If you had to pick another career, what would you do?

[InfoNerd101]

I know some people are unhappy as PA's and nurses. So if u had to do it over would you? And what would u do?

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[deleted6669]

knowing back in the day what I know now I would have gone to medschool (DO) and done a dual FP/EM residency and worked in a rural environment after graduation from residency. The happiest docs I know are all rural primary care and em docs. I have several friends who are double boarded doing both, loving their schedules and their lives. plenty of time off. great salaries. no debt. I am slowly but surely working myself into a position doing mostly rural coverage shifts, both double coverage and solo coverage positions. I'm at around 50:50 now, some months 60:40 in favor of rural. when I can make the jump away from urban shifts entirely I plan to do so.

 

[BreathDeep]

Well, if I went back in time I most definitely would still become an RT, only difference is I would have picked a better school and started on my Bachelors earlier.

Oh, and I would have have emigrated to Canada ASAP as soon I had the experience and the money to instead of dicking around with being an RT in the states. Canadian RT's have such a larger scope of practice and more autonomy than we do. Not to mention the advancement opportunities, as both Anesthesia Assistants and Cardiopulmonary Perfusionists are primarily RT's. Oh, if only...

 

[InfoNerd101]

Well, if I went back in time I most definitely would still become an RT, only difference is I would have picked a better school and started on my Bachelors earlier.

Oh, and I would have have emigrated to Canada ASAP as soon I had the experience and the money to instead of dicking around with being an RT in the states. Canadian RT's have such a larger scope of practice and more autonomy than we do. Not to mention the advancement opportunities, as both Anesthesia Assistants and Cardiopulmonary Perfusionists are primarily RT's. Oh, if only...

Really? What are they allowed to do in Canada?

Last I read Healthcare professionals aside from MD's had a more narrow scope of practice up there and that they don't even have PA's or APRN's up there

 

[BreathDeep]

Really? What are they allowed to do in Canada?

Last I read Healthcare professionals aside from MD's had a more narrow scope of practice up there and that they don't even have PA's or APRN's up there

There are indeed both NP's and PA's in Canada actually. They're not as big as in the States, but they definitely exist.

As for RT's, the scope encompasses much more. Just off the top of my head RT's up there: Intubate, manage IABP's and ECMO, insert A-lines and CVC's (peripheral IV sometimes too, but much less often), are much more protocol driven, and can bill for services out of the hospital (this is a big one, American RT's can't). As for advancement, first and foremost there are no CRNA's in Canada. In their place is the Anesthesia Assistant (similar-ish to American AA's, although not the same), which is an advanced RT specialization. Similar for Cariopulmonary Perfusionist, which is open to both RT and RN, but seems to be more RT heavy than RN.

Compare this to the US where AA's are rare and CRNA's dominate, so RT's have little opportunity to enter Anesthesia. CPP's are still an option, but not as much used anymore. With Respiratory Care still being stuck at the Associate's level with few Bachelors level options getting admission to the few remaining CPP programs can be challenging, requiring us to go back to school again to receive a second degree (often not even in respiratory) just to meet the minimum degree requirements.

Also in the US RT's can technically do all the things I mentioned for Canadian RT's, and we are definitely taught all those things in school, but in application we are rarely allowed to. The hospital which uses RT's for ECMO vs. RN's is rare. Even more so for IABP. Some hospitals let RT's insert A-lines, most don't. Same for PICC's and CVC's. Protocols are very hit or miss too. We in the US have a two front war as far as scope, it's either physicians who won't allow us to practice, typically because the majority of them don't know (or care) about the amount of education we actually have or what said education entails (which is funny, because the ACCP, ATS, and ASA control our field and RT only exists because of them. They also sit on the board of our organization and are responsible for creating our curriculum and approving all changes/advancements in professional practice). Or it's nurses (politically speaking) who keep us down so they can absorb these duties over us. In the end it basically can be summed up as: We are trained to do what Canadian RT's do, but only about 20% of us in this country are allowed to because of outside interference.

