Relationship Between EM and EMS Career Paths

[freethinker]

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Interesting observations:

Most emergency medicine doctors, nurses, and allied health were not involved with EMS when they were younger, either as basics or paramedics. They developed an interest from the definitive care standpoint later on. The same thing is often seen with psychiatrists. Only a few majored in psychology. The rest were bio/chem/nursing/whatever and took up the field later on.

The corollary appears to also be true. Most pre-med/nursing/allied health college students in EMS, either basics or paramedics, do not choose definitive care emergency medicine as their ultimate healthcare career. They frequently do something related to the broader field of primary care, but more often from the office-based side. Likewise, many psychology majors do not have an interest in the medical side of things.

Does anyone have any interesting thoughts on this?

 

[pseudoknot]

I know a bunch of people who went from EMS to EM. I don't know if anyone's done a study, but I'd bet that EMS people who go to med school are much more likely to do EM than the average med student.

I'm sure it's true that most EPs don't have an EMS background, of course, since most people in med school aren't career changers.

 

[crewmaster1]

Just wondering how you came up with this "observation" ?????

I would argue just the opposite....many people in EM have EMS experience. Sounds like you're just making crazy talk.

 

[freethinker]

It's not crazy talk.

I shadowed ER doctors before I became a basic and had this discussion with them. One explanation I heard was that more of the younger ER doctors were involved with EMS before. However, the older ones weren't, because they invented the system in the first place, so there was nothing to join. Another explanation was that people who develop an interest later think in terms of the medication perspective, and so bring a more intellectual focus. They usually don't think about the patient moving/manual labor part. That's why medical school/resident EMS rotation/ride-alongs exist: to see the care in context. You don't have to like it, you don't have to do it, but you have to be aware of it and its limitations. It seemed like a logical explanation to me.

I also talked about my observations with colleagues in EMS when I joined who were pre-med, nursing, and allied health. EMTs seemed more likely than paramedics to want to go to medical or any other healthcare school, and often were more likely to have a science and/or healthcare background. As a result, I observed some interesting social interactions between the EMT pre-meds and paramedics. The EMT who took Organic Chemistry, Biochemistry, 400-level biology, etc. might know stuff, but the paramedic can do stuff, which is ultimately what benefits the patient.

True, they did seem to favor emergency medicine more than other pre-meds or nursing students. However, I've seen the argument made that such people just want to come back to where they started, but at a higher level, sort of like the identity foreclosure concept from psychology.

I've also seen and heard something similar from a few psych majors: "I don't want to be a doctor, I want to be a psychiatrist." Me: "Why? If you don't really like the neuroscience side, you can be a counseling psychologist." Them: "Because it's the highest in the field...."

Yes, I'm judging by what I saw and heard, but I spoke to other people who seemed surprised and said, gee that's interesting, by golly they were quietly thinking the same thing. Hence the reason for asking other people's opinion.

 

[docB]

It's not crazy talk.

I shadowed ER doctors before I became a basic and had this discussion with them. One explanation I heard was that more of the younger ER doctors were involved with EMS before. However, the older ones weren't, because they invented the system in the first place, so there was nothing to join. Another explanation was that people who develop an interest later think in terms of the medication perspective, and so bring a more intellectual focus. They usually don't think about the patient moving/manual labor part. That's why medical school/resident EMS rotation/ride-alongs exist: to see the care in context. You don't have to like it, you don't have to do it, but you have to be aware of it and its limitations. It seemed like a logical explanation to me.

I also talked about my observations with colleagues in EMS when I joined who were pre-med, nursing, and allied health. EMTs seemed more likely than paramedics to want to go to medical or any other healthcare school, and often were more likely to have a science and/or healthcare background. As a result, I observed some interesting social interactions between the EMT pre-meds and paramedics. The EMT who took Organic Chemistry, Biochemistry, 400-level biology, etc. might know stuff, but the paramedic can do stuff, which is ultimately what benefits the patient.

I think some of what you're saying is true. Younger EPs are more likely to have been in EMS (more likely than older docs, not more likely meaning a majority). EMTs are more likley to be looking to other levels in medical care because they have younger and have less invested than paramedics.

So I'd say that your observations are true. I'm not sure that it tells us anything useful.

