Best HCE for pre-PA if $$$ is not a factor...

[mfields]

Hi-

 

I'm new to the site, so sorry I'm sure this has been asked before, but I'm looking to gain a few years of strong HCE prior to applying to PA school. Q: If money is not a factor, which of the paths below would you recommend as the best way to prepare myself for PA school (and if you can recommend another route not listed below, please let me know):

 

-LPN

-CNA

-EMT

-Medical Assistant

 

Many thanks and looking forward to interacting more with everyone here in the future- great site!

-Mark

[PhilipHennessey]

I'm not in PA school yet, but here is my two cents. I'm a practicing EMT with a high call volume urban service. I've also completed a CNA class and am waiting to take the state test. Based on these two experiences, my advice is to go the EMT route. IF (and that's a big if) you can volunteer or get hired with a reputable and busy service, and then bust your hump to show them that you're serious about patient care, you can learn an unbelievable amount and work on your own skills and patient rapport at the same time. I split time between BLS and ALS ambulances - the merits of that is a separate discussion - but getting a lot of "ride" time has been incredibly beneficial for me as a future PA. When it is just you and a partner on a call, the urgency of a patient needing care forces you to perform up to your full potential. I usually will finish a call, write up the patient care report, and then immediately get on the internet or go into my textbooks and do as much research about the patient's meds, allergies, past medical history, and their current complaint to help augment my knowledge. I ask the paramedics tons of questions about WHY and HOW they handled their part of the call in the way they chose to.

 

In addition, as an EMT, you'll be delivering patients to emergency departments and will have LOTS of interaction with MDs, PA, RNs and techs. I don't think I need to explain the long list of why this is benefical to you both as a practicing EMT and a future PA.

 

The CNA training I was provided didn't teach me a SINGLE thing beyond what I already knew from my EMT class and experience. Maybe the only benefit of being a CNA is that you'll develop long term patient relationships.

 

At least in my area, working in an emergency department as a paid tech requires both EMT and CNA certifications, and a lot of experience in one or the other, which is really the only reason I took the CNA class in the first place.

 

I'm sure lots of other people on here can vouch for this: being a practicing EMT, especially if you get on with a paid/commercial service, is no joke. It's a TON of work, long hours, learning how to deal with a LOT of gray area during emergency situations. It takes a while to get used to actually performing the job of an EMT, which is COMPLETELY different than anything you learn in your EMT class. Honestly, EMS seems to be the sort of profession that eats their young. It is, at times, brutal for lots of reasons. That being said, I LOVE what I do, most of my coworkers, and most of all the patient interaction I get to have. It has been immeasurably helpful in every aspect of my life as a future PA.

 

...again, just my two cents.

[EMEDPA]

the best hce is generally considered to be paramedic/nurse/resp. therapist

[mfields]

Thanks so much for the detailed, insightful response. RE: EMS "eating their young": have you seen Martin Scorcese's "Bringing Out The Dead"?

 

On a side note, my RN friend said that LPN's are being "phased out"; can anyone speak to this?

[EMEDPA]

The author of "bringing out the dead" is a friend of mine who went to Haiti with me after the earthquake. great guy and great medic.

lpn's are being used less in hospital settings(although my facility still uses them in the er ) but they are used widely in outpatient jobs at nursing homes, urgent cares, and clinics.

[Timon]

ER Tech if you can get in. Requires EMT-B certification. My experience has been amazing. It's not the money factor most people ask, it's usually the time factor. If you have time and presented with a open seat to any program I would rank it as follows:

 

RN > EMT-P > RT > LVN > ER Tech > Back office MA / Surgical Tech > X Ray Tech / Ultrasound Tech / EEG Tech etc > EKG Tech / EMT-A / EMT-B running 911 > Phlebotomist > CNA / EMT-B IFT

 

My rankings are skewed in favor of either how diagnostic or how much variety one would see in those roles.

[EMEDPA]

I would put surg tech way before xray/u/s etc.

they are in the o.r. working with surgeons and pa's while the other techs do a single thing (xray, u/s, eeg, ekg) and really have no direct involvement in the ongoing care of the pt.

[mfields]

Thanks all! I just signed up for EMT-B classes as a first step.

 

Timon- thanks, that is a very useful broad outline.

