Frontline role

[vector40]

Hi all,

 

I graduated last year and am midway through a one-year critical care PA residency. Trying to plan for my next step and am interesting in getting additional training/experience.

 

Can anyone comment on the current role for a deployed PA, e.g. Army? I'm interesting in getting more experience with trauma and resuscitation, as much of the current cutting edge in that area is coming from the active duty military. That's not the only thing I ever want to do, and I recognize that some of my skills on the medical side would probably get a little rusty (not too many 84yo heart failure patients getting shot) but would be willing to make that compromise for some unique training.

 

On the other hand I'm not interested in sitting back at a base doing urgent care. I do have an interest in serving as well as in some of the financial benefits of a commission, but this would mainly be about the experience, so I wanted to see if anyone could comment on the actual positions and opportunities that I could expect to come across.

[HMtoPA]

You would be doing a lot of time doing urgent care-type stuff, whether "back at base" or deployed. There isn't a whole lot of trauma resuscitation going on in the military right now (of course, that could change) as things aren't nearly as kinetic as they have been in the recent past. That said, the best trauma training the military offers is conducted at civilian trauma centers (in Miami and Los Angeles), primarily because that's where the volume is. There are a lot of good things about being a PA in the military, but if your primary goal is to get your hands on a trauma patient, there are better ways to do that (it would be quite possible to serve your entire term without ever seeing one).

[vector40]

You would be doing a lot of time doing urgent care-type stuff, whether "back at base" or deployed. There isn't a whole lot of trauma resuscitation going on in the military right now (of course, that could change) as things aren't nearly as kinetic as they have been in the recent past. That said, the best trauma training the military offers is conducted at civilian trauma centers (in Miami and Los Angeles), primarily because that's where the volume is. There are a lot of good things about being a PA in the military, but if your primary goal is to get your hands on a trauma patient, there are better ways to do that (it would be quite possible to serve your entire term without ever seeing one).

 

Thanks. As I'm flexible, are there any particular pathways in the service that would be more conducive to this? Or perhaps opportunities in a secondary/tertiary location to do the more prolonged period of surgical critical care (especially for someone with prior CCM training)??

[HMtoPA]

Thanks. As I'm flexible, are there any particular pathways in the service that would be more conducive to this? Or perhaps opportunities in a secondary/tertiary location to do the more prolonged period of surgical critical care (especially for someone with prior CCM training)??

 

 

The services do have several specialty tracks you can pursue. I'm not aware of a critical care pathway, but there are EM residencies and fellowships.

 

In the Navy, if you go through the EM fellowship you could theoretically end up in a Marine Corps Shock Trauma Platoon and working in an Echelon II facility - but it would be years before you got there. Assume an initial primary care tour of 2-3 years, and then EM Fellowship of 1.5 years (assuming you were accepted right away), followed by a 3 year utilization tour in a hospital ED, and then finally your 2-year USMC STP tour. Count on one deployment during that tour, but where? Are we even conducting combat operations anywhere in the world at that time, and will you end up anywhere near them? Too many variables to predict.

 

The Army may have more opportunities, not sure. But regardless, PA's are not primarily doing trauma resuscitation in any capacity and, more important, there are currently no significant streams of trauma to resuscitate.

[cc56]

I was In Afghan doing medevac in 2009.  We got a call for a guy who was walking home and a fire fight broke out.  He caught a round in the wrist and turned to run back to the base.  On his way back he tripped and broke his leg.  So he crawled back to the base and got treated.  I flew in looking for my patient and this guy comes out of a hole and waves me over.  He introduces himself as a PA and gives me a report.   His patient comes out on a litter and off we go.  I always thought that was awesome, he was the man out there with his medics making things happen.  Granted that could of been the call of his life time, but I still thought that was awesome.  

 

On the flip side we worked with 3 PA's from the 101st who worked with us. Ended up working in a family practice clinic back at base state side and when deployed a sick call clinic at base.  They got to fly with us some times and they saw some stuff.  Their SP was our supervising doc.  

 

Active duty in Korea had a PA in charge of a camp clinic (Garry Owen), with the SP at another camp (Stanton).  He did everything.  Train medics, run sick call, respond to trauma.  We went to a tank that hit a troop carrier, Tank on a guy, another guy ripped his legs off.  Went to tank MVA's, mechanics having accidents, etc....  A fair amount of trauma in the field.

 

 I guess each PA has a different experience.  You just never know.  Those were my experiences with PAs in the Army.  

[rocksmann]

Much like being an MP/cop in the military, most of the time these guys don't see a ton of action. Compared to a Civ cop anyways. I agree with  HMtoPA. 

[vector40]

Thanks guys. Very fair points. I'll give it some thought.