Firefighter (FF)/EMT and PA

[MedPsy82]

I'm curious if there are any Firefighter (FF)/EMT's and PA's out there that are able to work both jobs? This could be in either part-time for both or a volunteer FF/EMT.

 

I have been looking into becoming either a PA or Physician and trying to gather as many pros and cons as I can. Either path that is taken I would like to continue as a FF/EMT in some capacity.

 

I also wanted to know how many PA's are able to compensate for the lack of medical training that is gained in the didactic(?) years of med school and training during residency? Please don't take this question wrong, I am just trying to educate myself the best I can before making a decision this important. I am the type of person that wants to learn as much as possible to be the most helpful in the field I choose.

 

Thanks

[UGoLong]

I don't know what you are asking in your third paragraph.

 

I still work part-time paid EMS a few shifts monthly after 8 years as a PA. Until the truck carries me away, or I become a liability for the crew, I plan on continuing.

[JohnnyM2]

I'm curious if there are any Firefighter (FF)/EMT's and PA's out there that are able to work both jobs? This could be in either part-time for both or a volunteer FF/EMT.

 

I have been looking into becoming either a PA or Physician and trying to gather as many pros and cons as I can. Either path that is taken I would like to continue as a FF/EMT in some capacity.

 

I also wanted to know how many PA's are able to compensate for the lack of medical training that is gained in the didactic(?) years of med school and training during residency? Please don't take this question wrong, I am just trying to educate myself the best I can before making a decision this important. I am the type of person that wants to learn as much as possible to be the most helpful in the field I choose.

 

Thanks

If you mean: How do PAs successfully practice medicine without going through a full residency and having a shorter didactic schooling, there may be some things you don't understand about PA education.

To start with, you can get into med school with essentially no science background because all of the life sciences you need are taught to you during med school. To get into PA school, you must already have a strong life science background. Almost all PA schools require that, before matriculation, you must have completed courses in chemistry, anatomy & physiology, and biology. Generally, you must also have general and organic chemistry and microbiology, all of those courses with labs. Depending on the school, you may have to have completed two or three semesters of psychology, nutrition, and medical terminology. Many PAs have also completed courses in genetics, virology, and/or parasitology. So PA students enter school with much of what MDs learn in their first couple of years.

 

Second, PA school is generally four semesters of didactic training with heavy course loads each semester (17-21 credits). So a graduating PA pretty much has the same didactic education as an M.D.

 

MDs have longer patient training; three or more years, whereas PA have around one year of clinical rotations. Keep in mind, though, that most entering PA students have one to ten years, sometimes more, healthcare training as EMTs, nurses, techs, etc. In their first jobs, PAs are still learning from their supervising physician and other colleagues and know better than to practice beyond their scope of knowledge. Or, they may choose to do a residency/ fellowship in a field that interests them. By five years out, if they remain in the field of practice they started with, PAs are highly competent professionals and tend to be limited, in their scope of practice, more by their state licensing boards and their employers than by any lack of training or knowledge.

 

Sent from my Kindle Fire HDX using Tapatalk 2

 

 

[MedPsy82]

Re-reading the third paragraph I do see it is a bit vague. It seems to me that 1 year didactics (PA) vs 2 years didactics (MD/DO) there is a lot of information not being learned. There seems to be a lot of details that are not covered or covered as thoroughly, at least it appears like it would to me. I am just curious how this gap is lessened or does this gap in knowledge close by itself as time progresses? The second part is about residency training MD/DO go through and PA's do not. Is the training the PA's receive on the job comparable to years of residency? In other words, after a few years on the job are PA's well trained to the degree an MD/DO is through their residency?

 

I hope this helps in clarifying things.

 

UGoLong - How do you operate as an EMT with PA training? Do you just limit yourself as to what you can do in the field to the EMT level? Any issues with transfer of care if you operate as a paramedic?

 

Thanks for your relies.

[MedPsy82]

If you mean: How do PAs successfully practice medicine without going through a full residency and having a shorter didactic schooling, there may be some things you don't understand about PA education.