Personal example: In my current hospital I run my ventilators completely independently via protocol with the intensivists blessing. Unless it's a trauma surgery case, in which case the trauma surgeon demands full control. I have to get an order just to lower the FiO2 when he is in charge. I can insert A-lines, but we had to fight tooth and nail against the nurses - they didn't even want to do them, they just didn't want us to do them. Likewise I share responsibility with the RN's over Central Lines and PA catheters (monitoring/maintenance, not insertion), which again the nurses, not the doctors, fought us about. I am not allowed to touch and am discouraged from even caring about the IABP's. We have no protocol for medications, so I give a lot of not indicated breathing treatments (that Trauma Surgeon I mentioned? He orders Q6 ATC Albuterol/Atrovent on every single trauma surgical patient no matter their history until they discharge). Unless they're a COPD exacerbation, then I have full control again over ordering and altering their medications. I was allowed to intubate on the floors because the ED docs (of which there are 1-2 per shift) were tired of having to leave the ED to come intubate, but then they changed their minds and took over again. It's a big ass mess basically, but it's the life of an RT pretty much everywhere. I don't complain though, because when I worked at UCSF I was little more than a robot, following orders to the letter with absolutely no protocols and simply twiddling with knobs when told to.

Yeah, our profession is scattered and all over the place here in the US. I'm still deciding on whether I want to pursue PA school or emigrate to the great up north (with a lot of thinking/deciding yet to happen), but either choice will in the end be better than where I am now. Unless our political organizations get their **** together and there's a major culture change, but I won't really be holding my breath for that.

 

[Mad Jack]

There are indeed both NP's and PA's in Canada actually. They're not as big as in the States, but they definitely exist.

As for RT's, the scope encompasses much more. Just off the top of my head RT's up there: Intubate, manage IABP's and ECMO, insert A-lines and CVC's (peripheral IV sometimes too, but much less often), are much more protocol driven, and can bill for services out of the hospital (this is a big one, American RT's can't). As for advancement, first and foremost there are no CRNA's in Canada. In their place is the Anesthesia Assistant (similar-ish to American AA's, although not the same), which is an advanced RT specialization. Similar for Cariopulmonary Perfusionist, which is open to both RT and RN, but seems to be more RT heavy than RN.

Compare this to the US where AA's are rare and CRNA's dominate, so RT's have little opportunity to enter Anesthesia. CPP's are still an option, but not as much used anymore. With Respiratory Care still being stuck at the Associate's level with few Bachelors level options getting admission to the few remaining CPP programs can be challenging, requiring us to go back to school again to receive a second degree (often not even in respiratory) just to meet the minimum degree requirements.

Also in the US RT's can technically do all the things I mentioned for Canadian RT's, and we are definitely taught all those things in school, but in application we are rarely allowed to. The hospital which uses RT's for ECMO vs. RN's is rare. Even more so for IABP. Some hospitals let RT's insert A-lines, most don't. Same for PICC's and CVC's. Protocols are very hit or miss too. We in the US have a two front war as far as scope, it's either physicians who won't allow us to practice, typically because the majority of them don't know (or care) about the amount of education we actually have or what said education entails (which is funny, because the ACCP, ATS, and ASA control our field and RT only exists because of them. They also sit on the board of our organization and are responsible for creating our curriculum and approving all changes/advancements in professional practice). Or it's nurses (politically speaking) who keep us down so they can absorb these duties over us. In the end it basically can be summed up as: We are trained to do what Canadian RT's do, but only about 20% of us in this country are allowed to because of outside interference.