 

[EMmedic]

It's not crazy talk.

I shadowed ER doctors before I became a basic and had this discussion with them. One explanation I heard was that more of the younger ER doctors were involved with EMS before. However, the older ones weren't, because they invented the system in the first place, so there was nothing to join.

The company I worked for has been around for 62 years and was started by a man who is now 85 years old. The older EM docs did not "invent the system." They definitely developed it into what it is today, but they did not invent it.

I also talked about my observations with colleagues in EMS when I joined who were pre-med, nursing, and allied health. EMTs seemed more likely than paramedics to want to go to medical or any other healthcare school, and often were more likely to have a science and/or healthcare background. As a result, I observed some interesting social interactions between the EMT pre-meds and paramedics. The EMT who took Organic Chemistry, Biochemistry, 400-level biology, etc. might know stuff, but the paramedic can do stuff, which is ultimately what benefits the patient.

As a previous pre-med and a paramedic, I can tell you that the organic chemistry, biochemistry, etc that I took had virtually nothing to do with being a paramedic. Having taken premed orgo does not give you medical knowledge.

I don't really agree with a lot of what you have said. I know a lot of EM docs and nurses who started out as EMTs, paramedics, and firefighters. In fact many of the nurses still work as paramedics as second jobs.

 

[EMmedic]

Also, in regards to the EMT vs paramedic being more likely to go to medical school, it is probably true that EMTs are more likely. Being an EMT is more of a transition for a lot of people instead of the career path of a paramedic. However, I think the most important factor is that there are probably thousands more EMTs than paramedics...so statistically speaking...

 

[189362]

My local volunteer squad is notorius for producing EPs. It would seem that if you are in the EMS system and can practice a lot of the basics going in to EM would be a no brainer.

 

[kungfufishing]

Sometimes I get bored too.

 

[freethinker]

That's a good point. EMTs invest less time in their training, and often view it as part of the journey rather than the destination. I have noticed a difference in the approach to patient care, in general, among pre-med EMTs who took the advanced science courses and doctor shadowing before they joined versus those who became EMTs prior to the acquisition of the extra knowledge base. They tend to be a little older and see EMS as a healthcare application of what they learned, whereas the younger ones sometimes have a different attitude towards the short-term and meta-level learning objectives of the experience.

Likewise, do people who were involved with EMS still have to do the physician ambulance ride-alongs as medical students and/or residents? If so, does it feel different? The learning objective is different. You're there to observe the care in context and its limitations, not practice the skills like suburban EMT school students doing their practical with a high-volume urban ambulance service.

 

[docB]

Likewise, do people who were involved with EMS still have to do the physician ambulance ride-alongs as medical students and/or residents? If so, does it feel different? The learning objective is different. You're there to observe the care in context and its limitations, not practice the skills like suburban EMT school students doing their practical with a high-volume urban ambulance service.

I had to do ride alongs. It was kind of weird. I had been doing research with the guys on the rigs for a while and here I am showing up for a ride along. I was the only resident ever to arrive with their own turnouts😀.

 

[leviathan]

I had to do ride alongs. It was kind of weird. I had been doing research with the guys on the rigs for a while and here I am showing up for a ride along. I was the only resident ever to arrive with their own turnouts😀.

I am actually looking forward to EMS ridealongs, if I choose to do EM. I will be likely pursuing EM in a different area than where I currently practice as a paramedic, so I will get to see how things are run in a different area of the world.

For me personally, I think EMS has definitely influenced my decision for wanting to do EM, but I still don't know 100% if I will end up choosing to pursue it. I think EM obviously shares a lot of the same characteristics of EMS that I love, but I've yet to really be exposed to EM from a physician-standpoint to see if that is also something I will like to do.

That actually raises a good question which maybe deserves a new thread, but I will ask in here: For the EPs in here who used to be paramedics, what was the transition to medicine and emergency medicine like, what things have you enjoyed about it, and what things have you found you dislike which you did not expect?

 

[SilverScrubs]

I worked municipal, private, and volunteer FD. I miss the sirens that decreased my hearing and seeing naked people running in their house. I can't wait to be an EM doc so I CAN PLAY SOME MORE. Those that have prior experience, especially non-sparkies, are definitely part of an unspoken group, they have a secret comraderie that those who picked EM in their med school years will never have. I love it.

