# Why are we often looked down upon as a profession?



## Tachy55 (Mar 14, 2017)

I have noticed from time to time that MDs, Nurses, PAs, ER Techs, etc. often look down on us EMTs/ Medics, and view us as the absolute "bottom" of the healthcare totem pole. Yes, we don't go to school for eight years, but we sure do possess advanced skills/ interventions as well as dealing with very difficult situations and patients.


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## NysEms2117 (Mar 14, 2017)

Tachy55 said:


> I have noticed from time to time that MDs, Nurses, PAs, ER Techs, etc. often look down on us EMTs/ Medics, and view us as the absolute "bottom" of the healthcare totem pole. Yes, we don't go to school for eight years, but we sure do possess advanced skills/ interventions as well as dealing with very difficult situations and patients.


If you want my truthful and honest answer. We haven't proven ourselves. And TBH we don't yet deserve it as a community. Are there some medics/EMT's that deserve that level or respect, ABSOLUTELY, but not as a whole yet.
There is a whole thread on this.


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## Summit (Mar 14, 2017)

ER Techs are usually EMT/Medics...

It is not just that EMS doesn't go to school for 8 years, but rather EMS has the least education of the healthcare fields.

You can teach a monkey to intubate or start an IV. Of all the aspects that make a healthcare provider, the other professions are least wowed by skills while EMS as a field is most wowed by skills (and blinkies and woo-woos).

That said, if you have a good attitude and provide quality care, nobody should be looking down on you.

We look down on ourselves a lot... but a lot of that is to push progression in the field which is a good thing.


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## VentMonkey (Mar 14, 2017)

Ugh, not again with this. Doing your research on here OP before creating a redundant thread topic, lawdy lawd.


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## StCEMT (Mar 14, 2017)

While a good dude, I have a buddy who was excited to finally work as a medic (no 911, only urgent care experience, not that those are bad gigs) because it was "badass" comparatively. While I understand the enthusiasm, and I know everyone here can probably attest to the fact that I was chomping at the bits to finally get released as a medic, I didn't have this vision of being a badass paramedic saving lives every day. I had been working ALS trucks for a while, I knew what to expect in my area. I just wanted my damn pay raise to pay for school. 

Just because I have a P in my title though, doesn't mean I deserve respect or am good at this job.


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## hometownmedic5 (Mar 14, 2017)

For perhaps the one millionth time:

We undergo a short, skills based, limited protocol driven training program. The rest of medicine undergoes long, theory based, multi discipline education.

In short, they are professionals and we are skills donkeys. Maybe this is changing, but its going to be many, many years before our certification process is respectable.


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## Tachy55 (Mar 14, 2017)

I understand everyone's input, and I apologize if there have been similar posts before this one. Brand new here!


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## VentMonkey (Mar 14, 2017)

hometownmedic5 said:


> For perhaps the one millionth time.


...gazillionth?


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## EpiEMS (Mar 14, 2017)

When you define yourself by your skills rather than your knowledge, you tend to fall down the professional totem pole rather quickly.

Allow me to expand a little bit: The critical thing we bring to the patient is skills. What incremental "thing" does an ER physician bring over a paramedic? I'll give you a hint - it is not more skills. It is not just more equipment. It is a broader perspective - it is a multiple of years of basic science that layer on top of each other into forming a complete diagnostic picture. Sure, the ER physician might crack a chest or do RSI without a second thought, but he or she sure isn't just doing that "because protocol says so" (not that a good EMS provider is, but, you know, least common denominator and all that).


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## EpiEMS (Mar 14, 2017)

And to expand on this expansion, having had a lot of exposure (both personal and secondhand) to other fields that have more of a "professional" cachet, I can tell you this:

No profession - none - says "We can do A, B, and C, thus I should be [pick one: paid more, treated better, etc.]." They either (a) increase barriers to entry (cartelize, say) and/or (b) improve how they generate revenue, and secondarily (tertiarily, if you will) self-govern/discipline/regulate.

Take nurses as an example. Nursing, as we know it, was initially totally unskilled labor. Then, it turned into a skilled (if gendered) trade. Then, college/university level education became de rigueur. Now, nurses are fighting with physicians over who can be called "Doctor." Nurses made it by ratcheting up educational standards and self-regulating so much so that they can fight with the physicians over status. I don't want to be that way - but, boy, would I love to see entry to practice at a higher standard! And professional self regulation like they have elsewhere in the Anglosphere! And billing for what we *do* - not just for transport.

Heck, let's look at a true blue-collar field. Firefighters - what have they done? Hint hint - they have embraced two things: Prevention (let's call it what it is, they have regulated fire out of existence) and unionization/politicizing their message. They don't fight fires much any more, but they make six figures - 
	

	
	
		
		

		
			




Well, if we were as good at saying "You need us", we would be golden. Because, let's face it, we can't stop morbidity due to preventable causes*.

*I'm talking to you, medic with BMI of 35, and you, EMT who smokes, and you, AEMT that drinks too much.


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## NysEms2117 (Mar 14, 2017)

VentMonkey said:


> ...gazillionth?


fafillionth mo-millionth


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## VentMonkey (Mar 14, 2017)

NysEms2117 said:


> fafillionth mo-millionth


Oh sweet baby jesus! Thank you for not leaving me hangin', NYS...

...carry on.


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## SandpitMedic (Mar 14, 2017)

EpiEMS said:


> And to expand on this expansion, having had a lot of exposure (both personal and secondhand) to other fields that have more of a "professional" cachet, I can tell you this:
> 
> No profession - none - says "We can do A, B, and C, thus I should be [pick one: paid more, treated better, etc.]." They either (a) increase barriers to entry (cartelize, say) and/or (b) improve how they generate revenue, and secondarily (tertiarily, if you will) self-govern/discipline/regulate.
> 
> ...


Millionth thread or not... this post hits the nail squarely on the head.


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## Tigger (Mar 15, 2017)

Like everything, when you've seen one place, you've seen one place. Paramedics are part of the healthcare system here and are treated well. We have incredible backing from both hospital networks and while our seat at the table is small, EMS's opinion is asked for and respected. We have programs that include AMR, city fire, the local medicaid contractor, and the hospitals all working together to try to find new solutions to age old EMS programs. On a more basic level, the hospitals treat us like they treat their coworkers and we do the same as we respect the different jobs each of us do.


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## EpiEMS (Mar 15, 2017)

@Tigger, would you say the composition of your EMS workforce reflects the composition of EMS generally? Also, what type of agencies provides (911) EMS in your area?


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## Tigger (Mar 15, 2017)

EpiEMS said:


> @Tigger, would you say the composition of your EMS workforce reflects the composition of EMS generally? Also, what type of agencies provides (911) EMS in your area?


Yea I'd say it's pretty average. In the city EMS is provided by first response ALS fire (22 stations) and AMR with joint medical direction. The joint medical direction has drug fire out of the dark ages but they are still getting there. I may be biased, but the AMR operation here is very solid. We have a very strong CES program and new hire orientation that leads to some pretty high standards, that the docs back. Since 80% of the transports come from the city and most of the providers are pretty strong, the hospital's generally pro EMS attitude seems to extend by default to the fire protection districts in the county that do their own transport. They have the same medical direction but maybe not the same internal high standards. There are two third services in the region (one is my fulltime job) and I would put our standards as unnecessarily high but if it means trust from the hospitals I am all for it.


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## Bullets (Mar 15, 2017)

So this is ********. I have never seen our ER staff look down on our industry as a whole or with disdain. My agency gets along famously with the staff at the ER, from the Chief of EM to the housekeepers and linen stockers. There are a couple of agencies like this. Are there specific EMTs or agencies that the staff doesnt like? YES! Why? because through the years of them bringing patients, those people/agencies have shown poor clinical judgement, acumen, and attitude. Hell, my department head is HATED (rightfully so) by the ER staff, while the actual line staff regularly get kegs and eggs with night shift. 

So the profession isnt looked down on, providers are. If you stumble through a report to an RN over and over and over, activate a specialty team incorrectly multiple times, look or act unprofessional, then the ER staff isnt going to like you...but guess what? I wont like you either.

Make good clinical judgement, learn on your own and understand whats going on with your patient, ASK questions when you dont know something, show engagement, bring a cup of coffee, do the little things that makes ERs life easier, like know who gets an EKG bed right away, slap the ID bracelet on, ect. We are a team! they will help you if you help them!


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## WyMedic (Apr 9, 2017)

Reading these kinds of threads makes me want to get out of the profession. It's like I get this feeling that I'm not a "professional" and that the perception of EMS as, poorly trained, certification only, taxi drivers by the health care system is never going to change. I try to stay resilient but part of me really thinks that I am going to fall into that category of medics that leave after less than 5 years for that reason.