Personal example: In my current hospital I run my ventilators completely independently via protocol with the intensivists blessing. Unless it's a trauma surgery case, in which case the trauma surgeon demands full control. I have to get an order just to lower the FiO2 when he is in charge. I can insert A-lines, but we had to fight tooth and nail against the nurses - they didn't even want to do them, they just didn't want us to do them. Likewise I share responsibility with the RN's over Central Lines and PA catheters (monitoring/maintenance, not insertion), which again the nurses, not the doctors, fought us about. I am not allowed to touch and am discouraged from even caring about the IABP's. We have no protocol for medications, so I give a lot of not indicated breathing treatments (that Trauma Surgeon I mentioned? He orders Q6 ATC Albuterol/Atrovent on every single trauma surgical patient no matter their history until they discharge). Unless they're a COPD exacerbation, then I have full control again over ordering and altering their medications. I was allowed to intubate on the floors because the ED docs (of which there are 1-2 per shift) were tired of having to leave the ED to come intubate, but then they changed their minds and took over again. It's a big ass mess basically, but it's the life of an RT pretty much everywhere. I don't complain though, because when I worked at UCSF I was little more than a robot, following orders to the letter with absolutely no protocols and simply twiddling with knobs when told to.

Yeah, our profession is scattered and all over the place here in the US. I'm still deciding on whether I want to pursue PA school or emigrate to the great up north (with a lot of thinking/deciding yet to happen), but either choice will in the end be better than where I am now. Unless our political organizations get their **** together and there's a major culture change, but I won't really be holding my breath for that.

Turf battles are hilarious. We had to fight for the right to do PPDs, something nurses felt was a bother to begin with but didn't want to give up. Wtf, why?

Oh, and if you want to run ECMO as an RT, there are a few places where we do so. MGH comes to mind. It's not a bad career, but the inconsistency of practice hospital-to-hospital sort of makes it so, hence my getting out.

Oh, and the AA route exists stateside if you're looking to go RT>anesthesia, which I'm sure you know already, but it's very geographically limiting. Perfusion also seemed like a great idea at the surface, but the jobs just aren't there anymore.

 

[BSN2014]

I know some people are unhappy as PA's and nurses. So if u had to do it over would you? And what would u do?

If I had known then what I know now, I would have skipped the nursing degree entirely. I would have majored in an equally interesting but easier subject, completed my science courses, skipped the gap year and went straight on to med school.

That being said, I'm not sure that I would have had the same motivation that I do now. Basically, I'm not sure if I would have ended up doing well in my science courses or even making it to med school at all. Nursing opened my eyes to medicine and healthcare in a way that I don't think could be accomplished by a traditional premed path (for me).

 

[BSN2014]

Turf battles are hilarious. We had to fight for the right to do PPDs, something nurses felt was a bother to begin with but didn't want to give up. Wtf, why?

I don't know how your hospital operates, but the one I used to work at was in the process of stripping a lot of tasks away from the nurses - regardless of however much extensive training they had in that area. Granted, nurses are always busy, but a majority of the tasks we're busy with aren't the interesting, cool skills that we were stoked about during nursing school.

I was able to acquire some great experience in my senior practicum because I worked in an ICU for a month. That hospital had very few RTs, and no phlebotomists or IV teams, so ICU nurses (and any other nurses that worked there) were basically responsible for all of those tasks. They were also the rapid response nurses, so I was able to acquire some experience with codes.

I was bummed when I started my first nursing job at another hospital and realized that I wouldn't be able to perform any of those tasks again. But then when I got slammed with 8 patients for the first time, I was glad to see RT or lab walking towards my patients' room. One last thing I had to worry about.

 

[BreathDeep]

I was able to acquire some great experience in my senior practicum because I worked in an ICU for a month. That hospital had very few RTs, and no phlebotomists or IV teams, so ICU nurses (and any other nurses that worked there) were basically responsible for all of those tasks. They were also the rapid response nurses, so I was able to acquire some experience with codes.

What RT tasks did they have the nurses doing at that hospital?

 

[BreathDeep]

Turf battles are hilarious. We had to fight for the right to do PPDs, something nurses felt was a bother to begin with but didn't want to give up. Wtf, why?

Oh, and if you want to run ECMO as an RT, there are a few places where we do so. MGH comes to mind. It's not a bad career, but the inconsistency of practice hospital-to-hospital sort of makes it so, hence my getting out.