 

EMEDPA- I am going to get the "BOTD" book today from my library.

 

Looking forward!

[Timon]

I would put surg tech way before xray/u/s etc.

they are in the o.r. working with surgeons and pa's while the other techs do a single thing (xray, u/s, eeg, ekg) and really have no direct involvement in the ongoing care of the pt.

 

Had that reversed. Meant to put them with back office MA. It's fixed now.

[mfields]

Timon- where would you place LPN in your chart? (With EMEDPA's note in mind that, "LPNs are being used less in hospital settings but are used widely in outpatient jobs at nursing homes, urgent cares, and clinics")

[flyingsquirrel]

Honestly, EMS seems to be the sort of profession that eats their young.

 

As someone who grew up in an EMS/FF culture and has worked in EMS for most of the past decade, I would not say that EMS "eats their young". This phrase is usually applied to the field of nursing and, in my experience, refers to the merciless attacks on new staff (by senior members of the profession) for no secondary purpose, fueled by feelings of jealousy, ego, and competition. What I have seen, experienced, and participated in the EMS world is qualitatively different. There is a real concern that newbie EMTs, while they may have all the good intentions and medical aptitiude in the world, are just not cut out for operating in the EMS environment or are coming in with a 'cowboy attitude'. The process is meant to weed these people out, hopefully after giving them some tools and a little time to develop these skills and adjust their attitude. I will be the first to admit that, at times, this can look a bit like hazing, but everything that is done is with the intention of producing quality, dedicated members of the EMS profession whom we would be proud to call our partners.

[EMEDPA]

Timon- where would you place LPN in your chart? (With EMEDPA's note in mind that, "LPNs are being used less in hospital settings but are used widely in outpatient jobs at nursing homes, urgent cares, and clinics")

lpn=lvn. different names for same job.

[PhilipHennessey]

Flying Squirrel: Great point. You described what I was trying to get at better than I did. "Eat their young" was probably not the most accurate phrase to use.

 

To the original post: Given the choice between EMT and CNA, go with the EMT (my opinion). However, any program requiring at least an associates degree or equivalent amount of time spent training (paramedic, RN, respiratory therapist) is going to be the "best" for a couple of reasons: 1) typically these sorts of HCE roles have high levels of autonomy in terms of clinical decision making and responsibility, and 2) should you not get into the PA school, you'll have a somewhat stable/reasonable paying medical career already. Be aware that (at least in my home state of Connecticut) most paramedic programs are a two year associates degree with relevant prerequisites, and ALL (again, at least that I am aware of) require you to have SUBSTANTIAL experience (more than one year full time) as a practicing EMT or AEMT in order to be accepted to the program. I have no clue about the typical requirements for entrance into a paramedic program in other states.

[Just Steve]

I don't know your time table but my time as a Navy Corpsman has proven far more beneficial for me in PA school than my time as a paramedic. Don't get me wrong, being a paramedic has helped me but I am grateful every day of my Corpsman background.

 

With the explosion of on line programs for college credit, it's quite feasible to get your pre reqs knocked out while you are serving. I am assuming the military still has tuition reimbursement while on active duty and of course there is the GI Bill to pay for PA school when you go down that route. Plus the Veteran/life experience angle comes in handy when applying.

 

Just tossing that out there.

[meatbone1]

I have my EMT-B and CNA and finding it very challenging finding *any* part time/PRN job in the Atlanta area. I'm contemplating sitting for my EMT-A. My initial thought is to work within the hospital, where I will have more interactions with the various professions, however I'm trying to keep my hopes up. Am I limiting myself to PT/PRN or the environment? I'm going to school taking my pre-reqs so that's the reason for the type of shift I'm seeking.

[ebif]

I'll throw in the option that does not get too much attention: Ophthalmic Technician/Assistant. Each day, I "work up" ~15-20 patients for an ophthalmologist (spend 15-30 minutes with each patient), which includes taking a detailed history, reviewing allergies, medications, problems, review of systems, checking visions, performing refractions (determine eyeglass prescriptions), performing applanation (checking intraocular pressures), administering eye drops, checking pupils, and a few other things. Beyond this, if you find a good ophthalmologist/optometrist to work for, you could be conducting other diagnostic procedures (topographical maps, take sophisticated pictures of the back of the eye, assist in surgeries -- LASIK, PRK, etc).

