Paramedic to...? PA / NP/ MD?

[Quillthoughts]

I want to preface this with I spent an hour reading the forum and found several questions like mine but none that were close enough to give me the answers I require. So, like many other posts, I'm a paramedic at a crossroads. I've been a paramedic for five years, EMT for seven, I'm 30 years old and I'm bored. I love medicine and the limitations of EMS are boring me. I would like to go further but I don't know where to go and the fact that I'm posting in "Student Doctor Network" may be me dropping hints to myself.

I was going to the Paramedic to RN bridge with the intention of eventually becoming an NP. The series of bridges required had two very important factors that made me chose it, initially, over pursuing PA: financial and emotional security. I can work through all the bridges that go from a paramedic with a vocational certificate to a DNP. I don't have to depend on my husband (also a paramedic), who would actually be willing to do the extra work, for financial security. Emotional security was the big winner. It was pointed out to me that if I do all the coursework leading to PA / NP and don't get into the required schools, I either have a Bachelor's in Nursing and a guaranteed job or a Bachelor's in Biology. I've met a lot of people that have a BS... they're all paramedics.

I'm in my last semester of prereqs to apply to the first bridge. To date I'm taking one class, and have only taken one class, that is not required in all 3 programs. That class is "Pharmacology for Nurses" and, to put it bluntly, the course makes me want to stab myself in the face. That course is actually why I'm doubting the field because I might actually stab myself in the face if I have to take five years of courses that are taught like this one. All but the labs are online, which I actually like but the book itself repeats information at least a dozen times in each chapter. I wish that was hyperbole. It does the usual Fact-Example-Summary of texts then it goes FES again, contrasts it to the opposite medication, tells you the most common medications, restates itself, summarizes (yes the summary and restating are two different things) then tells you how to apply it to nursing. The advice given are things like, "This medication causes dry mouth through this mechanism that we're going to restate after explaining it three times so you should counsel your patients to drink more water."

Here's the crossroads I'm facing. I actually really want to be a doctor. I don't have the time or money to go to medical school. I don't want to enter my 40's with a quarter million dollars in debt. I'm willing to sell myself as the black female atheist I am and try to get scholarships, grants and rewards but I have some serious doubts about my ability to rock that "I could be more of a minority but I really love my husband and he's a man which makes us both pretty straight" to the tune of a quarter million dollars.

One of the reasons I didn't want to do PA was because of the time commitment but I dropped down to PT at my main job so now I have three PT jobs and can just arrange my schedule around school and studying. My husband would actually be quite willing to work extra hours to make up for the income I'm not bringing in and me continuing to work is solely because I've worked since I was 16 and honestly don't know how not to. I tried. It was the most anxiety inducing week of my adult life and I'm including that weekend when my doctor's office left a message to call after I had testing done and then they went on a three day weekend.

Another issue that I have is with schooling itself. I absolutely adore labs. My adoration of labs is negated by my disdain for sitting still and listening to someone talk. I have not successfully sat still in a didactic lecture since... ever. I was diagnosed with ADHD and medicated when the symptoms became a lifestyle problem and then I realized that I would probably already be in medical school if my mother had listened to the guidance counselor when I was in 2nd grade.

So here's my question and what seems to be relevant information for advisement.

After 5 years as a paramedic and dreams of moving forward in medicine, where should I go? MD, PA or NP?

Age: 30

Pros:
Smart
Supportive spouse, emotionally and financially if I'll let him
Unable to have children
Willing to dedicate the time
Self-motivated learner
Adore medicine
Adore a good challenge
Persistent to the point of being stubborn
Screw it, I'm just flat-out stubborn and refuse to give up
Some leadership abilities
Tests well
Love learning, love it so much. If I could spend eternity in school, I would
Willing to go back to the beginning and restart my education
After all my years in EMS, I have two PAs and one MD that will I know will let me shadow them and write a LOR plus several more of both that know me well enough to give me a chance.