Oh, and the AA route exists stateside if you're looking to go RT>anesthesia, which I'm sure you know already, but it's very geographically limiting. Perfusion also seemed like a great idea at the surface, but the jobs just aren't there anymore.

Power would be my guess.

And I actually was involved with ECMO at a previous job, truth be told I didn't like it (I prefer to chaos of the ED to the usually more controlled environment of the ICU) so I was mostly just upset out of principal lol.

I also looked into becoming an AA, but my state (California) doesn't have them, and I'm unable to pack up and move half way across the country for school, my husband might be a little upset about that. Last year (or maybe the year before?) there was actually a bill in the California Assembly to allow AA practice in California, but the nursing lobby converged immediately on the state capitol to fight it. There was much wailing and gnashing of teeth, apocalyptic tales of the potential wholesale slaughter of patients, and distraught nursing union leaders draped in sackcloth, faces covered in ash as they bemoaned the horrors that would befall their patients. The congressman who offered this unholy deal was cast down for sacrifice, and shortly thereafter the bill died in committee.

 

[tartesos]

Gigolo

 

[BSN2014]

What RT tasks did they have the nurses doing at that hospital?

One example would be vents. We had RTs, but because there were so few of them, day shift might see them once if they're lucky - usually at the beginning of shift. We were educated about, trained to, and allowed to, modify vent settings as needed. We basically only called RT if we couldn't figure it out ourselves or if we just wanted them to OK whatever we had to change/modify. 9 times out of 10 we wouldn't even do that. We would chart the change in settings and the RT that came around for the next shift or round would check it again.

When I switched over to the other hospital, RT did everything, everywhere, including in the ICU. Management didn't want nurses to even think about traches or vents. If there was a problem, protocol was to refer to RT.

 

[BreathDeep]

One example would be vents. We had RTs, but because there were so few of them, day shift might see them once if they're lucky - usually at the beginning of shift. We were educated about, trained to, and allowed to, modify vent settings as needed. We basically only called RT if we couldn't figure it out ourselves or if we just wanted them to OK whatever we had to change/modify. 9 times out of 10 we wouldn't even do that. We would chart the change in settings and the RT that came around for the next shift or round would check it again.

When I switched over to the other hospital, RT did everything, everywhere, including in the ICU. Management didn't want nurses to even think about traches or vents. If there was a problem, protocol was to refer to RT.

Damn, that hospital sounds like it had some messed up priorities. It's awesome though that you got be around vents at least and get more comfortable with them (most RN's I encounter seem to get nervous at even the slightest vent problems). Even though as an RT I can get a bit defensive of my machine sometimes, there's nothing I love more than working with a solid ICU nurse I can bounce ideas off of when things start to go south.

Still personally makes me a bit nervous though when I hear about RN's being allowed to fiddle with vents. As an RT our program had required us to take physics (5 semester hours) plus two semester long vent classes in the program over eight months (totaling over 500 classroom hours, not including lab time) just to really learn about everything involved with ventilators. And even after that plus three years of working I feel there's an enormous amount of information to still learn about them.

 

[BSN2014]

Damn, that hospital sounds like it had some messed up priorities. It's awesome though that you got be around vents at least and get more comfortable with them (most RN's I encounter seem to get nervous at even the slightest vent problems). Even though as an RT I can get a bit defensive of my machine sometimes, there's nothing I love more than working with a solid ICU nurse I can bounce ideas off of when things start to go south.

Still personally makes me a bit nervous though when I hear about RN's being allowed to fiddle with vents. As an RT our program had required us to take physics (5 semester hours) plus two semester long vent classes in the program over eight months (totaling over 500 classroom hours, not including lab time) just to really learn about everything involved with ventilators. And even after that plus three years of working I feel there's an enormous amount of information to still learn about them.

The next time an RN starts a turf war over vents or anything else, ask them how much of their education was devoted to that area.