 

I have done other volunteer opportunities and worked in different hospital settings, and this has by far been the most hands-on experience I have come across. I had no ophthalmology experience prior to this position. At the majority of clinics, you receive on the job training (and if you wish to become certified you can sit for your exam after 6 months full time of work).

 

PM me if you have any questions!

[sartort]

I agree with Just Steve. Military experience will get you a lot of variety, a lot of independence, and a ton of on the job training. I wasn't able to do much college coursework while I was in due to the demands of my unit, but the post 9/11 GI bill is excellent.

[uscbigdawg]

RN > EMT-P > RT > LVN > ER Tech > Back office MA / Surgical Tech > X Ray Tech / Ultrasound Tech / EEG Tech etc > EKG Tech / EMT-A / EMT-B running 911 > Phlebotomist > CNA / EMT-B IFT

 

ER Tech is an okay job, but man does it pay crappy. As a former Army medic, and now on-call phleb at our level 1 trauma center, I can tell you that in our case, the PCT's in the ER are over qualified, underpaid and given who does what, arguably not necessary. Yeah...I might 'only be a phleb,' but with everything that goes on in the ED/Trauma and the "interactions," with patients, nurses, PA's, NP's, MD/DO's on the floor, it's more than just dropping needles into folks. We don't have many CNA's or LVN's left in our facility, and our RT's constantly need our assistance. So...phleb's can be shifted up the scale (much) higher if you'd like. ;-)

 

Point being, that there's a big difference between the academics, the perception of what folks do and what actually goes on in a facility. To answer the OP's question though, depends on your situation. Given all that I know now about the area we live in, getting on an ALS truck as a Basic pays well enough and you get to do and see a nice variety. Forces you to document, be able to explain to your ED/Trauma team what's going on and...the trucks are getting nicer.

 

Rich

[baussie]

I have my EMT-B and CNA and finding it very challenging finding *any* part time/PRN job in the Atlanta area. I'm contemplating sitting for my EMT-A. My initial thought is to work within the hospital, where I will have more interactions with the various professions, however I'm trying to keep my hopes up. Am I limiting myself to PT/PRN or the environment? I'm going to school taking my pre-reqs so that's the reason for the type of shift I'm seeking.

 

Just wanted to quote this to point out that sometimes.. it doesn't matter how much money you DO or DON'T have.. the market can determine whether or not you get a job. I live in the Smokies and it is very difficult to find any kind of hospital work, whether RN, Tech, etc. We only have small hospitals around here that don't even employ ER Techs because they don't have the funding or the need because they rarely service more than Medicaid patients with a cold who don't want to make an appt with their PCP, if they even have one. They have doctors, nurses, and very little other staff than receptionists and the occasional x-ray tech. People graduating from the nearest Comm College (over 30 miles away) with EMT certs have a 13% hire rate, per the college's own statistics.

 

Programs at local colleges have extensive wait lists that are years long, compounding the problem. So even if you can afford a program, you have to get in, get through, and then there's probably not a job for you.

 

I understand this doesn't really add to the main topic & that you could "just move"... but it isn't always that easy. Then again, no one said it would be easy, and those who really want it will find a way. But certain areas just have nothing to offer newbies to the medical field right now.

[mkels]

HCE is what you make of it. I'm an ICU tech. I've learned a lot because of the effort I have put into doing so. There is nothing inherently better about being an RN unless you make the most of that experience. There are RNs in my unit that are less knowledgable than i am of the pathologies that we deal with, and there are RNs that are more capable than some of the residents. Do what interests you and then put your best effort into it. The larger the scope the easier it is to have access to knowledge...but that isn't always taken advantage of. The smaller your scope the more difficult to access knowledge....but that can be overcome with diligence. That's why all these blind scenarios of some unknown paramedic being a better applicant than a CNA or RN better than medic...etc, its all worthless chatter. An RN who has made the absolute most of their experience is better equipped than a CNA who has done the same. But I would bet my life savings that anybody who has the diligence to make the absolute most of their HCE, whatever it is, will also be a great PA.

