MD to EMT-P

[PowderHound]

---

Members do not see this ad.

Hey y'all,

I'm an EM resident and was an EMT-B in years past. Life changed and I let my cert expire, but since starting residency have really gotten interested in EMS again and would like to resurrect it in my career status post acquisition of the MD degree. Any thoughts on if it's possible for an MD to challenge the national registry exam for paramedic? What are the rules about MDs practicing in the field? If I want to work in EMS again (NOT as a medical director but actually out there running calls) do I have to go through the whole rigamarole (sp?) of EMT class and then paramedic class?

Thanks for any insight anyone out there might have on this situation...

 

[southerndoc]

Someone in my residency challenged the NREMT-P exam. However, he was still an NREMT-B when he did this. I think once you let your certification lapse it's nearly impossible to do this.

 

[bluealiendoctor]

Doesn't work. Paramedics are structured to follow protocol as written by the medical director and are therefore under the protection of them as well. You being a physician would not be granted the 'protection' that people of lesser qualification have. Also, if you arrive to a scene where there are multiple patients..you would be required to address all of them or face charges of neglect whereas a paramedics can just share the load. And, once you have seen a patient, you are responsible for that patient until someone of equal or higher qualification takes over. You can however talk to a medical director and perform 'ride outs' which allows you to go on calls as a 'supervisory roll' but you have to be chummy with a medical director to get to do this.

 

[chimichanga]

you'll neet to become recerted as a basic, then sit for that exam...then you can take a paramedic refresher class, usually 48 hours of class time, and sit for the NREMT-P exam...

I've checked w/ the NR (though I'm going from RN to EMT-P; for you it would presumably be the same, as the way I described it, is the quickest way allowed by the NR)

I have never been a basic, and all I have to do is take a EMT-B refresher, then sit for the exam...

 

[waterski232002]

You need to just go to a flight program and be a flight doc... then you can get paid as an MD, respond to scenes as an MD, do any procedures/interventions necessary as an MD... but still feel like an EMT-P. Look into the University of Wisconsin... their attendings fly.

 

[pseudoknot]

1. This will vary by state. I think you can do it in Virginia.

2. The legality of MDs working as paramedics is generally hazy and also state dependent. I would go ahead and ignore anything you read about it on the web and talk to your agency's medical director and perhaps a lawyer. The comments in post #2 are not correct in the jurisdictions I'm familiar with, but may be valid somewhere.

 

[pseudoknot]

You need to just go to a flight program and be a flight doc... then you can get paid as an MD, respond to scenes as an MD, do any procedures/interventions necessary as an MD... but still feel like an EMT-P. Look into the University of Wisconsin... their attendings fly.

Yes, it'll be tons of fun...until you crash and die.

 

[Tiger26]

Yes, it'll be tons of fun...until you crash and die.

Sadly, sorta true with regard to the risks involved

 

[189362]

you will be caught up in more scope of practice litigation than you would ever want to deal with. Apply into a "busy" ED

 

[southerndoc]

Yes, it'll be tons of fun...until you crash and die.

Life is fun, but eventually you die. It's a certainty we accept in order to experience life.

 

[pseudoknot]

Life is fun, but eventually you die. It's a certainty we accept in order to experience life.

You know, I try not to think about that, and now you've ruined my day by reminding me. Thanks a lot.

I was half kidding with my comment about crashing. I've never been on an EMS flight, and I'm sure I would think it was the coolest thing ever. I love driving code 3, too, but in both cases the rational part of my brain says that it's too much risk for what is usually no medical benefit.

I do know of several instances of MDs riding with volunteer rescue squads around here, but I think they were usually paramedics before med school. It may not make sense but I can see why someone would want to do it for fun.

 

[southerndoc]

I do know of several instances of MDs riding with volunteer rescue squads around here, but I think they were usually paramedics before med school. It may not make sense but I can see why someone would want to do it for fun.

I see you're from Richmond. Doesn't Ornato ride with RAA a lot?

 

[pseudoknot]

I see you're from Richmond. Doesn't Ornato ride with RAA a lot?

I had to check this out, but I'm told he does.

 

[howelljolly]

For an EMT-P to MD back to EMT-P...

does the EMT-P refresher course need to be done in the same state where the original licence was recieved?

 

[bartleby]

Being an M.D. supersedes any of the protocol-based certifications. While what lawyer ever have to go back to school to become a paralegal?

The greater question is why you even interested in doing this in the first place. It would be one thing to go for an observation shift with a paramedic once in awhile for education purposes. I was an EMT before I went to med school and loved it, but functioning as such as a board certified emergency physician is a waste of your skills and time. You will have more patient contact and, sadly, probably have less liability exposure doing so rather than riding the streets.

Hey y'all,

Thanks for any insight anyone out there might have on this situation...

 

[howelljolly]

Being an M.D. supersedes any of the protocol-based certifications. While what lawyer ever have to go back to school to become a paralegal?.

In education, maybe, but not in practice. Paramedics legally practice as physician extenders, sort of like PAs. They work under the license of the medical control physician... the medical director of the EMS, or the ED physician from where they're based out of. If a physican wants to work on an EMS unit, he still has to work under the direction of the medical control physician. Then it works back-to-front... to legally work under the medical control physician, they must be a certified paramedic. As part of the EMS unit, the physician can not work off of their own medical license. It isnt authorized by the EMS rules or the medical license rules.

