EMT training. If being a paramedic won't sate your thirst I'm sure the fire hydrant that is medical school will!

 

[Gurby]

...at every run I lingered. While most EMTs and paramedics would go to the EMS room for snacks or to socialize, I would hover over the various doctors watching and savoring the moments till I was needed back at the rig.

I did the same thing. Unless the city was blowing up, when dropping patients off in the ED I would always bring the computer and start writing my report at the bedside so I could see the doc do their assessment, etc.

 

[Medic741]

Paramedic.

You will learn a lot, develop a unique skill set. I have had some truly amazing opportunities that I would have never had if it weren't for a medic background.

Seriously, if you want to do EM become a medic first. Will help you make your niche before med school starts and gives you a certain amount of credibility for EM that other applicants won't have.

Most valuable part... making connections w docs and working alongside them has been priceless. Impress someone, build a relationship and you'll have someone on your side as you start your career.

Other med students don't have that advantage

And a final thought, being a paramedic is completely different than being an EMT basic. You'll have the experience of making very difficult decisions e.g. is this patient's airway unstable enough that I should RSI, which pressor is the best choice, or should I cardiovert or try Adenosine or Amio? And unlike other health professionals you will have no back up or Support available while you were making these difficult choices. Being a medic will give you a new perspective on medicine that you've never had as an EMT and I for one could not be more grateful for what I learned on the streets. Could not recommend this path enough to someone, and it will increase your earning potential as you go through Your GPA repair.

 

[Nasrudin]

Paramedic.

You will learn a lot, develop a unique skill set. I have had some truly amazing opportunities that I would have never had if it weren't for a medic background.

Seriously, if you want to do EM become a medic first. Will help you make your niche before med school starts and gives you a certain amount of credibility for EM that other applicants won't have.

Most valuable part... making connections w docs and working alongside them has been priceless. Impress someone, build a relationship and you'll have someone on your side as you start your career.

Other med students don't have that advantage

And a final thought, being a paramedic is completely different than being an EMT basic. You'll have the experience of making very difficult decisions e.g. is this patient's airway unstable enough that I should RSI, which pressor is the best choice, or should I cardiovert or try Adenosine or Amio? And unlike other health professionals you will have no back up or Support available while you were making these difficult choices. Being a medic will give you a new perspective on medicine that you've never had as an EMT and I for one could not be more grateful for what I learned on the streets. Could not recommend this path enough to someone, and it will increase your earning potential as you go through Your GPA repair.

Yes. This is actually the most sophisticated option. You build where you are. You treat the world as your apprenticeship. You don't just pass through and neglect this phase of your journey. You remember everything. How things work on the ground. What motivates and inspires people on the ground. What human characteristics lead to the most developed, skillful, adaptive, creative, and deeply satisfied professionals.

You stay small. Humble. Hungry. Observant. Curious. Passionately attentive.

With that attitude. You will earn a mentor or several of them. Who can launch you into medical school. By saying this mf'er right here (you), y'all don't know about this mf'er right here. You'd be lucky to get this mf'er right here. etc.

But. Note. The above poster clearly did something like the above. Being a career paramedic was not the focus for him/her. learning was. Development was. But they're in medical school. So. That's what I meant. But I dig the point they're making about the value of what's right in front of you. And that taking the apprenticeship role to fullest points towards syntonic development with your current job AND your academic pursuits.

 

[nlax30]

Paramedic.

You will learn a lot, develop a unique skill set. I have had some truly amazing opportunities that I would have never had if it weren't for a medic background.

Seriously, if you want to do EM become a medic first. Will help you make your niche before med school starts and gives you a certain amount of credibility for EM that other applicants won't have.

Most valuable part... making connections w docs and working alongside them has been priceless. Impress someone, build a relationship and you'll have someone on your side as you start your career.

Other med students don't have that advantage

And a final thought, being a paramedic is completely different than being an EMT basic. You'll have the experience of making very difficult decisions e.g. is this patient's airway unstable enough that I should RSI, which pressor is the best choice, or should I cardiovert or try Adenosine or Amio? And unlike other health professionals you will have no back up or Support available while you were making these difficult choices. Being a medic will give you a new perspective on medicine that you've never had as an EMT and I for one could not be more grateful for what I learned on the streets. Could not recommend this path enough to someone, and it will increase your earning potential as you go through Your GPA repair.

I kind of disagree with the notion of become a paramedic first if the goal all along is to become a physician. I get it if you're not sure, want to pursue being a medic first and then later go on to medicine, but if someone has already decided to go on to medical school then why waste time and expense of becoming a medic?

He's already an EMT and shown substantial interest in emergency medicine, spending time to become a medic JUST to buff up a resume for potential EM Residency down the road is not needed IMHO. Medicine is a long and expensive journey, no need to add to it.

Just had to get that out of the way first.

Honestly if I was in your shoes I'm not sure what I would do. Obviously this is going to be a very personal decision and one only you can make after some soul searching on what it is that you feel will ultimately fulfill you professionally.

If you will not be satisfied with anything else other than being the one in charge and 'captain of the ship' as the physician than by all means go for it. A firefighter/medic career is certainly something that can allow a comfortable lifestyle and early retirement after which you could go on and pursue other interests as others I've known have done. If you go the medicine route then just go in realizing that you will be delaying gratification and giving up the rest of your 20's and half your 30's to training. You will also not be gaining any ground, and actually losing it, from a financial standpoint. That's also something you and your family have to realize and be on board with.

PA is certainly another valid option and one I initially considered. I kind of consider it somewhat of a middle ground option here with less time commitment on the front end for training while still offering a good lifestyle. It also allows for some job flexibility if you decide to switch fields and decide 10 years down the road that you want to do something other than EM, something that really isn't practical for a physician once done with residency/fellowship training.

 

[blacchic856]

I'm in a similar situation right now. Currently an EMT-B finishing my last prereqs right now, sitting for MCAT late July. I'm older (28) and I don't want to add to the long route I've already taken. Whenever I bring up wanting to do more, the 1st thing everyone mentions is medic school. The adrenaline that comes when the pager goes off is fantastic but medics are so underpaid in my state (one of the most expensive to live in), it's ridiculous (base $52K). I'm flirting with the idea of PA (base $100K) because I'd learn sooo much more and gain an enormous amount of confidence in my medical abilities but I also don't want to devote 2 more years of my life to a career I know in my heart I'll grow tired of after a few years. Both medic and PA require the same amount of time. There is no right answer but I know that I'd rather be starting med school at 30 years old than 50.