I really only got 1 semester that included vents, but it included all of the other equipment you might see in the ICU, too. And our simulation labs didn't have any of that equipment, so unless you were lucky enough to land an ICU practicum (like I did and maybe 2 other people in my graduating class) then chances are, you graduated from a four-year nursing program never having touched a vent or any other critical care equipment. These are some of the same new grads that will be hired straight out of nursing school on a floor like CVICU or neuro trauma, even though they've never touched that equipment, and have likely forgotten all of the physiological changes that occur when you turn a knob on a vent. (After all, if you're just memorizing numbers, you're not learning how that actually applies in a real-life situation.)

I probably sound bitter. I'm getting out of nursing and becoming a doctor for many reasons, not the least of which is that I realized I didn't get to do nearly as much or learn as much as I wanted to. I have a lot of respect for nursing, but I think our jobs would be a lot easier if we could learn how to work with other disciplines, like RT.

 

[BreathDeep]

Oh goodness, them new hires going straight into critical care scares me the most. My hospital just went on a huge hiring spree and brought on 20 new-grad nurses. All of them ICU and ED. Now we're no academic center or anything, but we are still a Level II Trauma Center, Cardiac Center, and Stroke Center - and so by extension our ICU covers medicine, neurosurgery and neurology, cardiac surgery, and trauma surgery. No specialized nurses either, they all have to be able to handle it all. So far the new kids all seem to have that "holy **** what have I done" look in their eyes. It doesn't help the learning curve at all that we have the ****tiest EMR ever too. I weep for them.

But nah, you're not bitter, you're just tired of the bull****, as am I. Although my life won't let me get away with medical school + residency (much as I wish I could), I'm still working towards PA school myself. The MD/Mid-Level side of things definitely still has its own endless bull**** of course, but it's different than the never ending Passion Play that is being a clinician in a hospital, be it RN/RT/PT/RD/Whatever.

 

[gstead245]

sounds kinda depressing. I am thinking of PA, but don't really like the career ceiling that the profession has. Then I think of just getting stable income and then save up money to venture into other businesses. Does PA have a good work and life balance? The pa I work along with is always working, doing exact same thing as the doctor but getting paid a half less, but I know if you go into other specialties its apparently better.

 

[tartesos]

sounds kinda depressing. I am thinking of PA, but don't really like the career ceiling that the profession has. Then I think of just getting stable income and then save up money to venture into other businesses. Does PA have a good work and life balance? The pa I work along with is always working, doing exact same thing as the doctor but getting paid a half less, but I know if you go into other specialties its apparently better.

He's getting paid half less but for half less years of education as well( about).

I know pa's that are very happy and satisfied with their Carrer/ life.

 

[tartesos]

Wrong place.

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[Boatswain2PA]

Emergency Physician. Get the full training for the field that I love so much. Oh....and 3-4X the pay.

Got a 395k 3700 sq ft home........
I did get this fixed loan for 5 years then variable that I intend to refinance in 3-4years. At 3.1 rate, 100%.

Don't want to rain on your parade, but that's a dangerous loan. I hope you got a 15 year note so you can have some equity in 3-4 years. Otherwise you run the great risk of being in trouble when you have to refi. Interest rates have nowhere to go but up.

 

[tartesos]

Emergency Physician. Get the full training for the field that I love so much. Oh....and 3-4X the pay.



Don't want to rain on your parade, but that's a dangerous loan. I hope you got a 15 year note so you can have some equity in 3-4 years. Otherwise you run the great risk of being in trouble when you have to refi. Interest rates have nowhere to go but up.

Wrong thread! Sorry guys.
Thanks boat, it was a 30 year one and I got the house 20k below appraisal value so I'm happy and confident it will be ok.
Thanks.


