MediMike Posted December 21, 2011 Share Posted December 21, 2011 Hey guys (and gals), I've been lurking here for quite a while and wanted to thank everyone for the wealth of information available here. I've been a medic for 10 years now, and am ready to move forward, but what worries me is losing my independence. As a paramedic I've had my protocols to work with, but I've always managed to practice medicine, not follow a cookbook and have found that if I can justify it I can do it. I've had many many years of being in charge, and I'm worried about trying to step down from that role. I was curious if anyone else shared this concern. (Side note: By no means is this an attack on the profession in general, nor am I saying that PAs are nothing but an MDs lackey, just me venting some fear haha) Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 21, 2011 Moderator Share Posted December 21, 2011 If you can swing md go that route, if not work rural em and you should be fine. Link to comment Share on other sites More sharing options...
Just Steve Posted December 21, 2011 Share Posted December 21, 2011 Paramedic for about the same amount of time...can find scattered through my yearly evals statements like "clinically sound but can be a cowboy" or "very intelligent and aggressive in his medical delivery but can be a loose cannon" I always translated that to read "good at his job, can't tolerate those who can't keep up". However...as much as I like to think I pushed my scope of practice to the edge, when patient needs dictated it, I realize there were still edges. I still had to call for for some orders, or call if I wanted to work outside my protocols, I had to turn over patient care to someone(s) else, I still had a very small bit part in a very large picture. Our available "pharmacy" on the shelf behind plexiglass slider doors is minuscule when you compare to what we'll have available to us. Our contact time with the patient will no longer be a one time 20 minute transport, but rather a multi year, multi visit to manage a series of complex medical issues. We'll be engaging our brain on a much deeper level. If you still feel the need for that EM rush, now you'll be managing multiple patients at the same time, every day, all day. Will we still have an "overlord" who can still reign final word? Yes..but we always have. We've learned to work within that comparatively small box and have fun....now as a PA that box will be much bigger. With the lateral mobility of PA...once we find the edges, and become bored with one box, we can just change specialties for a whole new bigger box. It does help that my current PA school has an on going course in "professional role development" which has discussions on role transition. Being a paramedic was awesome...but if it was the best experience ever, we wouldn't be here on this forum, would we? We'd be over on EMS1 telling war stories trying to scare the newbies. :-) Link to comment Share on other sites More sharing options...
JasonD Posted December 21, 2011 Share Posted December 21, 2011 Simple, go to med school. Link to comment Share on other sites More sharing options...
MrsRonSwanson Posted December 21, 2011 Share Posted December 21, 2011 Have you shadowed any PAs? I'm shadowing in rheumatology and the PA is basically 100% independent. Likely because she has lots of experience and knows what she's doing. If the lack of total autonomy bugs you, medical school may be best. Link to comment Share on other sites More sharing options...
MediMike Posted December 21, 2011 Author Share Posted December 21, 2011 Steve, that was great. Well spoken, well presented and rather reassuring. I've seen very similar things on my own reviews haha, I appreciate the feedback all Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 21, 2011 Moderator Share Posted December 21, 2011 If you still feel the need for that EM rush, now you'll be managing multiple patients at the same time, every day, all day. Will we still have an "overlord" who can still reign final word? Yes..) if you work solo that "final word" is more like "suggestions for next time". if they aren't reviewing every chart in real time the choices are yours to make and live with. my charts are reviewed after the fact within 1 month. by the time they could disagree with something it's already a done deal. Link to comment Share on other sites More sharing options...
andersenpa Posted December 21, 2011 Share Posted December 21, 2011 Simple, go to med school. Autonomy is not the sole providence of physicians. It comes with experience and maturity. There are innumerable examples of PAs functioning with autonomy greater than the OP and in higher acuity situations. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 21, 2011 Moderator Share Posted December 21, 2011 Autonomy is not the sole providence of physicians. It comes with experience and maturity. There are innumerable examples of PAs functioning with autonomy greater than the OP and in higher acuity situations. agree- in the last week I have delivered a baby without a doc in house, managed an elderly pt with complete heart block, bradycardia, htn, and chest pain, managed multiple o.d.'s, suicidal pts, etc with essentially zero md input. several other empa's on this forum(kargiver, true anomaly, medic25, etc) do the same. Link to comment Share on other sites More sharing options...
MediMike Posted December 21, 2011 Author Share Posted December 21, 2011 Andersen/EMED that's good to hear. As I mentioned above, that was one of my concerns, and those concerns are quickly being put to rest. I suppose it would have been a better idea to start this thread with more of a "how much autonomy can I expect..." lean. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 21, 2011 Moderator Share Posted December 21, 2011 autonomy is earned. Andersen and I have been doing this for a while. it took 5+ yrs of jobs with relatively close supervision(and a decent amount of oppression and disrespect) before I got a solo job. now I do as many shifts alone as possible. that means nights/weekends/holidays.... Link to comment Share on other sites More sharing options...
mktalon Posted December 21, 2011 Share Posted December 21, 2011 You practiced medicine as a medic? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 21, 2011 Moderator Share Posted December 21, 2011 You practiced medicine as a medic? what would you call it? it's indirectly supervised by docs but running codes, starting IO lines, intubating, etc certainly falls within the realm of practicing medicine. I understand your semantic point but it is practicing medicine to a very limited extent. Link to comment Share on other sites More sharing options...
