I’ve had a number of people approach me about how to get in to wilderness/remote medicine as a career. I’ll cover some general thoughts and general routes in this post and the route that I took in a later one.
If you have questions after this post feel free to email me or message me through Instagram.
Let’s start with a few general statements.
Good money is hard to come by in most parts of the wilderness medicine world.
Many of the jobs are interesting or exciting and people are willing to take less money which drives the market down. Other positions are with poorly funded NGOs or other groups that don’t have the resources to pay great rates but do have a mission you might support and thereby be willing to take a pay cut for. Also most of these gigs will include cost of travel, housing, and food so if you don’t have expenses at home then the pay cut may not be as severe. For the sake of everyone in the remote medicine world know what is appropriate and what is ridiculous. Some employers, especially outside of the US, are willing to pay incredibly low rates because the market will bear it. Some will expressly state that they are hiring locals only. This usually means they are unwilling to pay western rates, not that they are actually looking to support the local economy. A few groups will hire 1-2 westerners to develop a program in country and train locals to do the bulk of the work to western standards. The westerners will be kept on to oversee the program and/or provide a higher level of care/service (western paramedics, local EMTs). I think that model is actually pretty solid as it builds capacity in the locals without sacrificing standards.
Many positions want experience either directly related to the work being applied for or at least similar.
Just being a good X in a well resourced location in the developed world doesn’t mean you have what it takes to function in the environments you may be exposed to in the austere world. Sometimes just the trip to your new job can be difficult and might be a turn off for new employees let alone the actual working conditions. Employers want to see that you can operate in these places before committing to the cost of on boarding and bringing you to that remote place.
Performing a UA for a patient and teaching Peshmerga nurses how to do the same.
Experience can be gained through volunteer opportunities.
If you can effectively provide patient care, facilitate logistics, etc in an austere environments many companies/organizations recognize that the experience gained volunteering is transferrable to paid positions. You may need to do several volunteer gigs (2 weeks – 1 month) to get enough experience to be viable to an employer.
Some volunteer opportunities are really expensive.
Some organizations run on a tight budget and charge the volunteers or don’t cover all expenses to go on the trip. The value to volunteer may be worth the cost to volunteer which if that’s the case then enjoy yourself. Make sure the organization is using your money and your time in the best way. Look for groups that are extremely transparent about how that money gets applied to your experience. I’ll add a note of personal annoyance, if you are an organization functioning in this manner looking for highly specialized people to work in extremely austere conditions on a short notice don’t be surprised when I’m unwilling to cough up $2500+ to support your group. I might not even do that if it was revenue neutral. Adequately fund your project so you can hire the people you need.
Reputation and word of mouth is huge.
Some circles are remarkably small so if you get a bad reputation that can follow you pretty far. That reputation is not just your skills/knowledge but also how you carry yourself, how you behave off duty, and how you conduct yourself online. One of the factors that makes these worlds even smaller is when people cross industries. For example, I’ve worked with folks in tv/film, humanitarian, military special operations, start up circles, traditional healthcare, public safety, and academia. I’m a bit of a connector but even more than me being able to connect individuals, many of the people I know in those circles are much stronger connectors than me so they are able to facilitate checks on someone. This happened recently with an instructor candidate. I looked at the individual’s resume and recognized a specialized military unit that I had a previous student in. The student didn’t know the candidate but he did know the candidate’s commanding officer and I ended up speaking to the CO who strongly recommended the candidate. The best jobs I’ve gotten so far have been from people I worked with texting or calling me and saying “Hey, this awesome gig is open. You want it?”
Personality is important.
A lot of remote medicine work involves spending long periods of time in close quarters with people so being able to get along with them is pretty important. Some gigs have more personality or customer service demands than others. Not only do people want you to be pleasant but you should actually be able to carry a conversation about topics outside of your professional discipline. Even if your hobbies or interests aren’t shared by the people around you many of the folks I’ve worked with love meeting people who are interesting and passionate so they will enjoy hearing about your hobbies, to a point.