To start with, you can get into med school with essentially no science background because all of the life sciences you need are taught to you during med school. To get into PA school, you must already have a strong life science background. Almost all PA schools require that, before matriculation, you must have completed courses in chemistry, anatomy & physiology, and biology. Generally, you must also have general and organic chemistry and microbiology, all of those courses with labs. Depending on the school, you may have to have completed two or three semesters of psychology, nutrition, and medical terminology. Many PAs have also completed courses in genetics, virology, and/or parasitology. So PA students enter school with much of what MDs learn in their first couple of years.

 

Second, PA school is generally four semesters of didactic training with heavy course loads each semester (17-21 credits). So a graduating PA pretty much has the same didactic education as an M.D.

 

MDs have longer patient training; three or more years, whereas PA have around one year of clinical rotations. Keep in mind, though, that most entering PA students have one to ten years, sometimes more, healthcare training as EMTs, nurses, techs, etc. In their first jobs, PAs are still learning from their supervising physician and other colleagues and know better than to practice beyond their scope of knowledge. Or, they may choose to do a residency/ fellowship in a field that interests them. By five years out, if they remain in the field of practice they started with, PAs are highly competent professionals and tend to be limited, in their scope of practice, more by their state licensing boards and their employers than by any lack of training or knowledge.

 

Sent from my Kindle Fire HDX using Tapatalk 2

JohnnyM2,

 

This is pretty much what I was asking, thank you. So the prerequisite classes that most PA school require are the same material, more or less, that med students learn in their 2 years didactic studies. I am guessing then that the 1 year didactics for PA's is basically to gain the classes and knowledge that were not learned from the prerequisite classes and previous experience prior to entering PA school. Once this is gained, the didactic years are on a, more or less, equal playing field. Then the only difference would be the length of time and route taken to learn the specific field of interest (internal, family, neurology, etc..).

 

Please correct me if I am wrong or missing something. Knowledge can only be gained if the question is asked to be answered.

[rev ronin]

Yes, I work as a family medicine PA and a volunteer fire officer, as well as EMT instructor/evaluator.  I started as a volunteer EMT, went through fire academy immediately afterward, and have stayed with the fire service since, even volunteering during most of PA school.

[MedPsy82]

Thank you Rev Ronin, it's nice to know one does not have to be given up for the other. I am curious how the EMS calls work though, all FF must be EMT-B certified to be employed where I am at. Is it just a matter of only operating at the EMT level or is there more to being a PA and taking these calls? I'm guessing this would be more of a state specific question however. I'll have to research that one with my state.

[cbrsmurf]

JohnnyM2,

 

This is pretty much what I was asking, thank you. So the prerequisite classes that most PA school require are the same material, more or less, that med students learn in their 2 years didactic studies. I am guessing then that the 1 year didactics for PA's is basically to gain the classes and knowledge that were not learned from the prerequisite classes and previous experience prior to entering PA school. Once this is gained, the didactic years are on a, more or less, equal playing field. Then the only difference would be the length of time and route taken to learn the specific field of interest (internal, family, neurology, etc..).

 

Please correct me if I am wrong or missing something. Knowledge can only be gained if the question is asked to be answered.

 

Undergrad classes are no where near the same intensity as what is learned in PA or med school.  There is no question that you learn more in med school.  Med school classes aren't necessarily harder, often times PA students are taught alongside med students at many programs, but there are more classes/hours overall (hence the extra year of didatics).  Residents (MD/DO or PA) will learn more in their residencies than a PA in their first jobs 99.9% of the time.

 

Another thing to consider is that while it may be possible to make an equivalent wage as PA and FF, a physician salary will be way higher.  Most people do not choose to do a second job at a much lower wage unless they truly love it and have the free time.

[rev ronin]

Is it just a matter of only operating at the EMT level or is there more to being a PA and taking these calls? I'm guessing this would be more of a state specific question however. I'll have to research that one with my state.

