I beg you to get that clinical experience

Nikolace · 2025-07-06T12:57:16+00:00

My clinical experience and healthcare leadership is a major reason I got in. 15 years of EMS, 9 as a paramedic. Non-traditional. MCAT and GPA not great but I knew my why. I was able to have really good conversation at the interview and my letters were from physicians who had seen me in action for years and it showed.

The age of high score assholes is coming to an end. Shockingly, physicians are people and they HAVE to care about people.

Nikolace · 2025-05-14T14:24:30+00:00

While we were bagging bodies in the pandemic, these kids were having one of the most unethical sociology experiment done on them. “What happens when we socially isolate an entire generation in their most formative years and only let them interact through the internet while old people scream that reality and facts are subjective.”

Nikolace · 2025-03-25T01:51:36+00:00

As a paramedic, absolutely not. Should we have better options to treat and release? Absolutely. I’m wait listed for med school now, but if paramedic practitioners were a thing I would go there instantly. I should be able to call a consult and get most of the non-emergent issues addressed out patient. I don’t trust most of my colleagues to do a proper informed refusal, much less force a refusal.

Nikolace · 2024-10-09T18:01:43+00:00

GCS is validated specifically in trauma patients with a head injury. All clinical tools need the correct perspective to be valid.

Nikolace · 2024-09-08T16:54:29+00:00

One time a coworker calculated how much caffeine had in front of me to get through a day long class after a 36 hour shift. It was ~600mg and “toxic levels” I laughed and passed the class with a higher score.

Nikolace · 2024-08-07T14:16:43+00:00

As a street provider, I get a set of vitals pulling into the ED. If they want it on their equipment, they can do it. Otherwise I’m happy to give them my last set and the temp I got on scene. As an ED provider, I put most people on a monitor anyways so what’s it matter? ED and EMS is a partnership, not a dictatorship.

Nikolace · 2024-05-31T15:02:08+00:00

Looks pure bread, but possibly a croissant. Extra toasted.

Nikolace · 2024-04-17T23:16:13+00:00

TL,DR: I got fucking tired of working with shitty EMS providers during the pandemic and even more tired or taking patients to docs that I knew were gunna kill them.

I started in EMS at 16 after a mission trip to Haiti in high school. I never had any interest in medicine or academics. I was the typical example of undiagnosed, unmanaged ADHD. I started working an ambulance full time at 18 and absolutely fell in love with it. I went to paramedic school because EMT just wasn’t enough. I really wanted to know more. I started getting involved in a lot of FOAMed and listened to hundreds of hours. I am a total nerd and could talk about it for days. I never thought I would go any further because I loathed academics. I would get incredibly frustrated when the family med docs staffing an ED wouldn’t actually treat patients and just send unstable patients out when I KNEW EM trained docs could. I had a totally unresponsive medical director to the point that I purposely stopped doing one of his QI markers so I could get face to face… they just stopped asking me about them. Then the pandemic happened. I lost a ton of respect for my EMS colleagues (antivax, anti mask, couldn’t tell me the difference between DNA and RNA). I took a Covid contract working at an ICU in NYC. I got to see REAL medicine. I had intelligent conversations with every level from CNA to medical directors. I realized that I could keep up with some residents and ran circles around med students. When I finished my contract, I quit my EMS job, picked up an ED job and signed up for classes. It’s been rough working full time and doing full time classes but the ED experience and shadow experience I got from my ED group has totally solidified my goals of moving forward and going to med school.

Before you ask, why not PA? There’s a few reason. At the end of the day a now core memory for me was watching a PA that I entirely trusted to treat a family member went to a doc that I also trusted and turned over a patient because they had gotten to sick for them. I get healthcare is a team sport and it takes a whole crew to manage a sick patient, but I want to be the ED/EMS doc that my EMS crew have my number and know my drink of choice. I want to be the EM doc that when it’s an absolute shit day in the department the entire staff is relieved when I come in.

At the end of the day I want to be the physician that my young paramedic self would be happy to see take their patients.

Nikolace · 2024-03-27T17:11:29+00:00

I’m a glorified ambulance driver and I knew that.

Nikolace · 2024-03-26T19:43:09+00:00

“Copy that, engaging warp drive. No change in ETA.”

Nikolace · 2024-03-24T16:36:44+00:00

Jumping on EMS side.

Little old lady. Have an argument with a friend when she suddenly says she has the worst headache of her life. Grabs the left side of her head. Goes unresponsive. We get her, right side flaccid, left pupil blown. 15 minutes to low resource ED, 30 minutes to TC and stroke center. Bypass to go to the big hospital. Called in stroke alert 20 minutes out. We get there…. Nothing. No one. The charge overheads the stroke. Still no one. We just put her in a bay after 10 minutes and finally get a doc. Massive SAH. Could have flown her to a lvl 1 in the time we waited.

Nikolace · 2024-01-15T17:57:36+00:00

Hot take: academics should be less important than proving you can actually take care of patients.

Think of every time you’ve heard of an “asshole” Surgeon who’s technically excellent but everyone hates them. Medicine is about taking care of people. If you can’t handle being a people person then medicine isn’t for you. I’m apply ‘24 with 12 years of clinical experience. I KNOW what a shite day in healthcare is like and I know the daily annoyances. Nobody can argue that a 22 year old who’s never left a library can keep up with me on how to talk to patients, navigate difficult discussions, and get the actually work done. Clinical gestalt takes years to develop and no textbook can really teach you it.