[Hoosier1]

It all depends on the area where you live. In central Ohio the EMS function is combined with fire. To get a true EMS job you need to have your P card and fire card. With that being said don't discount the private EMS sector. In Ohio the nursing homes and LTAC's do not want to call 911 because it counts against their state ratings. As a result they have contracts with the private EMS companies to handle them. When I was looking for a job after getting my EMT-B I looked for a company with the highest acuity patients. The company I ended up working for has been awesome experience. While we don't handle true 911 calls including MVA's, I am routinely dispatched on chest pain, shortness of breath, and other emergency calls. You will also transport patients to radiation, chemo, dialysis, the ED, etc... It may not sound sexy but these are some of the sickest patients you will encounter. You will get to hone your assessment and history taking skills. Most medics will tell you a good basic can make or break an emergency call. After interacting with various STNA's and CNA's the only other job I would take is ER tech. The others just don't seem like they would have provided the experience I have gained so far as an EMT. Obviously if you have the time to get your EMT-P or RN then go for it. Both would provide the best experience in my opinion.

[Timon]

ER Tech is an okay job, but man does it pay crappy. As a former Army medic, and now on-call phleb at our level 1 trauma center, I can tell you that in our case, the PCT's in the ER are over qualified, underpaid and given who does what, arguably not necessary. Yeah...I might 'only be a phleb,' but with everything that goes on in the ED/Trauma and the "interactions," with patients, nurses, PA's, NP's, MD/DO's on the floor, it's more than just dropping needles into folks. We don't have many CNA's or LVN's left in our facility, and our RT's constantly need our assistance. So...phleb's can be shifted up the scale (much) higher if you'd like. ;-)

 

I wish I could and I'm not knocking on PBTs. I got my CPT1 (ASCP) and did phlebotomy at UCI Medical Center. I put them there because a lot of schools don't accept it as HCE that I encountered, you could end up in a role strictly in the Lab processing orders, and although you are touching patients and learning all the diagnostic tests there is no responsibility of patient care outside of drawing blood. Many ER Tech jobs require phlebotomy certification in addition to EMT-B. Also depends where you work, some techs are glorified unit clerks while others are putting in foley caths, drawing blood, doing 12 leads, applying plaster splints, respond and perform CPR on all codes in the hospital, etc. I've seen the avg pay around $18-$22 an hour. One hospital pays their ER Techs $26 an hour in San Bernardino.

 

As for IFTs, many and not all of them, make up their own vitals, give in accurate info, and embrace the taxi driver mentality. The other day I had a IFT EMT bring a patient in who had a critical high blood sugar and a respiratory rate of 40. I asked if they were having kussmaul respirations and the guy and partner had no clue what that was. And often times when I ask questions like that to IFTs they don't know the answer. When I ask what the medical history is and they tell me hyperlipemia and HTN then I ask is that it and they say yes. Ill ask the patient and they'll go on about their cardiac history, had CABG x 4 2 months ago and has diabetes its hard for me to take anything an IFT says seriously when that routinely happens.

[Hoosier1]

Timon,

 

I've seen the same thing. It's amazing to me because the pay for an EMT-B is so crappy in my area. It's not like it would be a job you would go into without the desire for patient care. I do tend to see it more in those just doing their time before getting a fire job. I've also come across RN's that I'm amazed passed their boards. Actually had one tell me that adding a second oxygen concentrator at 5 LPM would bring the patient to the 10 LPM that was needed. I politely thanked her but said we could handle it :)

[kris_]

Sounds like you're fairly set now- but I wanted to mention clinical research assistant as a route. I've been extremely fortunate and have worked in many different research fields including smoking cessation, hypertension, and obesity-- the three leading causes of preventable death in the US. I do all sorts of clinical things such as blood draws, EKGs, blood pressures, tonometry, etc. I also take histories, give prescriptions (signed by an MD of course), explain medications and side effects.

 

I really love what I do, make a decent paycheck, and didn't need anything other than my bachelor's degree. Also- I'm interested in primary care so the field I've worked in has been particularly helpful! Prevention is very important to the role of a primary care PA. Good luck!

[funkytown]

Quick question: if I had a choice between CNA or phlebotomy tech, which one should I choose? I want to enroll in a certification course and can;t decide. Did phlebotomy years ago, but never got certified and worked as a medical assistant, but didn't get my cert. as it was too expensive.

THanks