mktalon Posted December 21, 2011 Share Posted December 21, 2011 I guess I'm just surprised at the terminology. I have quite a few medic friends and I've never heard them describe themselves as practicing medicine. Link to comment Share on other sites More sharing options...
mktalon Posted December 21, 2011 Share Posted December 21, 2011 I know aides that start IV's and administer meds. I would not call what they do "practicing medicine.". Medics certainly have a larger scope, but I would still be hesitant to walk around a hospital and throw out the words "Medical practitioner". Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 21, 2011 Moderator Share Posted December 21, 2011 I know aides that start IV's and administer meds. I would not call what they do "practicing medicine.". Medics certainly have a larger scope, but I would still be hesitant to walk around a hospital and throw out the words "Medical practitioner". aides do it because they are told to. medics do it because in THEIR JUDGEMENT it is indicated. in a hospital medics shouldn't talking about practicing medicine. but outside the doors of the ER they are it. in most circumstances there is nothing an er doc can do in the back of an ambulance that a medic can't. there are places where medics do perimorten c-sections for example. you won't catch an "aide" doing that. Link to comment Share on other sites More sharing options...
whimsygirl Posted December 21, 2011 Share Posted December 21, 2011 I would absolutely say a medic practices medicine. This comes from my experience as a patient in the back of that rig and as an RT in major trauma center. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 21, 2011 Moderator Share Posted December 21, 2011 how about they practice "field medicine". would that help with the semantic concerns? Link to comment Share on other sites More sharing options...
andersenpa Posted December 22, 2011 Share Posted December 22, 2011 they are performing evaluation and management with no direct supervision. we shouldn't be so restrictive with the term practice medicine....lots of folks doing that very thing each day who aren't MD/DO, or PA... Link to comment Share on other sites More sharing options...
mktalon Posted December 22, 2011 Share Posted December 22, 2011 Yeah I see you're point. I'm certainly not trying to argue a point here, I just never really was exposed to that terminology being used to describe the profession. I guess I am now a little blurry on what the definition of practicing medicine is. I thought this term was traditionally reserved for doctors, PAs and NPs (and I've even heard it argued that NPs don't technically practice medicine because they aren't trained in the medical model). Perhaps what I've been told is incorrect. Link to comment Share on other sites More sharing options...
SilverPA Posted December 22, 2011 Share Posted December 22, 2011 We all know that NPs practice medicine - even NPs will admit that in private - but in public, they practice "advanced nursing," which allows them to be licensed by the Boards of Nurse Examiners and stay out of the realm of the medical boards. It's pure semantics but it certainly works to their advantage. But totally off the topic - carry on . . . Link to comment Share on other sites More sharing options...
KCMA79 Posted December 22, 2011 Share Posted December 22, 2011 I've worked in clinic settings where I didn't see a doc for 2-3 mos at a time. When you make a mistake, and you will sooner or later, you better be ready to take the heat. I get the impression that you enjoy seeing yourself as a cowboy or loose cannon and attach a great deal of importance to autonomy. If that is the case I think you will be frustrated as a PA and should probably go the MD/DO route. Yes, there are PAs out there with large amounts of autonomy usually earned after yrs of experience and I don't think you have the patience to acquire the degree of autonomy you desire. Link to comment Share on other sites More sharing options...
HopefulPA Posted December 22, 2011 Share Posted December 22, 2011 I don't think you have a good understanding of the autonomy of PAs. You need to do some more research. It is all about finding the right job. Link to comment Share on other sites More sharing options...
MediMike Posted December 22, 2011 Author Share Posted December 22, 2011 With all due respect Hopeful that is what I am doing here, hence the reason for the initiation of this thread. KCMA I really hope that when I get into and through PA school one of these days I come out with as great a set of assessment skills as you. I'm thoroughly impressed that you know me as well as you apparently do, being able to judge my level of patience and how I perceive myself. I have no issues taking heat that is well deserved and have enough years of experience to have been on the receiving end a time or two, and am more than willing to put my time in. In no way am I trying to pick a fight here, I would simply appreciate you not jumping to conclusions and passing judgement on me. I do attach a certain level of important to autonomous work practices, but have never been afraid to ask for help when needed, you'll never know it all. I have worked in "mother-may-I" systems before, and found them distasteful. EMED I will agree with practicing field medicine, we do have a limited number of procedures, a limited amount of equipment, and a limited amount of education compared to other "practitioners of medicine". I have been lucky enough to work in a fairly progressive system where cookbook medicine is not forced upon us, and original thinking is encouraged (to an extent). Our Docs allow us to use our judgement for the majority of procedures. Link to comment Share on other sites More sharing options...
Just Steve Posted December 22, 2011 Share Posted December 22, 2011 You practiced medicine as a medic? Well..yes. When I walked into someone's house medical decisions needed to be made based on a patient interview and exam. Those decisions ranged from giving them a hug and a cookie to hanging dopamine and pacing them. Other times I sedated, paralyzed, and intubated all based on my sole decision. There were about a billion choices that were being made that could send the call a billion different ways. Were the majority of the calls a bunch of weak sauce that could have been handled by a cab driver and a box of tissues? You betchya...were there moments where my direct intervention greatly improved a patient's long term outcome? You bechtya. How did I learn to know the difference? By practicing. Link to comment Share on other sites More sharing options...
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