Sagvan (Kurdish fixer and friend), Stolley, and Dan enjoying a day off in Kurdistan.
Having multiple useful skillsets is often valuable
While a few positions may employ one very clear skillset many want you to be able to do at least two things if not more. Patient care and instructing are common. If you can teach CPR, ACLS, or non-certifying classes effectively you have more value. Other things like leadership, logistics, communications, speaking another language, providing security assessments, or simply being able to drive stick can be super handy. Sometimes these skills are specifically asked for (language is a common one) but often they just make you more effective at your position and in turn more valuable/easier to work with which builds your reputation. If you don’t have any pre-hospital emergency medicine training please consider taking a wilderness first responder or EMT-Basic course. At a minimum road travel is more dangerous in many parts of the world so your new skills might come in to handy there but also other bad stuff can happen and help may be delayed or you may be it.
Doing some administrative tasks while serving as a team leader with Team Rubicon in a Syrian Refugee camp.
In my travels I’ve seen a few types of people. See where you fit in.
Healthcare provider with a passion who occasionally does remote medicine
You’ve got an established career as a paramedic, RN, NP, PA, or MD/DO and have an interest in more remote medicine. You might be an avid outdoor enthusiast, climber, hunter, etc. Your hobbies bring you outside and your career gives you the stability to explore those hobbies. If you have recreational experience in a particular environment you might be able to find a way to use your professional credentials plus an established organization to find opportunities in those environments. The National Ski Patrol is an example of this. Try and figure who is providing emergency response in those places and see if there’s a way for you to fit in. You may find that many of those folks are volunteer. You may also recognize that your skills are needed by a group doing remote work and find your avenue that way. Plastic surgeons and OR nurses traveling to under-resourced countries to fix cleft palates, for example. This person might transition in to the next category in time.
Full time contracted provider
This is someone who has already developed a desirable skillset through a career in healthcare or the military and is able to accept a full time contracted position doing something in remote environments. Common schedules include 4 weeks on/4 weeks off, 6 weeks on/4 weeks off. The contract may be for a fixed period (12 months) or until the work runs out (6 weeks – indefinite). Remote industrial sites, oil rigs, seismic vessels, military outposts. Some gigs may not be terribly austere, just far from home and far from help. For example, a medical provider in a well stocked clinic on a pacific island. You can’t go home every night and if someone gets really sick you are stuck with them for hours or a days but outside of that the gig is pretty comfortable. Some of this positions may be comfortable and largely uneventful but have the occasional bit of danger or chaos (military hospital in non-combat zone, occupational health clinic in a hurricane prone area). Throughout 2019 I was on an indefinite 2 month on, 1 month off contract in Eastern Ukraine as a remote paramedic.
Many of the longterm US Department of Defense, Department of State, or United Nations paramedic contracts fall in to this category.
Outdoor career with a medical secondary skill set
Wildland firefighter/fireline EMT, Guide, Park Ranger, Outdoor educator. A lot of these jobs are done by people with a passion the work and not for the money. The medicine practiced as part of these jobs isn’t very sophisticated. That’s not a slam on the people or the positions just a statement. Often care will be BLS with a few extra things tossed in. Occasionally you’ll find a SAR team, or medical service that does paramedic level care but it isn’t terribly common, at least in the US. The TV/film industry sometimes uses these folks when they need a rigger, mountain guide, etc. In the TV/film world the set medic may be the same person or different depending on the risks.
Full time freelance
This was me! This is hard. I have had some regular employers and a network of occasional/one off employers. Pros: flexibility and variety. Cons: A bit of a constant hustle to ensure my schedule is full. Also, no guaranteed health insurance. Previously I’ve purchased it through a state exchange and have had it through a domestic partner. I have a few employable skillsets, teaching remote medicine (wilderness first aid all the way through advanced provider level), providing ALS pre-hospital emergency care plus some sick call stuff, risk management/mitigation, and project management. All of my work currently falls under those skill sets.