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## epipusher (Apr 9, 2017)

Skills donkeys? Nailed it. :endthread:


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## Summit (Apr 9, 2017)

WyMedic said:


> Reading these kinds of threads makes me want to get out of the profession. It's like I get this feeling that I'm not a "professional" and that the perception of EMS as, poorly trained, certification only, taxi drivers by the health care system is never going to change. I try to stay resilient


It is up to you to be better than that, to encourage others, and push your colleagues and profession to be better.


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## NomadicMedic (Apr 9, 2017)

Be the change you want to see.

Don't be the guy that talks smack about the ED nurses.
Treat your patients ethically and morally. 
Be an example for the other medics.
Read and learn about EBM.

Be nice. Be kind. Be honest with yourself. Be the kind of medic you want to see when you look in the mirror. Be the kind of medic that the others strive to be.

The only person that can make that change is you.

It can be done, but it's a battle. It's easy to become negative, lazy and complacent. 

Fight the good fight. 

The rest of us who are doing the same appreciate it.


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## TransportJockey (Apr 9, 2017)

NomadicMedic said:


> Be the change you want to see.
> 
> Don't be the guy that talks smack about the ED nurses.
> Treat your patients ethically and morally.
> ...


I'm doing that at my service and I was getting discouraged... but I've noticed a few of our younger and newer medics are emulating my example vs the salty burnt out medics. It gives me a little hope. But honestly, I see the EMT-B level as the main reason we are looked down on as a profession. Look at facebook posts in public groups by that particular EMS demographic as an example.


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## NomadicMedic (Apr 9, 2017)

TransportJockey said:


> I'm doing that at my service and I was getting discouraged... but I've noticed a few of our younger and newer medics are emulating my example vs the salty burnt out medics. It gives me a little hope. But honestly, I see the EMT-B level as the main reason we are looked down on as a profession. Look at facebook posts in public groups by that particular EMS demographic as an example.



The amount of sht I take at my job because I want the jump bag, monitor and stretcher to the house for every call is amazing. A simple thing like bringing my tools to the job gets me branded "super medic" and my partner called the "pack mule". Or worse. Much worse. 

Ya know what? I don't care. I'm not the guy that walks up to the house with nothing and I won't be jammed up with I walk into a code with nothing but a pair of gloves. 

The culture in my place is starting to change. Slowly. Some of the new guys are bringing their stuff to the house for every call. That's a positive change. 

It's a small example, but it's the stuff you need to do. 

You know how to eat an elephant, right? 
You just take one bite at a time.


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## DesertMedic66 (Apr 9, 2017)

I have yet to meet a medic in my system (aside from fire) who does not bring all their gear in on every call. We keep it all on they gurney so we just take everything in as one piece of equipment then just make fire carry out the stuff we don't need.


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## NomadicMedic (Apr 9, 2017)

DesertMedic66 said:


> I have yet to meet a medic in my system (aside from fire) who does not bring all their gear in on every call. We keep it all on they gurney so we just take everything in as one piece of equipment then just make fire carry out the stuff we don't need.



Nobody does at my place. NO-BOD-EEEEEEE.


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## DesertMedic66 (Apr 9, 2017)

NomadicMedic said:


> Nobody does at my place. NO-BOD-EEEEEEE.


I didn't even know that was a thing people did. During my medic internship we didn't bring the gurney in on calls and I thought that was weird enough


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## NomadicMedic (Apr 9, 2017)

It's a thing. We also don't track chute time, there's no QI feedback unless you're a total butt head and trucks often self dispatch to jump "good calls". LOL It's a cluster.


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## DesertMedic66 (Apr 9, 2017)

We track chute times/wheels turning time. Our QI is about the same as yours.


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## NomadicMedic (Apr 9, 2017)

When I say we don't track it, I mean there is zero accountability to make the crews get out to the truck to go to the call. 

I saw a chart the other day that had a 6 minute time from alert to en route.


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## VentMonkey (Apr 10, 2017)

WyMedic said:


> I try to stay resilient but part of me really thinks that I am going to fall into that category of medics that leave after less than 5 years for that reason.


If you think it hard enough it can, and will happen, but honestly it's all about your overall perspective and general outlook on life, not your career, life. I really like what @NomadicMedic said about being, and setting the example; I can't, and won't replicate it.

What I will say is strong leaders lead with actions, those that talk the most work the least (they're too busy talking). For me, being a social pariah or "cool" in the eyes of my co-workers means so much less to me than being a knowledgeable, and respected provider. 

Maybe ask yourself where you want to be as a paramedic in 5 or 10 years instead of weeding yourself out of the equation altogether.


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## WyMedic (Apr 10, 2017)

VentMonkey said:


> If you think it hard enough it can, and will happen, but honestly it's all about your overall perspective and general outlook on life, not your career, life. I really like what @NomadicMedic said about being, and setting the example; I can't, and won't replicate it.
> 
> What I will say is strong leaders lead with actions, those that talk the most work the least (they're too busy talking). For me, being a social pariah or "cool" in the eyes of my co-workers means so much less to me than being a knowledgeable, and respected provider.
> 
> Maybe ask yourself where you want to be as a paramedic in 5 or 10 years instead of weeding yourself out of the equation altogether.


This is great advice. Thank you.

Sent from my XT1565 using Tapatalk


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## TransportJockey (Apr 10, 2017)

Here's a perfect example of why. 






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## Summit (Apr 10, 2017)

EMS isn't the only healthcare profession to utilize an IV bag... the others just don't do while at work and sure as hell don't post it to facebook with idiotic comments like that.

I remember a medic coming in hungover one 911 shift and demanding I start an IV on him "and if you miss I'm going to practice a 14 on you."


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## TransportJockey (Apr 10, 2017)

That was the point I was trying to make lol

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## VentMonkey (Apr 10, 2017)

That is exactly why I'm glad to have never known what it is to own a Facebook account. It is also the same reason I don't follow the news or SM "religiously".

These are typically the folks that A) don't deserve to even possess an EMT card (let alone paramedic license), B) have the mental capacity of a tween, and C) will most likely never get respect from the respectable.

But hey, it's part of a culture change, and us older "salts" need to embrace that, right?...


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## cruiseforever (Apr 10, 2017)

VentMonkey said:


> That is exactly why I'm glad to have never known what it is to own a Facebook account. It is also the same reason I don't follow the news or SM "religiously".
> 
> These are typically the folks that A) don't deserve to even possess an EMT card (let alone paramedic license), B) have the mental capacity of a tween, and C) will most likely never get respect from the respectable.
> 
> But hey, it's part of a culture change, and us older "salts" need to embrace that, right?...



No.


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## VentMonkey (Apr 10, 2017)

cruiseforever said:


> No.


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## Albert Reyes (Apr 10, 2017)

yes we are the dump trucks!! be the best dump truck you can be!!!


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## VentMonkey (Apr 10, 2017)

Albert Reyes said:


> yes we are the dump trucks!! be the best dump truck you can be!!!







You're posts definitely don't help, random overzealous poster.

Also, when people come on here wanting folks to randomly share their "stories" in a thread for a supposed book, well yeah, it's absolutely deplorable in my opinion.

It just shows a huge gap in what some want to call a profession and career, others view as nothing more than a novelty.


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## MackTheKnife (Apr 11, 2017)

Tachy55 said:


> I have noticed from time to time that MDs, Nurses, PAs, ER Techs, etc. often look down on us EMTs/ Medics, and view us as the absolute "bottom" of the healthcare totem pole. Yes, we don't go to school for eight years, but we sure do possess advanced skills/ interventions as well as dealing with very difficult situations and patients.


I can't give you a good answer, but I'll try. When I was a full-time medic, nurses were generally supportive but some were jealous at the skills we performed. Intubation, crics, needle taps, central lines, etc. They couldn't perform these. We were/are autonomous. However, ER techs now are generally medics working in the ER.  Now, as a floor nurse, I have seen that there is a general lack of knowledge as to what a paramedic is and what a paramedic can do. I am moving to the ER soon and I believe that I won't experience the same thing.


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## WyMedic (Apr 11, 2017)

MackTheKnife said:


> I can't give you a good answer, but I'll try. When I was a full-time medic, nurses were generally supportive but some were jealous at the skills we performed. Intubation, crics, needle taps, central lines, etc. They couldn't perform these. We were/are autonomous. However, ER techs now are generally medics working in the ER.  Now, as a floor nurse, I have seen that there is a general lack of knowledge as to what a paramedic is and what a paramedic can do. I am moving to the ER soon and I believe that I won't experience the same thing.


I've really wanted to ask about this. People that have become nurses, how has it compared to being a medic? I've thought a lot about it but I sorry about being an ER robot and only doing what is ordered.

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## Summit (Apr 11, 2017)

WyMedic said:


> nurses, how has it compared to being a medic? ... I sorry about being an ER robot and only doing what is ordered.


