The Practicing PA-ramedic: Finding the Right Job

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.

What are you going to do with the rest of your life?

You don’t need to know the answer today. In terms of your professional life, rest assured: physician assistants (PA-Cs) work in all areas of medicine, and if you are compelled to change specialties, the door is already open.

The first job that’s perfect for you as a new grad may not be the best fit as you start to feel more comfortable in your new profession. Unlike the EMS agency where you might work, to upgrade, move, or change specialties, you won’t need to repeat the training academy or sit for a promotional exam. Despite the several months it might take to fully change from one position to another due to licensing and credentialing requirements, a competitive signing bonus might make the wait worth your while. Alternatively, you may get lucky and start your career in your forever home, right after graduation (a girl can dream).

Apprehension about the job application process is completely normal. By the time you’re ready to start finding that first PA job, you will have invested considerable amounts of time finding the perfect coffee shops to study away your days while you bleed your bank account dry, one sip at a time. Prepare to consult your classmates, advisers, and colleagues as you refine your resume, polish cover letters, review job offers, and examine the minutiae of an employment contract. Don’t be afraid to reach out to someone who’s been through it before; I spent several hours in conference calls with trusted faculty advisers and mentors reviewing job offers.

While it certainly more than looms in the background (read: ever-present on your mind once you take the time to read those statements that come in the mail), that first job is absolutely more than a way to pay off those student loans. It’s the proving ground for earning your stripes as a PA. With the right mentoring, coaching, and guidance, it’s where you could grow into a stronger clinician.

Overwhelmed at the Start

So, did I end up in a place where I felt like I could thrive and get the nurturing support I would need as a new graduate? I wish I had fought a little harder during the interview process to ensure I’d have more support and guidance in those precious first few months. Fortunately, after reaching out to my team and mentioning I needed more support, things got better quickly.

I am still adapting to my new role, and while it’s not completely what I expected, I know I’m growing into a better provider, little by little. I still miss the days when I’d respond at 2 a.m. with my partner and we could fluidly manage the entire call without exchanging a single word. It can be humbling to transition from the paramedic who transfers every patient to a higher level of care into the one who provides that higher level of care.

In the last two months, I’ve grown by leaps and bounds, and I’m proud to report I’ve cleared my first c-spine, managed to call for an ambulance just a few times (I love that my background has helped me appropriately utilize 9-1-1), recognized an acute appendicitis, drained a handful of abscesses, treated dozens of urinary tract infections, helped a family complaining of “a lot of boogers,” and, because you deserve full disclosure, even managed a few cases of scabies. Every single one of my colleagues agrees it is totally normal to feel overwhelmed at the start (cruising through 20–30 patients a day does not happen overnight). In the walk-in I’m currently seeing 16–21 patients per shift (when I started two months ago, I was much closer to 8–10 per shift). While I may not always have the time to do every single thing I know my patient needs, I do know in the time we spend together, I can do my very best to support them on their journey. Similar to the prehospital environment, it’s reassuring to know I can help the patient right now while knowing they can also plan a follow-up with their PCP.

As you go through the process of shadowing, clinical rotations, and ultimately interviewing for a position, think about what the clinical environment looks like and the pace you’d like to maintain during your workday. How much time you spend with each patient can vary considerably between different specialties and settings. If you love high-volume settings, urgent care or emergency medicine might be a good fit for you. Wherever you land, it’s likely to be a bit of a struggle at first, but it definitely gets better the more you learn and refine your practice of medicine.

Spoiler alert: The learning never stops. PA school is only your initial training. No matter how many shifts you pull, you still need continuing education hours, which are nothing new to someone who’s been in EMS. If you love a good conference, PAs also have plenty of great options (I’m excited to go to my first American Academy of Physician Assistants conference this May). Over the next 10 years, I’ll be renewing my paramedic four more times before I have to recertify as a PA.

Tune in next time to hear more about the meat and potatoes of what a typical day looks like as a PA in the urgent-care setting. You can follow me on Instagram @thepracticingpa.

Sarah Bowman, NRP, MCHS, PA-C, is a physician assistant at Columbia Valley Community Health in Wenatchee, Wash., and a recent graduate of the University of Washington School of Medicine MEDEX Northwest physician assistant program. She has worked as a paramedic in Alexandria, Va., and began her career as a volunteer EMT with the Fairfax County Fire and Rescue Department. Sarah has experience as a paramedic, physician assistant, and EMS educator. Follow her on Instagram (@thepracticingpa) for more.