 

[Mr. Freeze]

I want to go into EM so I can be the one who signs transfer orders instead of being on the transfer. And so I can bust the balls of overzealous QA nazi-paramagics who pick apart the most pointless, inane aspect of everything.

I jest. Sort of. 😉 I actually thought I'd do ANYTHING but EM. Currently, it will take one hell of an experience on some other rotation to dethrone it. Surgery was pretty cool, except for that whole live at the hospital thing.

But I do miss the firehouse. More the guys and the rhetoric than anything. I miss being able to talk **** in a bar without worrying if anyone had your back. Bless their heart, most medical students aren't very "humble in a rumble."

 

[SoCuteMD]

My local volunteer squad is notorius for producing EPs. It would seem that if you are in the EMS system and can practice a lot of the basics going in to EM would be a no brainer.

You overestimate the extent to which EMS prepares anyone to be an EP.

 

[tkim]

The company I worked for has been around for 62 years and was started by a man who is now 85 years old. The older EM docs did not "invent the system." They definitely developed it into what it is today, but they did not invent it.

Armstrong. Almost worked for them.

 

[MedicJ]

I have been a paramedic for several years. I know plenty of docs(from different hospitals) currently working in emergency medicine after doing some time on the ambulance. There are far more with no paramedic experience. I don't think there is really much of a correlation. My current medical director was a paramedic. He is excellent.
I honestly can't remember ever hearing of a paramedic going to medical school and specializing in anything other than emergency medicine. Nursing school is a different story. It is very common for paramedics to go to nursing school and work in the emergency department.
Even though I know of several docs with a history of EMS, as far as actual percentages, not many.
One thing not being discussed is the shelf life of a paramedic. They don't usually last very long. Most paramedics DO NOT start working in EMS and stay until retirement age unless they are working in a rural area. I have been a supervisor and considered one of the senior paramedics in my area. I am only 30. We have some paramedics between the ages of 30-early 40s...but most of them started in EMS late as a second career.
The typical paramedic lasts 5-8 years before going to nursing school or a non-EMS job. The rest turn weird, become dispatchers or go on disability. Some go to medical school but it isn't a common move. If you are going to find a doctor with ambulance time in his/her past, I would look in the ED.

 

[SilverScrubs]

I have been a paramedic for several years. I know plenty of docs(from different hospitals) currently working in emergency medicine after doing some time on the ambulance. There are far more with no paramedic experience. I don't think there is really much of a correlation. My current medical director was a paramedic. He is excellent.
I honestly can't remember ever hearing of a paramedic going to medical school and specializing in anything other than emergency medicine. Nursing school is a different story. It is very common for paramedics to go to nursing school and work in the emergency department.
Even though I know of several docs with a history of EMS, as far as actual percentages, not many.
One thing not being discussed is the shelf life of a paramedic. They don't usually last very long. Most paramedics DO NOT start working in EMS and stay until retirement age unless they are working in a rural area. I have been a supervisor and considered one of the senior paramedics in my area. I am only 30. We have some paramedics between the ages of 30-early 40s...but most of them started in EMS late as a second career.
The typical paramedic lasts 5-8 years before going to nursing school or a non-EMS job. The rest turn weird, become dispatchers or go on disability. Some go to medical school but it isn't a common move. If you are going to find a doctor with ambulance time in his/her past, I would look in the ED.

i don't think i know what you just said, but you made a good point 😉 jk

 

[MedicJ]

i don't think i know what you just said, but you made a good point 😉 jk

Lol. Thanx. I just logged back in to read what I wrote at 2-3am...on my 30th birthday.........after drinking an excessive amount of wine.
I still agree with what I posted but my paragraph was all over the place.🙄

 

[howelljolly]

Your garden variety hyper-competetive medical student is the one that will match into EM. Not the non-traditional, older paramedic who decided later on in life to go to med school.