You only do what is ordered right now. You have standing orders.

Many ERs have standing orders for their RNs. Same in ICU. Except there are actually a lot more things (and drugs) you can do or be a part of even though some might not seem as whizzbang as a cric that you probably will never do in your career. There's more thinking and accessing your knowledge base involved in choosing the action. There is a lot more collaboration. There is a lot more backup. You care for patients longer and you see a ton more patients (and more at the same time).


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## WyMedic (Apr 11, 2017)

Summit said:


> You only do what is ordered right now. You have standing orders.
> 
> Many ERs have standing orders for their RNs. Same in ICU. Except there are actually a lot more things (and drugs) you can do or be a part of even though some might not seem as whizzbang as a cric that you probably will never do in your career. There's more thinking and accessing your knowledge base involved in choosing the action. There is a lot more collaboration. There is a lot more backup. You care for patients longer and you see a ton more patients (and more at the same time).



I guess that I have only worked in ER's, I was a tech for a awhile before I got my paramedic and now work for a fire dept. The way that you describe it makes it sound a lot more appealing than what I had in my head I guess. Where do you work now? Could we talk more? I'm thinking about going back to school and i'm not sure what direction to go in.


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## CWATT (Apr 11, 2017)

I honestly believe its because we have too many different scopes of practice.  It's difficult enough for those of us in the profession to understand the different scopes, let alone others in the medical community.  Thus, it's lowest common denominator that takes the win.  Paramedicine is moving toward a single-scope, 4-year University Bachelors Degree to align itself with nursing and I'm all for it.  Only then will people be able to recognize the abilities that the higher trained professionals in the industry are capable of.


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## WyMedic (Apr 11, 2017)

CWATT said:


> I honestly believe its because we have too many different scopes of practice.  It's difficult enough for those of us in the profession to understand the different scopes, let alone others in the medical community.  Thus, it's lowest common denominator that takes the win.  Paramedicine is moving toward a single-scope, 4-year University Bachelors Degree to align itself with nursing and I'm all for it.  Only then will people be able to recognize the abilities that the higher trained professionals in the industry are capable of.



See, this is where i see the gap between EMS and RN's. I think that it has a lot to do with context. RN's get Bachelors degree's so they have to go through A&P Chem, bio chem, Pathophysiology etc. I really think that having that background knowledge is so important, and so lost in EMS


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## FLdoc2011 (Apr 11, 2017)

I agree with a lot of what has already been said.   Remember as well that to some degree this is a team sport and we have roles to fill in different aspects of the care of a particular patient. 

I will offer some encouragement in that I rely on you guys, among other things,  to be good initial "information gatherers" as you are usually the first healthcare contact for the patient.  When I'm seeing a consult the next day I always look for the first EMS report in the chart as sometimes I get a better narrative than what the ED doc documents and I want to know what you guys saw, documented and did in the field as that may affect what I do.   Many times for cardiac issues you guys may be the only ones to see that SVT, episode of chest pain, VT, or transiently elevated BP that may resolve before arrival to the ED and may be all I have to base my treatment on.   So I rely on our guys to be on the ball when in the field.  

Back to the OP though,  at least at my shop I think everyone has a good relationship with our local EMS.  I'm sure there are regional exceptions to that due to whatever politics play a role but for the most part I'd say that's not the case.


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## hometownmedic5 (Apr 11, 2017)

CWATT said:


> I honestly believe its because we have too many different scopes of practice.  It's difficult enough for those of us in the profession to understand the different scopes, let alone others in the medical community.  Thus, it's lowest common denominator that takes the win.  Paramedicine is moving toward a single-scope, 4-year University Bachelors Degree to align itself with nursing and I'm all for it.  Only then will people be able to recognize the abilities that the higher trained professionals in the industry are capable of.




Maybe "moving towards" is not necessarily incorrect wording, but its all about perspective. Whether you choose to look at is as an incredibly long distance or an incredibly slow pace, either way were not going to get there anytime soon.

I think thirty years is a conservative estimate. The first ten years will be passing the legislation necessary to make it happen, and then establishing a mechanism to convert current medic cards into universally accepted credits for an associates degree(the logical jumping off point), and creating the curricula at 200 different colleges. The next ten will be getting everybody up to that standard. Keep in mind how hard this will be fought. This isn't even a union vs private thing. Everybody will be against this because this is the first step in what will end up being billions of dollars annually in increased wages. The last ten years will be the jump to bachelors.

30 years. That's about how long it took nurses, give or take regional differences; and given where nurses started, its a very fair basis for comparison. So if we start the push now, and hard, i might live to see a bachelors in paramedicine exist as a requirement for practicing.


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## CWATT (Apr 11, 2017)

@hometownmedic5 - I agree, it's going to take a while.  However, I'm aware of four Bachelors of Paramedicine degrees right now, it's just they're not delivering to a recognized scope.  That said, as you correctly identified, nursing along with other medical professions like Respiratory Therapy, Diagnostic Imaging, and Cytology have all moved into Bachelors degrees, so it will be easier for people to understand the same for Paramedicine.  Ironically, the largest barrier I see are the current regulators.  There is widespread disagreement with scops as it is, so until a central regulating authority is elected, I predict further disagreement.


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## hogwiley (Apr 13, 2017)

I agree that EMS education is lacking. Having said that, the education and skill level of Nurses is always massively, almost comically overstated on this forum. Its always been a head scratcher to me. 

I think some of it is the American mentality of conflating pay with worth. There is an obscene pay difference between Paramedics and RNs in the US that goes way beyond skill and education level. 

Nursing is one of the few jobs where someone with a 2 year degree associates degree from a community college can make close to six figures, and the starting pay is probably around 65,000 for someone with no experience. 

By comparison, most brand new Paramedics have at least a year of EMT work experience in addition to  nearly 2 years of Formal training, and yet start out making less than 30,000 a year. I had an Associates Degree and 3 years EMT experience, and I started out at just over 29,000 a year. 

Both experienced RNs in my class washed out of Paramedic school due to poor clinical performance and early on both were clearly not cut out for the field.  They only lasted as long as they did due to being RNs. 

I dont blame Nurses for that, in fact i applaud them for being able to demand such high pay and prestige relative to their actual training. They are well organized and highly successful at lobbying for pay and conditions. Pay differences and PR aside, They are still an equal level of licensure to a Paramedic and have a reduced scope of practice. 




.


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## DesertMedic66 (Apr 13, 2017)

Hospitals in my area are starting to only hire BSN. The older nurses who do not have a BSN are starting to be retire early...


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## hometownmedic5 (Apr 13, 2017)

DesertMedic66 said:


> Hospitals in my area are starting to only hire BSN. The older nurses who do not have a BSN are starting to be retire early...



It's been that way at the major academics in Boston for years.


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## DrParasite (Apr 13, 2017)

Bullets said:


> So this is ********. I have never seen our ER staff look down on our industry as a whole or with disdain. My agency gets along famously with the staff at the ER, from the Chief of EM to the housekeepers and linen stockers. There are a couple of agencies like this. Are there specific EMTs or agencies that the staff doesnt like? YES! Why? because through the years of them bringing patients, those people/agencies have shown poor clinical judgement, acumen, and attitude.


But you are doing the same thing that I do; when you work for a decent agency, and have a decent relationship with the ER staff, what they are describing doesn't happen.  How about I group you guys in with MONOC BLS, Able Ambulance, or any of the fly by night transport companies in NJ?  Remember, you are often judged by the lowest quality in your field, and we had some winners, especially in the transport companies.



Bullets said:


> Hell, my department head is HATED (rightfully so) by the ER staff, while the actual line staff regularly get kegs and eggs with night shift.


You think that's bad?  We used to get invited to the ER Christmas party, and I may or may not have woken up the next morning next to someone who worked in the ER......


Bullets said:


> So the profession isnt looked down on, providers are. If you stumble through a report to an RN over and over and over, activate a specialty team incorrectly multiple times, look or act unprofessional, then the ER staff isnt going to like you...but guess what? I wont like you either.


How often have you seen or heard that volunteer EMTs suck?  and yet, I can show you several two hatters who are pretty decent, as well as some volunteers who are better providers than their paid counterparts.  But people still group everyone in with the retards.

I've never had any issues with any hospital staff.   That's not true, an L&D nurse pissed me off immensely, but I was able to get that issue resolved.  I also know many MDs and RNs who would listen to my reports and ask me questions when I brought in a sick patient.  But I also knew those people, and they knew me.  I know of several EMTs who don't even deserve to still have their certs, and a couple medics who I am shocked were able to pass paramedic school


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## Carlos Danger (Apr 13, 2017)

hogwiley said:


> I agree that EMS education is lacking. Having said that, the education and skill level of Nurses is always massively, almost comically overstated on this forum. Its always been a head scratcher to me.