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[pamac]

Alternate career... I would have just become a nurse right out of high school, and transition to NP ASAP vs waiting over 10 years. I looked hard at a few options like medical, dental, podiatry, and PA. The first 3 involved geographic moves I didn't want to make at the time. I was made it to the interview phase at a fire department I tested for, but moved to a different city. I thought about law enforcement, and have friends in that. Military service seemed like a good option. Looked into architecture. What a country and time where you could consider any of those avenues and achieve them! I won't deny that financially, some of my options (like the ones that come with the title "Dr.") would have the awesome payout. That seems to be the bottom line in every conversation. But I come back to nursing because of flexibility, demand, diverse opportunities, and ability to pick up and move state to state very quickly and work. And standard 3 day work weeks.... I can't say enough about that. 4 days off?..... Amazing. People work 5 days a week durring prime daylight hours. That is so strange to me now, and I love that. I know nurse couples who each work just 2 shifts a week and absolutely enjoy life 5 days at a time. And you can even spread it out so you are working a Monday, then a Thursday, and you wouldn't believe how work stress melts away when you know after a bad shift that you don't have to work again until the opposite part of the week. Of course, I'd have probably sold out and become an 8-5 NP to chase more money. But ultimately, I'd love to find a way to work 3 days a week once I'm NP'ing it. I'm sure I can, but I run the risk of not bringing in the kind of money in hoping for.

 

[Takamori]

knowing back in the day what I know now I would have gone to medschool (DO) and done a dual FP/EM residency and worked in a rural environment after graduation from residency. The happiest docs I know are all rural primary care and em docs. I have several friends who are double boarded doing both, loving their schedules and their lives. plenty of time off. great salaries. no debt. I am slowly but surely working myself into a position doing mostly rural coverage shifts, both double coverage and solo coverage positions. I'm at around 50:50 now, some months 60:40 in favor of rural. when I can make the jump away from urban shifts entirely I plan to do so.

I am 35 and about to apply to MD/DO schools, but realized that it might not be the best idea at my age because of the debt considerations and my future abilities to pay it back. I read you quite often and think that your advice would be valuable for me on that matter. Anyone else, gentlemen, your opinions are as precious. Thank you.

 

[tartesos]

I am 35 and about to apply to MD/DO schools, but realized that it might not be the best idea at my age because of the debt considerations and my future abilities to pay it back. I read you quite often and think that your advice would be valuable for me on that matter. Anyone else, gentlemen, your opinions are as precious. Thank you.

If you love medicine, don't let debt discourage you from pursuing it. You will( eventually) pay it back and have the option to go rural or academic and have some assistance with them, or not.

It's a long process, think it through but don't let debt get in the way, it's only money.


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[Mad Jack]

Damn, that hospital sounds like it had some messed up priorities. It's awesome though that you got be around vents at least and get more comfortable with them (most RN's I encounter seem to get nervous at even the slightest vent problems). Even though as an RT I can get a bit defensive of my machine sometimes, there's nothing I love more than working with a solid ICU nurse I can bounce ideas off of when things start to go south.

Still personally makes me a bit nervous though when I hear about RN's being allowed to fiddle with vents. As an RT our program had required us to take physics (5 semester hours) plus two semester long vent classes in the program over eight months (totaling over 500 classroom hours, not including lab time) just to really learn about everything involved with ventilators. And even after that plus three years of working I feel there's an enormous amount of information to still learn about them.

As a current med student and licensed RT, I can back that RTs know more about vents than even most physicians, with the exception being critical care and anesthesia trained docs (and those that take a special interest in vents). Even then, however, much of the basic art of vent management (such as equipment vs patient troubleshooting to locate the source of a problem) is unknown to them (except perhaps anesthesia). Like, I can tell you in ten seconds where volume loss in a system is coming from and fix it because I'm very familiar with the equipment. The idea of a nurse handling a complicated equipment problem (of which there are many) is pretty damn terrifying to me.

 

[Mad Jack]

I am 35 and about to apply to MD/DO schools, but realized that it might not be the best idea at my age because of the debt considerations and my future abilities to pay it back. I read you quite often and think that your advice would be valuable for me on that matter. Anyone else, gentlemen, your opinions are as precious. Thank you.

The debt takes care of itself, don't worry about it. Even after debt and taxes, unless you're clearing a ton now and end up with low pay later, you'll be coming out ahead every month.

 

[Takamori]

@Mad Jack, @tartesos, thank you. That's exactly what I needed to hear!