Cons:
Issues being still
Issues focusing when I have to sit still for longer than 45 minutes (and that's medicated)
Prefer to be in a lecture setting as little as possible
Addiction to working
Do not want to enter my 40's with a quarter of million dollars in debt
Husband has health problems and will likely only last, physically, another 5 or 8 years in EMS
Would rather not start from the very beginning of my education

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[QofQuimica]

You're bored with your current clinical practice as a paramedic, you hate your nursing classes, and there's not one thing on that list that convinces me that you really want to be a physician. In fact, I'd say you mainly want to do it for reasons of ego and challenge, neither of which is a good reason to go into six figure debt and spend ten years of your life pursuing this career. Since you want to be an eternal student, why not get a PhD and become a professor? It's not a bad life. You don't have to be particularly smart to get through med school as long as you're willing to work hard, and in fact, being too intellectually curious may be a detriment in med school if it distracts you from focusing on memorizing what you need to know for your exams. In contrast, graduate training allows people to go on tangents, which may wind up being more productive than the original line of inquiry. You also don't have to take out loans to be a grad student; classroom time is relatively minimal; and if you're bored with one research project, you can drop it and work on another. Getting a PhD is also much harder than getting an MD is, which should appeal to your sense of wanting a challenge. (Not getting into the program itself, but actually completing the degree.)

Seriously, you sound like a good grad school candidate to me. Think it over.

 

[pharmnrp804]

I love the above answer by @QofQuimica. I think I agree with pretty much everything. Too many people think that the MD is the be-all, end-all degree. Not everyone needs to be a physician, and there are many more wonderfully challenging fields! That is precisely why I chose to combine my professional studies with a PhD. It would also allow you to make your own schedule, so you could still work in EMS if you felt it wouldn't interfere with your work (I still do this today). However, if you're absolutely determined to obtain one of these professional degrees, it sounds as though your path of least resistance is the NP. Granted, you also learn the least, so that may be a major negative for you. While you may certainly be capable of doing well in med school, you may not enjoy it, especially in the early years where there is a lot of rote memorisation. And by the way, you can certainly go to nursing school while completing the medical school prerequisites. That may give you more options. You may even fall in love with floor nursing... Just a thought.

 

[QofQuimica]

I did my PhD prior to going to medical school. It always made me laugh when I got accepted to med school and people said things like, "now you'll be a real doctor." They have no idea what they're talking about. A PhD is the highest level degree you can get, period. It's not a coincidence that grad school is considered graduate education, while med school is considered undergraduate education (with residency being considered the graduate part of medical education). Not to discount a professional degree, because it takes a heck of a lot of sweat and tears to get one. I busted my butt plenty hard to get my MD and go through residency. But the MD is still a lower level degree than the PhD.

If I could go back and do it all again, I would do what you are apparently doing (PharmD/PhD). My PhD is in pharmaceutical chemistry, and it's the drug aspect of medicine that I find most intellectually interesting. My best friend from grad school is a PharmD/PhD (also did separate degrees, but he went to grad school after finishing pharmacy school).

 

[rwmedic906]

OP, you seem to be suffering from the plight of all EMS personnel. The unfortunate aspect of EMS, and nursing for that matter, is it has become the breeding ground for the pursuers of "the past of least resistance". For most of my career in EMS, many of my co-workers and friends sought one of two fates once it became clear supporting a family on paramedic wages was not possible. They either went to the FD or they started taking online nursing classes. The problem that this has created is the perception that if you're smart and have some clinical knowledge then you should be able to usurp the hard road paths to advanced clinical degrees, because, after all you've proven your acumen in the field. This was the hardest lesson I had to learn. I was a paramedic for ~10 years and the age of 31 prior to starting medical school. I too began the long journey with the same state of mind as you have now, and it was only after years of humbling moments, over and over, that I realized there is no bridge course to becoming a doctor. You will be held to the same standards as every other medical school applicant, they will expect that your grades are good, your MCAT is competitive and that you are willing to work hard. Being a paramedic gave me no advantage over others in the process, in fact it disadvantaged me in the beginning because I felt entitled to become a physician based on the fact that I had been a paramedic (We're all ego maniacs). No one can tell you what to do or which path to take, you have to make that decision on your own, but do so with an honest heart and know that this will not be an easy journey. Medical school is not what you imagine in your mind. Becoming a doctor is much more about tenacity and will power than it is about intelligence, and many admissions committees can differentiate a hard worker from a "easy roader" from a mile away. Medical school will teach you that there were many holes in your EMS education and even worse, much of the learning is not as sexy as that of paramedic school (take a look at Robbins and Coltrans pathology book sometime). Medical school is a long hard journey. I will be close to 40 by the time I am actually practicing medicine as a physician and I will be 250K in debt, but I will also be a Doctor. It is THAT satisfaction that is the reason I decided to take the hard road. I think you should do some soul searching on exactly what it is you want from medicine, and, if it is to become a doctor, then go do it! Don't let the difficulty in the process deter you but instead, let it show you capabilities you have yet to discover about yourself.