It is difficult to directly compare nursing and EMS education. Paramedics receive a brief, very focused but somewhat in-depth education that is meant to train them to do one thing only: get a critical patient from where you found them to the hospital, alive. That's pretty much it. Nursing education is much broader and less in-depth in any specific area. It is meant to train nurses to provide comprehensive care and support to a very broad range of patients in a broad range of settings. It is a better foundation for continued learning and specialization later on.

I don't know if the education of nurses is overstated on this forum or not, but there is a pretty big difference. You can still easily become a paramedic in 10 months of vo-tech style training that is based on textbooks written at a 10th grade reading comprehension level and only requires 9 hours or so a week in the classroom and 12 or so in clinical. I know some programs are better than that now, which of course is a good thing, but that's what my initial paramedic program was like and it still works pretty much the same way, as do many of the others that I'm familiar with. Two-year nursing programs are significantly broader and longer than that, and require actual college-level course work (albeit it lower-level). Even so, two-year programs have been judged by the nursing establishment to be undesirable in length and depth, hence the movement towards 4-year degree entry requirements that has been going on for some time now.



hogwiley said:


> Nursing is one of the few jobs where someone with a 2 year degree associates degree from a community college can make close to six figures, and the starting pay is probably around 65,000 for someone with no experience.



Compensation is largely regional, but this is a bit misleading. An entry-level welder can make close to those numbers and much more with experience; it isn't hard to make that kind of money if you simply choose to enter a field with demand and are then willing to go where the money is. A paramedic working for a city or county in SoCal or the Pacific Northwest can make way more than a RN here in the rural southeast.

Paramedics around here start around $15/hr, which with the OT built into their (48hr/wk) schedules translates to about $40k/yr to start, and then they move up a little from there over a few years. They pretty much cap out in the mid $40s unless they work extra OT, which many do. It's not great money by any means, but cost of living around here is low, and lots of people who work full-time get by on less.

New grad nurses here start around $50k. They'll get up to about $55k, maybe close to $60k in a couple years, but that's about all they'll ever make aside from small annual increases if they stay in the same position. So the difference between what paramedics and RN's make around here is significant but not massive. Probably $10k-$15k or so, assuming the nurse stays in the same entry-level position. Keep in mind that most new grad nurses spent 3x as long in training (if they have a BSN) as compared to the new grad paramedics. It's fairly hard for a new grad ASN to get a good job in a hospital around here.

Some RN's do make quite a bit more than that, but these are generally folks who work in specialty areas where they spend quite a bit of time on call, AND had to go through quite a bit of additional training to get, which makes them more valuable.


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## DrParasite (Apr 13, 2017)

Remi said:


> I don't know if the education of nurses is overstated on this forum or not, but there is a pretty big difference. You can still easily become a paramedic in 10 months of vo-tech style training that is based on textbooks written at a 10th grade reading comprehension level and only requires 9 hours or so a week in the classroom and 12 or so in clinical. I know some programs are better than that now, which of course is a good thing, but that's what my initial paramedic program was like and it still works pretty much the same way, as do many of the others that I'm familiar with. Two-year nursing programs are significantly broader and longer than that, and require actual college-level course work (albeit it lower-level). Even so, two-year programs have been judged by the nursing establishment to be undesirable in length and depth, hence the movement towards 4-year degree entry requirements that has been going on for some time now.


Honestly, this has always been something that irked me.... if the NCLEX is the bar that nurses need to pass, shouldn't the diploma nurses be unable to pass the exam because they lack the education?  and the ADN nurses should have the same issue.  in fact, if a BSN is what is needed, than only BSN nurses should pass; after all, if you don't have the knowledge to pass the baseline exam, it's obvious that your program was deficient. 

otherwise, it's a lot of fluff to pour more money into the college system, to generate instructor jobs for MSNs, in academia, to require elevated degrees (without any change in mortality, I mean, you would think with all the increased education patients would have much high death rates in the past vs today) to do the same job that their grandparents did.


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## NysEms2117 (Apr 13, 2017)

My take as a current part time BSN, student is this. I have a degree in another science field, I'm currently back at school to become a RN, for a part time job. I am currently an EMT, and just the little experience I have at the moment the way the people handle themselves at the hospital(RN's, ER techs, MD's, ect) compared to EMS, is different... You can tell the difference in professionalism in my opinion. Not to say all EMS providers are horrible and disrespectful, however I notice quite a big difference between the two. I've come to notice in the short time I've had in the "adult world"(<5 years) that the pay scales really aren't that far off in most professions. So I think at this moment where you can still be a paramedic without having a degree, they shouldn't be getting the money an RN is getting(base). If a company mandates to have a bachelors in paramedicine, then yeah pay up.  However, additional certs on top of a base medic should add value, same for RN. I really think it comes down to regulation. Simple as making a national minimum for EMS, especially since the NREMT isn't recognized by all states, sure it can help, but there needs to be a national minimum, where if you pass the national cert you CAN be an EMT, or paramedic in every single state. 

An aside about college in general, it's becoming the new hs diploma, the trades are going away, so like remi said, electricians, car mechanics, welders, plumbers can all charge higher prices because nobody is going into those fields.


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## Summit (Apr 13, 2017)

hogwiley said:


> I agree that EMS education is lacking. Having said that, the education and skill level of Nurses is always massively, almost comically overstated on this forum. Its always been a head scratcher to me.
> 
> I think some of it is the American mentality of conflating pay with worth. There is an obscene pay difference between Paramedics and RNs in the US that goes way beyond skill and education level.
> 
> ...


You have so many misconceptions, underestimations, and overestimations all backed up by an anecdote or two, I'm not even sure where to start correcting you.


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## DesertMedic66 (Apr 13, 2017)

hogwiley said:


> They are still an equal level of licensure to a Paramedic and have a reduced scope of practice.



I don't think anyone would agree with either of these statements. 

As for the reduced scope of practice, it depends on hospital or agency. My girlfriend is a CCT nurse on a ground transporting ambulance part time. The only and I mean only thing that I can do as a medic that she can't is intubate. Now if we move into the HEMS in my area the nurse can do literally anything the medic can do and more. The nurse can tube adults/pedi, needle/surgical cric, RSI, needle T/chest tube, and much more but as a medic I am limited to adult intubation and needle T.


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## Carlos Danger (Apr 13, 2017)

DrParasite said:


> Honestly, this has always been something that irked me.... if the NCLEX is the bar that nurses need to pass, shouldn't the diploma nurses be unable to pass the exam because they lack the education?  and the ADN nurses should have the same issue.  in fact, if a BSN is what is needed, than only BSN nurses should pass; after all, if you don't have the knowledge to pass the baseline exam, it's obvious that your program was deficient.
> 
> otherwise, it's a lot of fluff to pour more money into the college system, to generate instructor jobs for MSNs, in academia, to require elevated degrees (without any change in mortality, I mean, you would think with all the increased education patients would have much high death rates in the past vs today) to do the same job that their grandparents did.



You are 100% correct that regardless of which degree you've earned, basic clinical nursing is all the same. This is exactly why everyone takes the same NCLEX whether your initial nursing education was a diploma program, ASN, BSN, or MSN. It's a hoop that we all have to jump through to prove baseline competency and show that we are all on the same page with the basics of entry-level nursing.

Your degree program is a completely different thing, though. Preparation for the NCLEX is only part of what your degree program is meant to accomplish. You just don't have time for much more than the basics in an ASN program, but the nursing establishment has long felt (and rightly so, IMO) that professional nurses should be learning more than the very basics, which is why the BSN has been pushed. The "fluff" in a BSN program is meant to better prepare you to do things like interpret research, teach, manage, get some exposure to the basics of healthcare policy and regulation, think critically, and communicate better. So in a BSN program, you still spend roughly two years learning the basic nursing stuff that prepares you for entry-level clinical nursing and the NCLEX, and the rest of the time is meant to better prepare you for a professional role.  

The analogy to EMS would be that everyone takes the same NREMT-P exam, but then some of the more motivated paramedics go on to earn a 4-year degree in EMS or a related field. That degree probably won't help them do a better job with their basic paramedic role or score better on the NREMT recert exam, but it has other benefits. If there were more 4 year degree initial paramedic programs, it'd be the exact same situation as nursing.


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## Carlos Danger (Apr 13, 2017)

DesertMedic66 said:


> hogwiley said:
> 
> 
> > Pay differences and PR aside, They are still an equal level of licensure to a Paramedic *and have a reduced scope of practice*.
> ...



Wow, I missed that gem the first time I read and quoted his post.

Just another example of the "skills" mindset that plagues EMS. Which circles this discussion right back around to the original topic of the thread.


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## EpiEMS (Apr 13, 2017)

@Remi makes a great point - and there is a good body of research (linked to some examples - not necessarily great ones) demonstrating improved patient outcomes for baccalaureate prepared nurses. So, as might be evident, better workers make more money...sure, there is some "sheepskin effect", but it is not *all* that.

