The Practicing PA-ramedic: A Different Calling

By: EMSWORLD

A possible next step from paramedic on the career ladder is physician assistant. What’s that job like? Gain some insight with this new series, “The Practicing PA-ramedic,” which follows the journey of NRP-turned-physician-assistant Sarah Bowman.

A paramedic mentor once advised me that the day you start to have more bad days than good days, that’s the time to leave. Nobody ever explained what to do when you still love your job, still have mostly good days, and find yourself at a departmental meeting hearing the newly hired fire chief suggest your position be eliminated. Disheartening as it was to hear the only way to continue as a paramedic was to become a firefighter, it emboldened me to search for a better solution.

Investing in prerequisite courses, burning through all my paid time off to attend classes, forgoing vacations, moving across the country, and kissing my debt-free life good-bye to go to PA school was no small decision. I looked within to search for reasons why I loved the paramedic profession so deeply: working on a team, practicing medicine, helping people, and offering compassion and concern to those who need it most. Alternative professions that ticked all those boxes included physician assistant (PA), advanced-practice nurse practitioner (ARNP), and doctor.

Already in my mid-30s and with interests in growing a family, continuing frequent travel, and investing in my retirement savings, I narrowed my search and dove headfirst into learning everything I could about my options. PAs stood out in their ability to change specialties or stay in the same specialty throughout their careers. In contrast, after a residency program or NP training, it could be more difficult to change practice specialties. Ever the paramedic (we are hard to keep entertained, aren’t we?), I loved the notion that I could start and finish my career in completely different specialties if that’s where life took me.

Little did I know then my actions were being watched by a number of fellow medics in the fire department. Since my departure a handful of my former colleagues have started PA school. Tracy Wulff, who just accepted her position in a PA program, recently told me, “You started the medic-to-PA trend here.” She’s the same one who met me for donuts and coffee to talk about my journey to PA-dom. Look at her now! And don’t worry: If you’re at a loss for a predecessor, reach out to your medical director and see if there are opportunities for shadowing a PA at your local ED, then go from there.

After you’ve spent a few shifts with a PA and realized you could see yourself crushing it, it’s time to get your pencils sharpened so you can pour your efforts into an essay describing why you’d make a great PA. This question, or some version of it, will pop up in your application, your interviews, on the first day of class, and probably a few other places. Never one to stray too far from anything food-related, I included in my application essay a great anecdote about a cheeseburger. As delicious as that story was, I also highlighted the defining moment that led me to pursue medicine: when my friend went into cardiac arrest following a scuba dive (we got him back). Pro tip: Be unique and wow your audience. Application essays are the place to have your very own bragfest without repeating a single thing you’ve listed in your resume.

Paramedic, PA Similarities

While interviewing for the school I ultimately attended, I nervously spent several more hours expanding upon why I wanted to be a PA. It’s hard not to notice the similarities between paramedics and PAs. Often working somewhat autonomously on scene and during transport, medics are well-groomed to feeling comfortable directing patient care.

As you’re well aware, paramedics have protocols and online medical control, and there’s always the option to call for additional resources. As a PA I have privileges and a supervising physician, and my clinic has a medical director. If I get in over my head, instead of calling in the cavalry with dispatch, I can reach out to another provider in my clinic, my supervising physician, or the medical director. And of course, I just might end up calling 9-1-1 to transfer my patient to the ED.

When it comes to getting in over my head, I wish I’d known everything my faculty warned me about would be true. They said I’d be nervous my first day (in response I had puffed my paramedic chest and shrugged off the notion of future anxiety). It’s come true: I’m nervous, within reason, to start seeing patients as a newly minted PA-C.

Thank goodness, while I’m earning my sea legs, I have amazing support from the fantastic team at my clinic; they made my first several days go better than I could have imagined. Whether it’s in the ED, the family-medicine clinic, or while scrubbed in on a case, teamwork remains essential while providing patient care in the PA realm, just like you can’t possibly manage a full code all on your own. Good providers can direct a patient encounter; great providers know when to reach out for advice and support.

If you’re thinking of starting this adventure, get to it. Remember, it’s a long process, and there is no exact timeline or mold that fits everyone. Stay tuned for more on navigating landing your first job as a PA (it isn’t as hard as it seems). PAs are especially valuable when it comes to providing care in underserved areas, and the community health center where I’ve landed is already starting to feel like a second home (not too different from that station where your second family lives). I’ve even picked up my first overtime shift!

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