Its like the "non-solicited medical intervention protocol" in New York City. A physician who's a bystander/good samaritan to a medical emergency in the streets can help the victim, but must, by law, stop, cease, desist, chill out, etc when the paramedics arrive. If they insist on continuing care, the paramedic can put them on the phone with their medical control physician, and they can have an official MD to MD transfer of patient care sign-off, with volumes of documentation. The MD must then get on the ambulance, and take over. Then he must officially transfer care over to the ED physician at the recieving hospitlal. If he decides not to stop what he's doing when paramedics arrive, and he doesnt follow the non-solicited medical intervention protocol, hes in violation of the law.. anyway....

Paramedics can not practice as paramedics on BLS ambulances (they must practice as EMTs), and physicians can not simply get on a MICU truck and work, without special agreements similar to what many EM residency programs have.

There are plenty of physicians that work on EMS. I know more than my fair share of them, and they all must maintain their paramedic certifications to work on the ambulance.

That said, there are two ways a physican can work on an EMS unit.
1. They can do what we are trying to sort out on this thread, i.e. get an EMT-P card, one way or another.
2. BC/BE EM physicians can to a fellowship in EMS/Prehospital medicine.

 

[leviathan]

I've never been on an EMS flight, and I'm sure I would think it was the coolest thing ever. I love driving code 3, too, but in both cases the rational part of my brain says that it's too much risk for what is usually no medical benefit.

I had the chance to tag along with some flight paramedics for the first time about a month ago. It was a blast, but I don't know if the risk is worth it. That said, I guess it is like an addiction, as I know it is dangerous and could eventually kill me, but I want to keep doing it.

 

[notdeadyet]

Maybe I'm missing something, but from my read of the thread, physicians can really only function on rigs if they have their paramedic license. But even with their paramedic license, they can't operate outside the scope of practice of a paramedic, regardless of their MD. Is this correct?

And if it is, what's the point? I don't see the attraction of being an MD doing paramedic any more than the attraction of paramedic doing EMT. Limiting what you can do in the field to a skillset well below your paygrade would seem pretty frusterating. Maybe it's just me.

 

[Jeff698]

This is a state by state issue. EMS is regulated by each state in a different way. What you hear/see in one state has no bearing on what the requirements are in another.

Here is how this works in Texas (although, government being what it is, it's likely to change by the time I finish this post). I say this as a current Texas emergency physician, current Texas paramedic and former Texas state EMS training coordinator.

The only agency with the authority to regulate who can or can't operate on an EMS unit is our health department. They write the regulations in terms of what an agency has to do to be in compliance with those regulations.

They say you must have a current Texas EMS certification/license in order to STAFF a unit. MD doesn't qualify. An MD is welcome to practice medicine on the truck but it still must otherwise meet staffing requirements.

There is also the matter of our medical board's regulation of the practice of medicine and tort law. Our board says we have the right to the unrestricted practice of medicine. Unrestricted. I can't practice under a delegated model.

As for civil law, I will never be held to the standard of a paramedic again because I'm a physician. It doesn't matter what uniform I am wearing.

Again, it can't be stressed enough that this is a state issue and your mileage WILL vary. Pseudoknot's advice to disregard anything you read online (including this post) is outstanding.

BTW, I have no intention of letting my Texas paramedic license expire. I can't actually use it but still. It's been with me for 20 years and is like that warm, comfy blanket from my childhood. I had to give up my blanket and I'm still pissed about that (the therapy is going well, thank you).

Take care,
Jeff

 

[corpsmanUP]

Nice hearing from you Jeff, it's been a while. I jut had one of TAM's student's up here doing a rotation, and he said he knew you. This is what I am planning in regard to EMS. I am heading back to the "Houston area", preferring not to say where just yet as I am caught in a love triangle with 3 groups, all of which are excellent. One though may be offering me a chance to do some EMS direction with a very reputable EMS agency. I am currently a director under my PD here in Pa of our local EMS. I routinely go on calls if they are a priority 1, which here means there is something serious. I also go on bad MVA's. I am no longer a paramedic and have not legally been one in years (7 to be exact). I will continue to do the same thing where I live in in suburbia after residency. I still plan to show up on calls and plan to provide on scene medical command at times. Here in Pa, we actually have a prehospital physician certification that only qualified EM docs can acquire. The way I see it, if it is your agency, and you want to go on the call, then go. It's good for EMS comaraderia, and it gets you respect from your medics. I don't see why an EP would want to obtain a medic cert though if you don't already have one. The only role for an MD in the field is a supervisory one. Staffing should not change because you are there.

 

[bartleby]

An EMS fellowship has nothing to do with providing certification to provide prehospital care. A fellowship gives you the opportunity to get on the bus. My residents get to do EMS ride-alongs too.

That said, there are two ways a physican can work on an EMS unit.
2. BC/BE EM physicians can to a fellowship in EMS/Prehospital medicine.

 

[HNS]

I am also in PA and became a Pre-Hospital Physician the easy way. I had been a medic for quite a while and just produced my PA Physician license. Within one week I had my card mailed to me. The interesting thing is that here both the EMT-P and Pre-Hosp Physician cards are permanent certifications.

I imagine that many states have similar avenues available to physicians, though regulations likely vary drastically. As has been stated, the only good advice is to follow up in your state and through your programs administration.