Of course, hospital administrators have incentives to hire better nurses - you know, quality-based payment and all that - while it's not clear that most EMS administrators have the same direct revenue-side incentives (all else equal)



Remi said:


> Just another example of the "skills" mindset that plagues EMS. Which circles this discussion right back around to the original topic of the thread.


This, this, this!


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## DesertMedic66 (Apr 13, 2017)

Remi said:


> Wow, I missed that gem the first time I read and quoted his post.
> 
> Just another example of the "skills" mindset that plagues EMS. Which circles this discussion right back around to the original topic of the thread.


I missed it also. Went back after I saw it quoted.


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## Summit (Apr 13, 2017)

DrParasite said:


> if the NCLEX is the bar that nurses need to pass


The NCLEX is really designed to check for minimal knowledge/reasoning competency required to not kill your patients in your first year of practice.

If the industry would like to demand more than that, then they may be operating at a level above what the NCLEX was meant to guarantee.


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## Summit (Apr 13, 2017)

Nursing scope of practice varies, but it is generally extremly broad and limited by individual competency and organizational policy. That is because RNs are educated as generalists, then they specialize. This is as opposed to EMS training which creates specialized technicians, thus they tend to have explicetly enumerated scopes. 

Here is an example of the CO RN scope of practice guidance from the BON.



> *Ask the following question: Is this task/practice within my scope of practice?*
> 
> 
> Was the skill/task taught in your basic nursing program?
> ...


*
*
See how different that is than a 15 page chart of skills with check boxes for 5 or 6 different levels of EMS training that you can get from your EMS board?


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## VFlutter (Apr 13, 2017)

hogwiley said:


> I agree that EMS education is lacking. Having said that, the education and skill level of Nurses is always massively, almost comically overstated on this forum. Its always been a head scratcher to me.
> 
> Pay differences and PR aside, They are still an equal level of licensure to a Paramedic and have a reduced scope of practice.



I will agree that on this forum we see the best of both professions and not all RNs are skilled ER/ICU clinicians just as all medics are not exceptional. It is hard to have an accurate representation of a group on an online forum. Having said that I think that your misconceptions about nursing are blatantly ignorant and not worth the effort to argue.

The scope of practice thing always makes me laugh. EMS has a broad scope of practice out of necessity, that does not mean that is deserved nor does it validate yourself as a professional. What happens to your scope of practice if you work in an ER as a Medic? Most Nurses do not need a broad scope of practice because it is not necessary working in the hospital. What happens to a Nurses scope working in the transport environment? In the military you have medics trained to the EMT-B level doing surgical crics in the field. Is that ideal? No. Is it necessary? Yes.  Does the ability to do that skill make them equal to an anesthesiologist? Or superior to a Physician Assistant since they can not?

Scope of practice is a product of the environment you are working in, do not act like it justifies  or validates your misguided argument. Take the ego out of it.

Even in the ICU a Physician is at a patient's bedside for literally 2-3 minutes out of 24hrs.

I do not know what ICU you did your clincals in but I invite you to check out a high level unit sometime and see what it is like. The Physician is not at the bedside. I have standing orders and adjust dialysis and replaced electrolytes off labs I draw, titrate drips, time the IABP, using PRN meds, etc all without a Physician holding my hand nor even a phone call.


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## VentMonkey (Apr 13, 2017)

@Chase I have to ask: 

Does this apply to _all_ ICU, and ED RN's, or is it a case by case basis after establishing rapport with your respective EM physicians, and intensivists that you're given such leeway?

My understanding has always been, just like anywhere (and like in the field) that they begin to know and trust the more competent providers, and therefore know if such provider is in fact calling them for orders at 3 a.m. it isn't without valid reasoning behind it.


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## EpiEMS (Apr 13, 2017)

Summit said:


> Here is an example of the CO RN scope of practice guidance from the BON.



Professionals versus technicians - this epitomizes the difference, in my mind: Professionals police their own (and are expected to exercise more judgment), while technicians are regulated by others.

QUOTE="Chase, post: 643796, member: 11015"]EMS has a broad scope of practice out of necessity, that does not mean that is deserved nor does it validate yourself as a professional.[/QUOTE]

This is a great line, @Chase 

EMS could learn a lot from nursing.


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## VFlutter (Apr 13, 2017)

VentMonkey said:


> @Chase I have to ask:
> 
> Does this apply to _all_ ICU, and ED RN's, or is it a case by case basis after establishing rapport with your respective EM physicians, and intensivists that you're given such leeway?
> 
> My understanding has always been, just like anywhere (and like in the field) that they begin to know and trust the more competent providers, and therefore know if such provider is in fact calling them for orders at 3 a.m. it isn't without valid reasoning behind it.



A little bit of both however for a lot of things  (Dialysis, Electrolytes, pressors) etc is all standing orders. A new nurse on day 1 is expected to understand and follow them. But like you said, I felt more comfortable deviating or working around with certain physicians who trusted me.   

If you have a chance to go to a CTICU look at the Post-CABG Nursing standing orders. Everything is done off protocol. The surgeons drop off a case and are in the OR for the next. There is no calling for orders unless it is an emergency.

Initial vent settings then weak to extubate within 8 hours. Hemodynamics: Index less then 2 start Dobutrex then Primacor. MAP less then 60 give 500ml bolus then albumin then start levophed and add Vasopressin and Epi if needed. ACT over 200 give protamine A fib give amio bolus and start drip is stable cardiovert if unstable. etc etc


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## VentMonkey (Apr 13, 2017)

EpiEMS said:


> EMS could learn a lot from nursing.


This is beat to death everyday. The truth is as one profession to another this could be held true with _any_ industry.

We could stand to learn a lot from other "blue collared" organized professions as well. The biggest lesson we stand to learn on the whole has nothing to do with EMS vs. nursing, it has to do with the fact that in any, and every profession the professional is not defined by their skill set, but moreso their individual character as it relates to the profession, and moreover the definition of professionalism itself, not heroism, _professionalism_.

Now, back to the OG topic:

Where does that leave guys (and gals) such as myself who are vastly outnumbered in _this_ particular industry?


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## EpiEMS (Apr 13, 2017)

VentMonkey said:


> Where does that leave guys (and gals) such as myself who are vastly outnumbered in _this_ particular industry?



At this point, I would guess that teaching (or FTO'ing) is the way to go. Or perhaps advocacy for changes in training pathways - NASEMSO is pulling together a new national scope of practice doc now.


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## VentMonkey (Apr 13, 2017)

EpiEMS said:


> At this point, I would guess that teaching (or FTO'ing) is the way to go. Or perhaps advocacy for changes in training pathways - NASEMSO is pulling together a new national scope of practice doc now.


Right, but what if neither of those are what I, or someone similar wanted? I get "sucking it up" as door number 3, but surely implementing change is more than just legislation, and pencil pushing.

FWIW, I did the FTO/ preceptor thing for 5 years, and it instilled less hope in myself than anything else. Again, these are all my viewpoints.


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## DrParasite (Apr 13, 2017)

Remi said:


> The analogy to EMS would be that everyone takes the same NREMT-P exam, but then some of the more motivated paramedics go on to earn a 4-year degree in EMS or a related field. That degree probably won't help them do a better job with their basic paramedic role or score better on the NREMT recert exam, but it has other benefits. If there were more 4 year degree initial paramedic programs, it'd be the exact same situation as nursing.


that's kinda my point..... if the entry level bar is the NREMT-P, should we make the curriculum harder or longer, or raise the bar, making the program who aren't long enough or hard enough die because they aren't preparing their students enough for the exam.


DesertMedic66 said:


> The nurse can tube adults/pedi, needle/surgical cric, RSI, needle T/chest tube, and much more but as a medic I am limited to adult intubation and needle T.


NJ ground medics can tube anyone, surgical cric (as a last minute option), RSI, and needle T.....if you can't do any of those things as a flight medic, well, that's a conversation you should have with your medical director.

BTW when we are comparing nurses, I think ER and ICU nurses are awesome.  Can you say the same about ortho nurses?  what about med/surg nurses?  the running joke at my former trauma center was when nurses moved upstairs they lost their brains.... and i met too many of them that I wouldn't trust to change a bandaid.


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## NysEms2117 (Apr 13, 2017)

VentMonkey said:


> Where does that leave guys (and gals) such as myself who are vastly outnumbered in _this_ particular industry?


Where would you like to be left? If you can describe the Job in EMS you always wanted what would it be? Requirements for said job? How would you like to regulate it ect.


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## DesertMedic66 (Apr 13, 2017)

DrParasite said:


> NJ ground medics can tube anyone, surgical cric (as a last minute option), RSI, and needle T.....if you can't do any of those things as a flight medic, well, that's a conversation you should have with your medical director.