 

[Cawolf]

I would suggest shadowing.

I am a paramedic who is currently trying to get into medical school and shadowing PAs, NPs, and physicians really gave me a better understanding of each of their roles in medicine.

 

[makingthejump]

I'm not a medic, pa, np, etc...I was however a confused young twenty something trying to find my path. I took half a decade to figure it out through shadowing and weighing pros/cons. You absolutely need to shadow every profession that interests you and talk to professionals to gain an understanding of the career. If you do this, you will find yourself making the right decision for the next step of your journey...it will become clear without you even realizing it.

 

[deleted92121]

Current medic, in EMS for ~10 years, 4 of which in a busy Level II trauma center as staff medic, educator and managerial roles. I'm 29, in a relationship, no children, $100k in debt from a prolonged undergrad and some other issues (yes the debt hanging over my head sucks but what the heck, can't change the past).

I had a longer post written and rewritten but it seemed contrived and wordy. I prefer purposeful brevity.

So here's my thought.

I am a big believer that life has no intrinsic meaning. There is no reason we are here and we have no predestined purpose. We are here because of luck and perhaps being the strongest, most opportunistic swimmers.

So it is up to you to give life a meaning and yourself a purpose.

In my world, the meaning I give to my life is very simple. It is to be happy in as many aspects of my life as possible. Personal and professional. I'm very happy personally and I am working hard to make sure my professional one is equally as positive. For me, that means earning my MD/DO.

The purpose I have given myself is to use my talents to better the world I live in. Turns out my talents lie in the practice and art of medicine. I truly have a passion for medicine, from the science to the business aspect. I am luckily my passion inside and outside of work is the same.

All the best to you on your journey

DXU

 

[jsmith522]

So I too was a paramedic for the last 17 years and an EMT for three years before that. I choose the EMS life because in the 90s when I failed out of school it seemed like a good choice until I got my head on strait and went to medical school. I have always wanted to go into medicine. I found that the challenge of EMS was not the same for me as my partners and friends. I longed for the increasing challenge of treating complicated medical issues for a period of time longer then 10 minutes. I will be in my late 40s when I complete residency but that doesn't worry me. So I have lots of thoughts and I am going to try and sum everything up and sorry if I jump a little here.

First, as you and other stated EMS is not the end all of everything out there. We are taught just enough to make us really dangerous and then sent on our way. For some of us that learning never ends and won't even when we go onto bigger and better things. But, being bored in EMS doesn't mean you should go onto a different field in medicine. For me I decided that I should be the best person at reading ECGs at my department. I spent hundreds of hours going to classes, reading books (like Merriams Cardiology), and reading ECGs. But, that doesn't mean that I was ready for medical school or that I should be given the opportunity for medical school. For that I had to work just as hard as everyone else and get good grade (even better then most since my overall sGPA and cGPA was going to be lower then other since I failed out in the 90s). In my interviews it was brought up that both I was a paramedic and that I failed out of school in the 90s and what that meant to the school and y interviewer. As for a paramedic all I could say was that it just gave me a taste of what medicine entailed and that helped me determine the path that I am taking. As for the grades I would just explain that I was a dumb kid with no direction and ended in a place that lead me to where I am today. Then they would was why after 20 years would I leave and what I would do if I didn't get accepted. I would always say that although I love my job I want to have more interaction with patients then the 10 minutes I have in the back of a medic. I would also say that if I didn't get in then I will continue to work as a paramedic.