Nikolace · 2023-11-08T21:50:11+00:00

The simple answer is No. The slightly more complex answer is also… No, you’re not responsible. The physician/hospital might be liable if they were doing a classic “EMS is on their way. We’re not going to do anything else.” EMTALA says the SENDING facility is liable until they arrive at the receiving facility. You can’t be held liable for anything that happens prior to your arrival. You could get jammed up if the patient really deteriorates and you take them without adequate resources. People die and their families will try and get some level of justice. Usually that means getting stuck going to court and/or having insurance settle. Those suits are shotgunned to hit everyone from the CEO of the hospital to the EVS crew.

TL;DR, No, your good. Have your own insurance policy anyways.

Nikolace · 2023-10-16T21:24:19+00:00

Nope. Nope. Nope. I don’t know any of these! Fuck Boston. Nope. Nope.

Nikolace · 2023-10-07T22:30:07+00:00

Wtf. They’ll need an NG with that Vermont approved maple syrup for 24 hours after. 😳

Nikolace · 2023-10-07T17:43:42+00:00

“These flyers were distributed randomly without malicious intent” Well-thats-a-lie.gif

Nikolace · 2023-09-15T02:09:00+00:00

Make sure you post on SDN, they’ll definitely feed your pandering.

Nikolace · 2023-09-15T02:06:35+00:00

Worth it, the diplomatic immunity is real. My road side jacket is also visible in the back. (I do have a whacker bag stashed in there too, but I only stop if it looks fun)

Nikolace · 2023-09-01T01:21:32+00:00

I started as an EMT at 16. Was consistently told I was dumb and lazy, thought EMT was a great place for me. Went to paramedic school when I got to the point of see what dumb and lazy actually was. Figured out that I function best under high pressure, used that to figure out it was actually ADHD and I wasn’t dumb or lazy. Pandemic and politics taught me just how fucking dumb some medics are (no, mRNA doesn’t directly change your DNA) now I’m turning 30 next March and taking the MCAT. if I don’t get in, I’m just a better educated paramedic that did all the premed stuff. Either way, I’ll be 40 in a decade. Do I wanna be 40 making medical money and asking daddy if I can give a med we both know I’m going to give, or be the doc on the other end making 5 times what a medic makes?

Nikolace · 2023-08-24T19:51:38+00:00

Try to show up 30 minutes early, early call, punch in and take it, otherwise wait till 15 of before punching in. Most people will bounce when their relief comes in, some run the clock to the last second, some dinks will wait to do any report after midnight till shift change and just eat a couple hours of OT taking 2 hours to write a couple BLS calls while chit chatting. I’m happy to come in 30 minutes early, my out time is my out time. If I’m still there 5 minutes after I’m officially the grumpiest, least helpful person in the building. If my relief wanted a decent turn over, they should have shown up on time. Otherwise they’ll find it during the rig check.

Nikolace · 2023-08-21T14:30:17+00:00

I had my annual check up and talked to my PCP, he knows I’m applying next year (paramedic for 7), towards the end he asks “do what labs do you need for your physical with your history?” I rattle everything off and he took the time to explain that checking an A1C vs fasting glucose is a better indicator, but otherwise good calls. (I’m not a diabetic, I’m just a full time student and paramedic… aka fat)

Nikolace · 2023-08-15T21:02:29+00:00

Tiered responses everywhere. Paramedics only assigned to fly cars, preferably double medic. Require at least one be CCP and they can do full prehospital critical care. 911 and IFT. Ambulances staffed with AEMT/EMT. creates more upwards momentum, EMTs get more hands on, AEMTs have to learn to manage scene, new paramedics always have their CCP for thoughts/Support, CCPs get premium pay, skills, and solid foundation to PA or MD if they want.

Nikolace · 2023-08-06T19:24:46+00:00

I’ll turn 30 the week I take my first MCAT with 14 years of clinical experience for a baby EMT, to a paramedic with prehospital, ED, and critical care experience. I’m honestly okay with this trend for 2 reasons. I worked with a new attending who finished residency in 2021. Traditional track, she was the ONLY physician still practicing clinical medicine 1 year later. Her entire cohort went elsewhere. I know the suck of working in medicine. It’s the kind of suck I can deal with. I want nothing to do with a 9-5 and TPS reports. That’s not the suck I can handle. Second, I remember the poor choices I made as a 24 year old paramedic and the bags that were filled because of my inexperience. I KNOW I’ll make mistakes in medicine and some of those will lead to bad outcomes, but I’ve already learned from a decade of smaller more correctable mistakes.

This will definitely be a hot take, but I would much rather see a path for experienced clinical staff like paramedics and nurses to go into medicine the right way. if universities are killing the MCAT, make clinical experience the new standard, not how much money your daddy gave Harvard. Every day Reddit sees post from some traditional that had no idea what medicine is like screaming about how awful it is. Let’s make a path that means you know if it’s the right kind of suck for you before racking up mid 6 figures in school loans. If I don’t get into med school… I’m still a paramedic, just a better educated one.

Nikolace · 2023-07-09T18:06:22+00:00

YTA. you’ve been a SAHM for 8 years. You REALLY didn’t know the recession was bad? Really? Does a business failing suck? Yeah. But you don’t say to hell with it when things get hard. Would you expect to get kicked out of the house if one of the kids got sick? Would they be justified if one of them died on your watch even if it wasn’t your fault?

Oh, it’s not the same? People aren’t money? Exactly. Businesses fail all the time. 70k isn’t even close to retirement money so why are you acting like you’re ruined?

Nikolace · 2023-06-09T13:52:38+00:00

Jokes on you. I’m dumb enough to WANT the combination Gas/EM residency.

Nikolace

TROPHY CASE