The issue with CA is that it is not up to the agencies medical director. It is based on the state scope for paramedics and then from that state scope the individual counties pick and choose what they want their medics and EMTs to do. Surgical cric and RSI medications are not on list for medics.


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## VentMonkey (Apr 13, 2017)

NysEms2117 said:


> Where would you like to be left? If you can describe the Job in EMS you always wanted what would it be? Requirements for said job? How would you like to regulate it ect.


I don't care about regulations right now. Honestly I'm tired of all the dead end talk. Do we need people like @EpiEMS ? Absolutely.

What about the professional currently surrounded by the egocentric "heroes" that they may have once been themselves, but have since outgrown? The guys and gals "fighting the good fight" day in and out, and who overall like field work too much to move up, or on? Realizing what it took to get where they are, yet being constantly thwarted, and bombarded by such pompously immature coworkers?

How about instead of talking about where we need to be headed all of the time---which I believe we can all agree upon---we focus on the now? I'm not the only one that feels this way, nor is this a new thing, but I would like to know what can be done now aside from what has been beaten to death time, and time again?

As far as where I would like to be? I am where I want to be, yet still surrounded by less the professional, and more the Facebook posting goon, so what's say you? What's the solution other than ignoring such behaviors?


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## EpiEMS (Apr 13, 2017)

VentMonkey said:


> What's the solution other than ignoring such behaviors?



Well, I did neglect to add an idea - there is the possibility of moving to management at your organization? As a field supervisor, you can help a lot, no? Of course, this might involve stepping back somewhat from clinical duties, but not always!


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## VentMonkey (Apr 13, 2017)

EpiEMS said:


> Well, I did neglect to add an idea - there is the possibility of moving to management at your organization? As a *field* *supervisor*, you can help a lot, no? Of course, this might involve stepping back somewhat from clinical duties, but not always!


I have done this as well, it's been a pretty long time, but still will occasionally.

It's also hardly a step back clinically. We're on an ambulance all day, every day especially if and when working as metro paramedic supes.
Tack on the front-line managerial tasks as well, the full-times definitely earn their pay.


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## NysEms2117 (Apr 13, 2017)

@VentMonkey I agree on most of what you said, more importantly I feel we need to give folks like you, who have battled through people yelling at you for years, the benefits/pay/respect you EARNED. I do think there needs to be a plan though, this topic has been beaten to death and I think it is safe to say that anybody who is a medic who wants to be a nurse, will become one---vice versa too.  You don't feel that there needs to be regulations so your surrounded by other people like yourself? Quite honestly I can't tell you what the solution is I haven't been in EMS long enough, he'll I probably couldn't tell you the le solution. Whatever the solution I do know that if it doesn't involve getting people that actually care, actually want to learn more, and don't have the I'm in it to save lives mentality, that EMS will lose respect. Do I think it deserves to? Ofc not, I'm in ems and trying to make it better. Youthful ignorance maybe, but I'm trying. I think there should be a senior spot, past fly car past all that stuff, that says "hey you've been with our company for 15 years WE TRUST YOU, go do your thing". Which in my experience in the "real world" trust is a word nobody really throws around.


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## EpiEMS (Apr 13, 2017)

VentMonkey said:


> It's also hardly a step back clinically. We're on an ambulance all day, every day especially if and when working as metro paramedic supes.



Gotcha! I think the field supe concept differs from place to place. My service has something similar. FDNY, though, for example, puts field supervisors in nifty pickup trucks and they drive around not doing too much patient care (anecdotally).



NysEms2117 said:


> think there should be a senior spot, past fly car past all that stuff, that says "hey you've been with our company for 15 years WE TRUST YOU, go do your thing".



Wake's APP, perhaps?


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## VFlutter (Apr 13, 2017)

DrParasite said:


> BTW when we are comparing nurses, I think ER and ICU nurses are awesome.  Can you say the same about ortho nurses?  what about med/surg nurses?  the running joke at my former trauma center was when nurses moved upstairs they lost their brains.... and i met too many of them that I wouldn't trust to change a bandaid.



Absolutely but it goes both ways. I have met many medics I wouldn't trust.


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## VentMonkey (Apr 13, 2017)

@EpiEMS we have supes the same as FDNY as well. @NysEms2117 I appreciate your thoughts, here's the thing- my question was full of rhetoric. It holds different meanings for every individual.

This job is what you make it to be. A steppingstone, a lateral, a career ladder, or anything in between. If I really, and truly could not stand it to the point that I let some newcomer and their naive ways drive me away, well, that says more about me than the noob.

For me, I paved every single road in this career path I have chosen so far. Is it always easy to hear some of these blissfully ignorant fresh new faces who are flush with false notions fed by their instructors? Nope, but it isn't their fault entirely either. So like @NomadicMedic eluded to: walk it, don't talk it. That's the best a field schlub such as myself can do.

If I truly believed I was deserving of some "special position" because I am a tenured employee at my respective service, then again, I would be filled with no less self-entitlement than some of the newer folks. Creating change when you're completely unaware is perhaps some of the best practice one can employ. I highly doubt many leaders spent their waking moments wondering what kind of rewards awaited them in the end, most were (are) truly selfless.

And before this becomes a tiresome EMS vs. nursing debate, I'll only say that part of being a critical care paramedic is leaching off of, and learning from the sharper RN's. In a perfect EMS world our egos would not be so shallow that we always needed to compare the two. They're apples and pears, if you blend them together it's an awesome hybrid.


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## Carlos Danger (Apr 13, 2017)

DrParasite said:


> that's kinda my point..... if the entry level bar is the NREMT-P, should we make the curriculum harder or longer, or raise the bar, making the program who aren't long enough or hard enough die because they aren't preparing their students enough for the exam.



I don't think so, personally. Assuming that the exam (either the NCLEX or the NREMT) actually does a good job of ensuring basic competency, then I think that's all we need in an entry level board exam and frankly anyone who can demonstrate that competency should be admitted, regardless of the type of educational preparation they have.

I actually like the fact that there are several options available for entry into nursing. I think a BSN is ideal for a career / profession minded person, but I also think that as long as folks are learning what they need to learn to be safe and competent, they should have options.


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## DrParasite (Apr 13, 2017)

EpiEMS said:


> Gotcha! I think the field supe concept differs from place to place. My service has something similar. FDNY, though, for example, puts field supervisors in nifty pickup trucks and they drive around not doing too much patient care (anecdotally).


A supervisor belongs in a flycar, not on an ambulance.  if a supervisor is on an ambulance, they are supervising that ambulance, not a shift.  for a department that only has one ambulance in service, sure, but bigger systems should not have supervisors permanently assigned to an ambulance, because while you are transporting that non-emergency patient, you are unable to respond to the major MCI.





EpiEMS said:


> Wake's APP, perhaps?


ehhh, they deal more with fall prevention and overdoses, with the occasional high risk refusal (plus a ton of non-emergency stuff).





Remi said:


> Assuming that the exam (either the NCLEX or the NREMT) actually does a good job of ensuring basic competency, then I think that's all we need in an entry level board exam and frankly anyone who can demonstrate that competency should be admitted, regardless of the type of educational preparation they have.


That was kind of where I was going with that (and it runs contrary to everyone who says paramedics need a 2 year or 4 year degree): if you have the knowledge to pass the basic exam, why should it matter how long you went to school, or what degree you have... if you have enough basic competency to pass the basic competency to pass the exam, shouldn't you get your P card?


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## EpiEMS (Apr 13, 2017)

DrParasite said:


> A supervisor belongs in a flycar, not on an ambulance. if a supervisor is on an ambulance, they are supervising that ambulance, not a shift. for a department that only has one ambulance in service, sure, but bigger systems should not have supervisors permanently assigned to an ambulance, because while you are transporting that non-emergency patient, you are unable to respond to the major MCI.



No disagreement here - supes belong in a fly car for sure.



DrParasite said:


> That was kind of where I was going with that (and it runs contrary to everyone who says paramedics need a 2 year or 4 year degree): if you have the knowledge to pass the basic exam, why should it matter how long you went to school, or what degree you have... if you have enough basic competency to pass the basic competency to pass the exam, shouldn't you get your P card?



I think there is a distinction between baseline clinical/practical competency and the actual work of paramedicine/[insert profession here]. Why have a degree program at all if you can pass the exam? An exam is another barrier to entry, sure, but it is only one of many designed to weed people out. There is something that an exam cannot do that school can: exams don't test certain cognitive and personality traits very well (empathy..."stick-to-itiveness"...leadership...), and there are some of those that we ought to be monitoring.

Look, realistically, anybody (with enough study time) could take and pass pretty much any exam. Exams are great, but they aren't the be-all and end-all of assessments, especially in fields like EMS where basic human traits (empathy, etc.) matter.