Yes, in Washington State, every responder, regardless of other medical certification(s), must be either an FR, EMT, or Paramedic to respond on EMS calls. On my volunteer shift, I'm a PA and an EMT, we have one MA/CNA/EMT who works as a pediatric ER tech, another EMT who works as an ER tech and used to work private ambulance, an EMT ex-army medic premed student, an EMT who also works private ambulance, and an LMP USAF reservist who used to be an EMT but now just drives the engine because he didn't keep his cert current. Needless to say, our shift could do a WHOLE lot more than what's within our scope of practice.

 

I can do all sorts of things that are within an EMT scope of practice but not typical training.  Think of all the non-invasive special tests... e.g., for ortho problems. In scope (I'm just performing an exam), but not something most EMTs would even know about.  I can also work backwards from a pile of med bottles to a problem list in ways that most EMTs can't, can document all sorts of cool things that the ER docs will never read (e.g. "Levine's sign") from our field report, and if I'm the one doing the patient exam, you can bet I get a better H&P than a typical EMT as well.  But the fact is, my PA-specific skills really don't make that much of a difference in a field environment--again, I was never a paramedic, so I don't have those skill sets.

[MedPsy82]

Undergrad classes are no where near the same intensity as what is learned in PA or med school.  There is no question that you learn more in med school.  Med school classes aren't necessarily harder, often times PA students are taught alongside med students at many programs, but there are more classes/hours overall (hence the extra year of didatics).  Residents (MD/DO or PA) will learn more in their residencies than a PA in their first jobs 99.9% of the time.

 

Another thing to consider is that while it may be possible to make an equivalent wage as PA and FF, a physician salary will be way higher.  Most people do not choose to do a second job at a much lower wage unless they truly love it and have the free time.

Hey cbrsmurf,

 

Thanks for replying. My idea of maintaining the FF position while being a PA or MD/DO is because of the job itself and not the pay, would most likely be on a part-time/volunteer basis as a FF. Pay between a PA and MD/DO is not really the issue for myself, I understand that MD/DO's make more money across the board, however, some jobs are worth working around and I believe this is one of them. I just want to see if it will be possible to maintain a position in a fire department while working as a medical provider and not have any issues doing both considering the advanced training I would have that others in the department do not.

 

Again, thank for the reply. Every response helps in the decision making process.

[UGoLong]

The Rev is pretty much on. As a PA, I do have the right under our state's law to take charge in a true emergency and go beyond the protocol we have but I never have had to do it. Our protocol is pretty good and our crews well-trained.

 

On runs, I just do what paramedics are allowed to do (since I am one), but with additional medical skills. I am big into the patient's meds since most patients don't seem to know what is wrong with them. It feels like being an old time Indian scout, looking a bent twigs and hoof prints.

 

I seem to always get put in de facto charge whenever it's a medical run and I use my PA physical exam skills in other instances. I consider it a great chance to train others since I'm not really doing anything in the field that they can't be taught to do. And they help me keep my non-PA procedure skills up.

 

It's a great double life!

[Simplify]

Re-reading the third paragraph I do see it is a bit vague. It seems to me that 1 year didactics (PA) vs 2 years didactics (MD/DO) there is a lot of information not being learned. There seems to be a lot of details that are not covered or covered as thoroughly, at least it appears like it would to me. I am just curious how this gap is lessened or does this gap in knowledge close by itself as time progresses? The second part is about residency training MD/DO go through and PA's do not. Is the training the PA's receive on the job comparable to years of residency? In other words, after a few years on the job are PA's well trained to the degree an MD/DO is through their residency?

 

I hope this helps in clarifying things.

 

UGoLong - How do you operate as an EMT with PA training? Do you just limit yourself as to what you can do in the field to the EMT level? Any issues with transfer of care if you operate as a paramedic?

 

Thanks for your relies.