That means, the EM resident the one that went to undergrad directly out of high school, and spent their free time at a lab bench or a library, not an ambulance. They might have taken lifeguarding or first-aid classes. At best, they took a lighter load during one semester to take an EMT-B class, and got zero field experience (trust me on this, I headed a college based EMS where every member was pre-med). Directly after graduating with a B.S., they started med school. In med school, they did well in all their classes, and ultimately matched into EM. Nowhere in this scheme did they take two years off to go to paramedic school, and then take a few more years to gain some experience.

On the flip side, paramedics might discover a niche in a clinical field other than EM. As a paramedic I had the opportunity take care of pediatrics with cardiac problems on what seemed like a weekly basis. I had thought about pediatric cardiology as a career, but quickly decided against it when I discovered that those fellowship programs would have prefered that I spent more time in research than on an ambulance. Also when I was a young an impressionable paramedic student, and spent a lot of time rotating on the Vent unit, CCU, ICU, etc. I crossed paths with a pulmonolgist who made me think of that as a career. Similarly, a paramedic might go to med school with the intention of going into primary care for the underserved, trauma surgery, or something else that caught their attention on the job.

My point is, that in recent years the typical EM resident is not the medic-turned-nontraditional-MD, and at the same time, a paramedic might be perfectly happy with his career, but want to go into medicine with the intention of going into another field entirely.

 

[vtucci]

Howelljolly- I assume you are kidding with your post.

Although it is often cited that EM is becoming an increasingly competitive field, it is one the fields that truly considers the entirety of a person's application and heavily weighs their abilities on clinical rotations, SLORs and performance in an interview. We do not rise or fall with our step scores and AOA status. Some of the students who match into EM may be hypercompetitive but I would suggest that the percentage of students with that personality will be far lower than many other fields. EM is a field that not only allows but at times, seems to require a diverse range of interests.

Non-trads often have a wealth of experience and do well in clinical rotations whether they are former medics, EMTs, nurses or hail from an entirely different profession. That being said though, I agree though that in terms of time invested, EMTs are more likely to go to medical school than paramedics. EMT certification has been touted at many post-bac programs as a way to get clinical experience for busy professionals as the hours include nights/weekends. We have one paramedic planning on entering EM residency in our class. We have multiple others (myself included) who were EMTs going into the field as well (time actually spent in the field is variable).

I wonder though if the EPs who are EMS directors more than not had prior EMS experience.

 

[howelljolly]

I'm not kidding, but I am overstating the case a bit. I'm also biased since im even more non-traditional since I'll be a Carribean grad. Matching into EM is getting harder every year. Ive been told on a number of occasions that paramedics will actually need to break a 230 on the Step1 to demonstrate their ... interest, if you will.... in academics, since they might need re-training as an EP. I dont know... theres different ideas out there.

 

[EMmedic]

I'm not kidding, but I am overstating the case a bit. I'm also biased since im even more non-traditional since I'll be a Carribean grad. Matching into EM is getting harder every year. Ive been told on a number of occasions that paramedics will actually need to break a 230 on the Step1 to demonstrate their ... interest, if you will.... in academics, since they might need re-training as an EP. I dont know... theres different ideas out there.

I really don't know a lot about this, but I find it hard to believe that if you are a paramedic you will need a higher step 1 score to match into EM. I'm not saying you will have an easier time, just that I don't see how it would really change your application for the worse. I get the whole re-training idea, but is this really a huge problem? I feel like by the time you get to residency, you are thinking as a physician and not as a paramedic anymore...the scope of your knowledge and skill has expanded by leaps and bounds. I feel like a paramedic, who has seen and experienced the ED more than just a few rotations in med school, is much more reliable in their expression of interest in the field. Also, how does a step one score demonstrate someone's interest? Its a standardized test...it has no relevance to interest or the necessity to re-train....

 

[howelljolly]

I totally agree on the re-training issue, but it does come up. By the time you're in your third year, the paramedic experience basically washes out. Once in a while a patient will code, and for some reason, you'll be the only one that isnt doing something particularly stupid.

 

[vtucci]

Howelljolly- I think the 230 step I might have more to do with IMG/Caribbean school status than being a former medic. I have never heard that being a paramedic is anything but a plus in terms of demonstrating interest in the field.

Good luck in whatever field you chose to pursue.

 

[howelljolly]

Good point.

Anyone here know of people that went into a specialty other than EM, because of their EMS experience?