As rwmedic906 stated it is very hard to raise a family on a paramedic's wage. I too went the fire department route for some of that reason, also because I liked fire fighting as much as medicine. But, many of my good friends still work for either a private service or a hospital based service and are able to raise their family on that salary. So, the money thing should be a BS excuse. You might have been surprised at how little you made at first, but you stuck around, so it wasn't the money. I may go out on a wire here but you stuck around because you liked working with patients. Which leads me to the question about debt. Yes you are going to have debt no matter which field you choose. Whether you choose nursing, PA, MD/DO, or PhD you are going to have school debt. As such you are going to have to pay that debt off, so as a nurse you might end with 50K with a salary to match and maybe the MD route you end with 250K with a salary more or less matching that amount. So either way you will end with debt. Having family support makes it easier, but schools esp medical and PA school will try and make it easier on you so that money worries don't interfere with your learning. So really you are going to have to figure what you want to do.

As for me I had no interest in nursing. I also thought that PA might be a possible choice but when sat down and thought about it I felt that the DO route was the best option for me. The PhD route was also a possible choice but wasn't sure that after my under-grad research that was the path I wanted to go. If you are truly looking for a challenge then yes the PhD route would be the best. But, you might end with a little less patient interaction. If that is ok for then you then follow that path. If not then you really need to sit down and think about the reasons you want to remain in medicine. You should find a challenging aspects and continue to learn in every field EMS, nursing, and advanced medicine as a PA or MD/DO. But have a reason to follow that path. You should talk to people and ask them what they like and dislike about their career. Your in EMS, a huge advantage to interact with lots of different professionals. Take that extra couple of minutes at the hospital to talk to the nurses, PAs and docs. You will find those that are happy and unhappy with their choices. But, that also lets you see all aspects and allows you to make a better choice.

Becoming a doc should be something in your soul that drives you to follow that path. The other choices should also have that same feeling and drive. Sit down and think long and hard about the path you should take. Shadow and ask as many questions possible so that it helps you make that hard decision. It won't be your last hard decision. You will, if you are lucky enough, get into several schools and then another decision will have to happen. It just happens over and over in life and that is what makes life so interesting. Hope that this didn't thoroughly confuse you, stay positive and the path you should take will show itself and then it is only up to you to follow it.

 

[deleted6669]

former emt/er tech x 5 years and paramedic x 5 years who became a PA 18 years ago. now finishing a doctorate in global health. there isn't a day that goes by that I don't wish I had gone to medical school back in the day. I'm doing fine financially now and have a couple good jobs that I started within the last 5 years, granted they all require tons of driving because they are very rural (most good pa jobs are).
the first decade as a pa was pretty rough. tons of disrespect from docs and nurses. no one knows what a pa is or can do. it's almost unbearable.
> 10 years of college education and some folks still think I am a medical assistant, despite the fact that I work solo the vast majority of the time now and can't remember the last time I had any real supervision from anyone. sure, my charts get read by a doc somewhere within a month of me seeing pts, but they have zero impact on how I practice in real time.
anyway, bottom line : MD/DO>PA>NP>RN if you want to practice medicine. best of luck whatever you decide. If you want to look into pa some more check out the pa forum at www.physicianassistantforum.com

 

[tigers2007]

Did you ever consider CRNA or Anesthesiologist Assistant? I have a few paramedic friends that went the CRNA route and now make excellent money. I think the AA's go up to $200k/year; granted that might be in a ridiculous city like San Fran where a 1000sf house goes for $1M and a regular nurse makes $140k/year. Regardless, the AA training program is about 2-years and many programs seem to have the same prereq requirements as med schools but allow lower GPA's and MCAT scores.