 

In the interest of accuracy, I would also point out the differences between a year of PA school and a year of med school.  Med school students have summers off between 1st and 2nd year and often between 2nd and 3rd.  PA students schlog through back-to-back semesters.  So, in actuality, the academic year for PA students is actually 3 semesters in length, completed over the course of one calender year, whereas the med students will spend 4 "traditional" semesters completing their didactic education.  It's  a small point, but I think we need to be more vocal about the fact that PA school isn't half the length of med school.   The vast majority of PA schools are 7 semesters long, vs 10 semesters for our med school colleagues.

[SocialMedicine]

there is a PA who was just featured on the HBO documentary on firefighters. Check it out he is an FDNY boss. He runs a 9/11 foundation or clinic or something.

 

You compensate for lack of residency and basic science education similar to what goes on in the firehouse. CONSTANT learning and reading and drilling. Forever trying to improve yourself. Many PAs elect to do a residency (not as lengthy as a physician) and I know they are offered at a bunch of places in emergency medicine and burn / trauma care.  

[jphillipspac]

I started in Fire/EMS before PA school and never lost my love for emergency services, I have worked in emergency medicine for 12 of my 15 years as a PA.  I have been a volunteer FF with my current department for 13 years where I'm currently one of 3 lieutenants.  I practice in NC where PAs can serve as assistant medical directors and have been Assistant Medical Director for the last 4 years.  This allows me to acutally do more on the scene if I need to.  I listed our medical director as one of my supervising physicians and developed a practice agreement that allows me to function on scene where I can basically perform any task that is listed in our local system protocols.  I do not "take over the scene" from my paramedics but if they need help I can step in if needed.  It has worked great for me and is certainly doable if you have the desire to keep up your PA CME and FF training.

[MedPsy82]

Hey jphillispac,

 

I currently reside in Western NC and plan on practicing within this same area if I can. Still trying to decide on the PA or MD/DO route, but definitely don't mind keeping all the CME and training up to date. How do you like practicing EM in NC? I'm kinda interested indoing what you are, EM and Fire/EMS. However, I am also thinking about a fee for service FM practice catering to Firefighter/EMS service members and their families (not sure if that qualifies as concierge or not). I'm not really sure if that is feasable as a PA, might have to go for MD/DO to do that, but something I have been thinking of.

[Acebecker]

I work as a volunteer EMT still.  Our requirements are 10 runs/month.  Relatively easy to achieve.  On the trauma calls, the medics get my deference as they have much more experience than I do.  On the medical calls, everyone defers to me, esp the codes (which to me is really funny since I have only run a couple of codes).  I continue to work on obtaining new certifications such as supraglottic airways, intraosseous placement, etc.  I am a basic EMT for all practical purposes but because of the way Idaho works I can start IVs, given saline or D5W, do IM injections of epinephrine for anaphylaxis, place advanced airways (haven't gotten them to let me place ET tubes prehospital yet), etc.  I also have a special certification called "Ambulance Based Clinician" which allows me to practice full scope paramedicine on a transfer from one hospital to another.  I don't do a lot of critical care, but I feel very comfortable managing a drip line or two and pain medication (e.g. a complex fracture that needs care in another city). If the patient codes, I am expected to perform full ACLS protocols so I continually work at keeping those skills sharp. 

 

It's a hoot.  I really love EMS.

[MedPsy82]

Here's a good question I have been pondering for about 2 days now, have not really looked up anything yet though. It appears that some PA's hold 2 jobs, either both in the medical field or one in medicine and another elsewhere. Has anyone ever successfully held a job as a PA and Firefighter? Also how has/does managing 2 jobs, regardless of type, work?

 

The basic schedule for a firefighter here in Western North Carolina, at least around my area of the woods, is 24on/48off. I would think during the 48 off a PA could work part-time, maybe full-time if able to negotiate well, in certain fields. The fields I am thinking about in these terms would be like EM, FM, and maybe surgery if acting more as a first assist(?). 

 

I doubt I would actually be a part-time PA since the training/schooling is a lot more in many ways, but you never know who might prefer it that way. I would prefer to be a full-time PA and maybe a part-time/Volunteer Firefighter.