My experience with particular places or roles may lead to future employment (having worked on the Bering sea, as a medic in a conflict zone). I have also shown that I can adapt to different roles and different environments. If you need someone with a high depth of knowledge about something specialized I’m probably not the guy but if you need someone who can work reasonably well in a variety of places or learn those places quick, I’m a good choice. If the gig requires one person who can serve as a rescue diver, dive medical officer, service the general medical needs of the crew, and whip up a frittata I can’t do all of that. However, if you have someone who can serve as the rescue diver to get the patient to the surface then I can work with that person to fulfill the job requirements. This is especially true if I have a few weeks-months notice where I can seek out additional training/education to get up to speed.
Getting ready to do some rigging in British Columbia during filming with the Discovery Channel
Getting Started
Here are a few volunteer groups that might get you some great experience.
Team Rubicon, a NGO founded in the US with chapters in multiple countries now, has some limited opportunities to provide healthcare in resource limited environments and from time to time they will do a true disaster response.
Med Global provides some disaster and some pre-planned responses focused on delivery of healthcare.
Global Response Medicine continues to change from their founding in Iraq. Assess each new call for volunteers to see how you fit with the mission needs.
If you can volunteer at some ultra-marathons or long distance adventure races (not tough mudders but multi-day type things) that can be good experience. I worked the Keys 100 in 2017 and 2018 through the SUNY Upstate Wilderness Medicine Fellowship. I’m not a fellow, they just let a few pre-hospital folks tag along (to keep the MDs out of trouble). If you are already affiliated with a hospital or academic institution that has some sort of wilderness medicine program talk to them about opportunities.
Education
The Special Operations Medical Association Scientific Assembly is a great conference. It’s a wonderful way to learn from some of the best in the business as well as meet many folks active in austere places. It leans more military but definitely not only military. I loved it last year.
Look at the Wilderness Medical Society and their conferences as a way to gain some knowledge and network.
If you aren’t already familiar with the idea of prolonged field care look in to it via the Prolonged Field Care Working Group. The podcast is solid and the website has a bunch of content.
Learning another language is definitely helpful. Spanish, Arabic, and French all go a long way. This is a major deficit of mine.
If you are looking to work in a role that is pre-hospital or has a pre-hospital/emergency response capacity the following certs are asked for pretty commonly:
PHTLS, TECC, or TCCC*
BLS CPR
ACLS and PALS
Having an instructor cert in any or all of those could be useful too, especially if you are experienced in those areas and a competent instructor.
*Just having a 16 hour “tactical” or “trauma” class doesn’t mean you actually know anything about trauma or can work in the environments where those skills are needed. I made that mistake early on in my EMS career and probably made a few recruiters roll their eyes at my limited resume with a 16 hour class on it applying for high threat work. I didn’t know what I didn’t know. That said, some employers still want those certs along with the right background.
If you have any interest in water focused stuff getting your Dive Medical Technician is helpful. This course seems to be really focused on just DMT not basic first aid as well like many programs are so assuming you are an EMT or Paramedic that could be a more efficient course. If you don’t have that pre-hospital experience look for a program that covers the full content.
ATLS may be useful for paramedics to audit. It is a desired cert in many areas and if working in a facility utilizing ATLS having previously taken it will help you be on the same page.
Additional areas of knowledge and skill, getting decent at primary care, sick call, and nursing care is actually way more useful that being high speed on the trauma side. There’s no question one needs a solid foundation but I find myself dealing with rashes and coughs much more than blast injuries. Even when I worked in Mosul at the end of the fighting I saw more casualties with severe dehydration, infected wounds, malnourishment, and exacerbation of chronic conditions than I did major trauma. Granted, we had a high volume of patients so I saw a ton of trauma but the balance was 60:40 in favor of non-trauma or at least non-acute trauma. If you are able to do rotations in a burn unit, wound care unit, urgent care that would be a great way to build your knowledge and skills.