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## VentMonkey (Apr 13, 2017)

My personal opinion is *ALL* paramedics belong on fly cars, but I digress. You know one simple distinction between the EMS field, and nursing is summed up with one word, and a class they seem to focus on: ethics.

When was the last time we could all look at our respective EMS peers and say across the board we all abide by them? It's something that is seemingly, and appropriately emphasized with most medical professionals. Most importantly, it is taken seriously by them. 

And no, I am not referring to a watered down oath, or mantra. I mean, again, portraying these ethics wholeheartedly to the point that there's no doubt what one's interpretation of "patient advocacy" implies. For some odd reason it is easier said than done within the EMS community.


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## EpiEMS (Apr 13, 2017)

VentMonkey said:


> For some odd reason it is easier said than done within the EMS community.



Lack of training, lack of emphasis, lack of QI...the reasons go on and on. Of course, more education and professional autonomy (i.e. self regulation once the education is in place) would go a long way towards addressing that - when we can discipline our own and not worry about what non-EMS providers expect, we can really push harder for more vocal patient advocacy (e.g. "No, Doctor, we did not apply a backboard to this patient because [insert one of the myriad reasons here], and you can do what you like, but it is not indicated."). For employees, unions would help us at this, and I'm usually no fan of unions.


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## DrParasite (Apr 13, 2017)

VentMonkey said:


> You know one simple distinction between the EMS field, and nursing is summed up with one word, and a class they seem to focus on: ethics.
> 
> When was the last time we could all look at our respective EMS peers and say across the board we all abide by them? It's something that is seemingly, and appropriately emphasized with most medical professionals. Most importantly, it is taken seriously by them.


yeah, because those who are more educated never do anything unethical....
http://www.nj.com/news/index.ssf/2015/04/umdnj_whistleblower_cases_cost_rutgers_nearly_2m_i.html
http://www.nj.com/news/index.ssf/2009/09/umdnj_to_pay_83_million_to_set.html / http://www.nytimes.com/2006/11/24/nyregion/24hosp.html
https://www.ahcmedia.com/articles/102211-problems-at-umdnj-not-likely-a-surprise-to-leaders
http://www.dailymail.co.uk/news/art...-hospital-guilty-neglect-abuse-face-jail.html
http://www.foxnews.com/us/2017/02/0...er-va-scandal-ranked-among-nations-worst.html
http://www.medicaldaily.com/drug-scandal-colorado-hospital-3000-hiv-positive-388726
http://www.lamag.com/longform/kickb...nd-californias-largest-medical-fraud-scandal/
https://www.revealnews.org/article/...in-kickback-scheme-looks-to-spread-the-blame/
http://www.nbclosangeles.com/news/l...CEO-Charged-in-Insurance-Fraud-247193111.html
http://cironline.org/reports/california-doctors-used-fake-hardware-spine-surgeries-lawsuits-say-6523
http://www.mirror.co.uk/news/uk-news/victorina-chua-nhs-nursing-scandal-5726241
http://www.dailymail.co.uk/health/a...rses-earn-2-000-shift-drain-NHS-millions.html


so how are valuable were those ethics classes?  I'm sure everyone involved in them passed their ethics class.......


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## Summit (Apr 13, 2017)

^Some nice anecdotes you have there... 

Now nobody said other professions were perfect.

What was the point you were attempting to make?


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## VentMonkey (Apr 13, 2017)

DrParasite said:


> so how are valuable were those ethics classes?  I'm sure everyone involved in them passed their ethics class.......


About as valuable as they made them out to be. Clearly these exemplify nothing more than what's true with mankind in general. Regardless of a chosen career path no one is immune to foolishness.

I'm not saying it's some foolproof barrier to prevent malpractice, erroneous behaviors, or plain dubious providers. What I am saying is our focus as a "profession" does not reflect professionalism in general. Is nursing more right than EMS? Hardly. There is no more right than the other, but how can we not learn from other professions when their curriculum at least chooses to focus on an approach that seems both realistically applicable, and generally lacking in the EMS community. 

There has to be a way other than over glorifying the "coolness" of a select few calls we see to convey the realities of this job regardless of our entry requirements. Again, living in the now, not dwelling on past mishaps, or constantly looking to the future.


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## Carlos Danger (Apr 14, 2017)

DrParasite said:


> That was kind of where I was going with that (and it runs contrary to everyone who says paramedics need a 2 year or 4 year degree): if you have the knowledge to pass the basic exam, why should it matter how long you went to school, or what degree you have... if you have enough basic competency to pass the basic competency to pass the exam, shouldn't you get your P card?



I agree.

When I started the Excelsior College nursing program in 2004, they had a slogan that went something like "the knowledge you possess is more important than where or how you acquired it". That idea is the basis for their non-traditional nursing programs, and also why I always thought it was stupid for RN's with certain backgrounds to have to complete an entire paramedic program to work in the field, and vice versa. It is also much of the basis for the libertarian argument that we shouldn't even have professional and occupational licensing by the government, but that's a whole other topic of course.

As much as I think anyone who can do the job should be allowed to do the job, there is clearly a market for higher levels of education, too. If hospitals prefer to hire BSN's, for instance, because of a perceived increased level of competency in areas aside from basic clinical nursing, that's not a bad thing at all. Market demand really should be a big influence on people's decisions about how much education to invest in; the fact that we got away from that quite a while ago is a big part of the reason for the student loan debt bubble and the devaluing of 4-year and higher degrees in many fields. But that's another topic, too.


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## EpiEMS (Apr 14, 2017)

Remi said:


> also why I always thought it was stupid for RN's with certain backgrounds to have to complete an entire paramedic program to work in the field,



I'm generally sympathetic to this - as long as the exams are passed. Would you agree that there is value inherent in, say, the field rotations for non-prehospital/flight/CCT RNs (i.e. given the differences between in-hospital and out of hospital conditions)? These are the sort of non-cognitive skills that a bridge program may help with (or not, as the case may be), in my mind.


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## Carlos Danger (Apr 14, 2017)

Here's an important thing to consider for those who want to see educational minimums for paramedics to increase:

The industry EMS can do that by itself. It doesn't have to wait for the NHTSA to mandate 2-year degrees for paramedics. If more paramedics sought 4-year degrees, more schools would offer those programs. If there were more options for 2- and 4- year degrees in EMS, more paramedics would do them. Those paramedics would be more competitive and would put pressure on the rest of the members of industry to increase their levels of education, which in turn would create more demand for degree programs, which would make them more numerous and convenient.

That's basically what happened in nursing over the past 20 years. BSN programs became common and the percentage of RN's graduating with a BSN exploded long before hospitals started to mandate that level of education. And it still isn't required for licensure. People often say that EMS can learn from nursing; that's probably the best example there is of something that the nursing industry did that the EMS industry can and probably should do as well.


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## Carlos Danger (Apr 14, 2017)

EpiEMS said:


> I'm generally sympathetic to this - as long as the exams are passed. Would you agree that there is value inherent in, say, the field rotations for non-prehospital/flight/CCT RNs (i.e. given the differences between in-hospital and out of hospital conditions)? These are the sort of non-cognitive skills that a bridge program may help with (or not, as the case may be), in my mind.



Well yeah, there has to be some way to show competency. Exams are far from perfect, but I don't think anyone has found a better way. As for field rotations to fill in the gaps in experience, sure, if they are needed. That should be between the clinician, the employer, and any relevant accrediting agency, though. I'm not a fan of arbitrary government regulations that say "nurses can't work in the field without a paramedic license, and they can't get a paramedic license without attending a full paramedic program" regardless of how much relevant knowledge and experience they may have gained somewhere else. Those regulations (almost all licensing laws, in fact) have origins in protectionism and cronyism and have nothing to do with public safety.


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## EpiEMS (Apr 14, 2017)

@Remi, I'm with you 100% on these points. That said, (just to put it out in the open) there are many corollaries introduced, in theory, by this approach that many stakeholders (e.g. nursing unions) would not be amenable to (paramedics in the ER, say), so such an approach to addressing licensing laws has its (political) problems.



Remi said:


> The industry EMS can do that by itself. It doesn't have to wait for the NHTSA to mandate 2-year degrees for paramedics. If more paramedics sought 4-year degrees, more schools would offer those programs.



Demand creates its own supply  in a sense -- 100% agreed here, too!


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## MonkeyArrow (Apr 14, 2017)

Remi said:


> I'm not a fan of arbitrary government regulations that say "nurses can't work in the field without a paramedic license, and they can't get a paramedic license without attending a full paramedic program" regardless of how much relevant knowledge and experience they may have gained somewhere else. Those regulations (almost all licensing laws, in fact) have origins in protectionism and cronyism and have nothing to do with public safety.