[rev ronin]

Yes, there is one PA who works as both a paramedic and an urgent care PA.  For a long time he was doing urgent care as locums, and only getting benefits from the fire job, but I understand that's changed.  It seems pretty rare, though.

[DJ Bunnell MSHS PA-C]

Here is a view of the future from Arizona.

 

Mesa’s PA unit eases load for 1st responders

http://www.azcentral.com/community/mesa/articles/20130418mesa-trv-medical-response.html

[medic25]

Here's a good question I have been pondering for about 2 days now, have not really looked up anything yet though. It appears that some PA's hold 2 jobs, either both in the medical field or one in medicine and another elsewhere. Has anyone ever successfully held a job as a PA and Firefighter? Also how has/does managing 2 jobs, regardless of type, work?

I spoke with a PA at a SEMPA conference who worked full-time with a career department in California, and worked part-time in the ED as a PA.  He was exploring possible methods of combining the two jobs with his department.

 

I volunteer with my town fire department as a FF/EMT.  One of the other PA's in our ED is the chief of department of our neighboring town.  The ED physician who functions as the SP for both of us is also a volunteer with the same department; it's not that uncommon in our area for ED personnel to volunteer with their local departments.

[GreatChecko]

What states have an "ambulance based clinician" level of cert? Google says, Oregon and Idaho. Any others?

[BruceBanner]

There was a guy in my class who was a FF, but not a medic. I think he was an EMT-B. Anyways, he obviously could not work much during school. After school, the debt burden becomes real and you will likely be more focused on getting work that pays. Last I talked to him he was in EM and volunteering occasionally.

[jphillipspac]

MedPsy82

 

I really enjoy being a PA in emergency medicine, I am fortunate to work for a group that allows PAs a lot of autonomy.  We are not confined to "minor care or fast track" patients, we pick up whatever comes in.  Of course the docs are there for really critical patients but I have run more than one code by myself while the doc was in another code.  As far as a family practice that caters to FF/EMS, that sounds like a good idea and you do NOT have to go the MD/DO route to do that.  In NC a PA can own their own practice you just need a supervising physician but they do not have to be the owners of the practice.  I have a couple of PA friends that started a few urgent care centers that make a very good living.  As far as working both jobs I think financially it would be better to have a full time PA job and part-time fire/ems job.  Working in the ED I have several days a month available to work at the fire department if I want or need to, as a matter of fact I'm at the fire dept right now.

[fireguy]

16 years as a full-time, paid firefighter in a large urban fire department.  Went to PA school while on the job.  still working as a firefighter (24 on 48 off) and spend my days off working in the ER as an EMPA-C.  Had a long discussion with my medical director before I started PA school and he was very supportive.  We decided that I would get no special protocols or privileges while on duty, that my protocols would be the Medic protocols for my department.  I'm 7 years in as a practicing PA and active FF.  So far have not ran into anything more complicating (or humorous) that a third city service medic or two being very shocked when they run into me in the ER after treating me like a "dumb fire medic" on a scene.  

[JHuffaker]

Outsider looking in, volunteer or paid, a fully certified fireman, that is a PA, can bring advanced practice care into environments denied to the street medic, and to the patients involved, that can mean everything. Prehospital damage control resuscitation, damage control surgery, and critical care level interventions, where ever needed. Yeah, I know that's a mouthful, now make the patient(s) a kid, but from what I've been able to gather, its at least doable as a PA.

Firefighter I/II, Engine Co ops, Truck Co ops, Rescue Co ops, auto extrication, heavy rescue, confined space, hazmat, structural collapse, trench rescue, high angle, water/ice, and the wilderness versions of same.' and each has their own medical implications. Prolonged Field Care (.org) spec ops medics/ PA's and docs, developing treatment protocols for when evacuation is delayed, and those situations don't only happen in the military. 

Wilderness medicine: Can't get your patient to higher or there is no higher right now, if your scenario fits this definition, it is wilderness medicine

Regards, Jim

Edited August 22, 2020 by JHuffaker
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