So do you think the converse should be allowed too (paramedic to nurse)? Can you clarify your point as to how much, if any, education should be required in your mind to be eligible for hire/certification? Should an aspiring doctor forego medical school, but if able to pass Step 1, Step 2 CS/CK, Step 3, be board eligible?


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## Carlos Danger (Apr 14, 2017)

EpiEMS said:


> @Remi, I'm with you 100% on these points. That said, (just to put it out in the open) there are many corollaries introduced, in theory, by this approach that many stakeholders (e.g. nursing unions) would not be amenable to (paramedics in the ER, say), so such an approach to addressing licensing laws has its (political) problems.



Oh of course it has political problems - that's why the laws exist in the first place. Licensing laws aren't going anywhere.


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## EpiEMS (Apr 14, 2017)

MonkeyArrow said:


> So do you think the converse should be allowed too (paramedic to nurse)? Can you clarify your point as to how much, if any, education should be required in your mind to be eligible for hire/certification? Should an aspiring doctor forego medical school, but if able to pass Step 1, Step 2 CS/CK, Step 3, be board eligible?



This is way off topic, but the marketplace would govern. Would you go to a "physician" who has no medical education but passed the exams? Would you hire a "paramedic" who passed NRP but didn't ever take a class or step foot on an ambulance?


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## Carlos Danger (Apr 14, 2017)

EpiEMS said:


> This is way off topic, but the marketplace would govern. Would you go to a "physician" who has no medical education but passed the exams? Would you hire a "paramedic" who passed NRP but didn't ever take a class or step foot on an ambulance?



Exactly. There are still non-governmental certifying bodies (the NREMT, or the NCSBN, for instance) who objectively verify education and competence. If medical licensing laws went away entirely, it's difficult to imagine that much would really change. Insurance payors, accrediting bodies, and employers would still require verification of training and competence, which would be provided by non-governmental certifying boards and/or credentialling services. But without the clumsy, protectionist laws in the way, competition between credentialing agencies would demand flexibility and allow for innovation and new approaches to education.

Physicians in Europe are educated quite differently and in a significantly shorter period of time than here in the US. Are they unqualified just because they aren't educated the American way and aren't licensed in the US? There are lots of qualified doctors from overseas who can't practice in the US for no reason other than the fact that there educational institutions were not accredited by the ACGME, which intentionally keeps the supply of doctors educated in the US low as compared to demand. Of course they tell us it's for our own good; that we need the government to keep us safe because we aren't capable of making rational decisions on our own. But in reality, it is pure protectionism.


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## MackTheKnife (Apr 14, 2017)

EpiEMS said:


> @Remi, I'm with you 100% on these points. That said, (just to put it out in the open) there are many corollaries introduced, in theory, by this approach that many stakeholders (e.g. nursing unions) would not be amenable to (paramedics in the ER, say), so such an approach to addressing licensing laws has its (political) problems.
> 
> 
> 
> Demand creates its own supply  in a sense -- 100% agreed here, too!


Actually, supply creates its own demand. Sayes' Law of economics.

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## EpiEMS (Apr 14, 2017)

MackTheKnife said:


> Actually, supply creates its own demand. Sayes' Law of economics.
> 
> Sent from my XT1585 using Tapatalk



Say's law is a major point of, shall we say, theoretical contention in macro theory, and the idea of Say's law is wayyyy broader than this (i.e. aggregate demand always must equal aggregate supply in the [insert time frame here based on your ideological stripes...obviously it is true in the long term] run)..I could go on and on, but this isn't the place. The point remains...if more people wanted degrees in EMS, more programs would emerge (or the total number of seats would grow), at least in the short to medium term


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## MackTheKnife (Apr 18, 2017)

EpiEMS said:


> Say's law is a major point of, shall we say, theoretical contention in macro theory, and the idea of Say's law is wayyyy broader than this (i.e. aggregate demand always must equal aggregate supply in the [insert time frame here based on your ideological stripes...obviously it is true in the long term] run)..I could go on and on, but this isn't the place. The point remains...if more people wanted degrees in EMS, more programs would emerge (or the total number of seats would grow), at least in the short to medium term
> 
> 
> Sent from my iPhone using Tapatalk


Epi, you are da man! Great recitation of Eco 101! Seriously, bro! Just wanted to realign the two terms in proper alignment.

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## MackTheKnife (Apr 18, 2017)

EpiEMS said:


> Say's law is a major point of, shall we say, theoretical contention in macro theory, and the idea of Say's law is wayyyy broader than this (i.e. aggregate demand always must equal aggregate supply in the [insert time frame here based on your ideological stripes...obviously it is true in the long term] run)..I could go on and on, but this isn't the place. The point remains...if more people wanted degrees in EMS, more programs would emerge (or the total number of seats would grow), at least in the short to medium term
> 
> 
> Sent from my iPhone using Tapatalk


You are also correct in your assertion. If more people wanted the degrees, they would indeed be available. I think it's inevitable, at some point, we'll see degrees as de rigeuer for medics, just like nurses. Nurses have an associate as a minimum requirement but that is slowly going by the wayside. 3 of the 4 hospitals require a BSN to get hired in my area. I'm at the 1 hospital that doesn't. I'll complete my BSN at the end of the year and eventually move to 1 of the 3. Better hospitals, better environment overall.

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## MackTheKnife (Apr 18, 2017)

DrParasite said:


> A supervisor belongs in a flycar, not on an ambulance.  if a supervisor is on an ambulance, they are supervising that ambulance, not a shift.  for a department that only has one ambulance in service, sure, but bigger systems should not have supervisors permanently assigned to an ambulance, because while you are transporting that non-emergency patient, you are unable to respond to the major MCI.ehhh, they deal more with fall prevention and overdoses, with the occasional high risk refusal (plus a ton of non-emergency stuff).That was kind of where I was going with that (and it runs contrary to everyone who says paramedics need a 2 year or 4 year degree): if you have the knowledge to pass the basic exam, why should it matter how long you went to school, or what degree you have... if you have enough basic competency to pass the basic competency to pass the exam, shouldn't you get your P card?


The basic problem is the comparison amongst all disciplines in the healthcare community. Physical Therapists and Occupational therapists have Master's degrees while many nurses have an Associate's. We all work side by side in the hospital yet nurse have a higher degree of responsibility and skills yet less educated. This educational disparity leads to the inevitable "WTF"? So the argument goes we nurses all should hold at least a BSN, if not higher to be more equal. Medics have a huge level of skills and autonomy more so than anyone else. Yet a prevalent lack of degrees.

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## EpiEMS (Apr 18, 2017)

MackTheKnife said:


> I think it's inevitable, at some point, we'll see degrees as de rigeuer for medics, just like nurses.



Here's hoping - it *ought *to be associated with an increase in wages (though not necessarily for any productivity reason).


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## MackTheKnife (Apr 18, 2017)

EpiEMS said:


> Here's hoping - it *ought *to be associated with an increase in wages (though not necessarily for any productivity reason).


I cannot fathom how medics get paid squat and there are morons out there demanding $15/hr for working at McDonalds. How many of these people have seen a child abuse victim, pronounced someone dead, seen a person burned to death? How many have recognized and saved someone in extremis?

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## EpiEMS (Apr 19, 2017)

MackTheKnife said:


> morons out there demanding $15/hr for working at McDonalds


You can demand anything you want 

I will say this...many of those folks may find themselves out of jobs. And fortunately/unfortunately, EMS can't substitute capital for labor quite as easily as fast food can, I would wager.


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## DrParasite (Apr 19, 2017)

EpiEMS said:


> And fortunately/unfortunately, EMS can't substitute capital for labor quite as easily as fast food can, I would wager.


with the amount of EMTs and paramedics that are being enrolled in classes every semester, and with many less than reputable companies only requiring a valid card and a pulse, that might not be as accurate as you might think, especially if you consider how big and bureaucratic some of the fast food corporations are, and how easy some people can hired on at a private ambulance where HR is all handled by one person.


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## EpiEMS (Apr 19, 2017)

@DrParasite, I guess I don't follow your logic there...

I was trying to get at the point that fast food workers can be easily replaced by machinery (think self service kiosks), while it is highly improbable that, say, even self driving ambulances would require a smaller crew.


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## DrParasite (Apr 19, 2017)

EpiEMS said:


> I was trying to get at the point that fast food workers can be easily replaced by machinery (think self service kiosks), while it is highly improbable that, say, even self driving ambulances would require a smaller crew.


Sorry, I thought you meant how replaceable individual workers were, with a relatively low entrance requirement, and plenty of available supply.  So if you wanted $15, management could just fire you and replace you with  another application in the stack for near minimum wage.


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## EpiEMS (Apr 19, 2017)

DrParasite said:


> Sorry, I thought you meant how replaceable individual workers were, with a relatively low entrance requirement, and plenty of available supply.  So if you wanted $15, management could just fire you and replace you with  another application in the stack for near minimum wage.



You're not wrong at all, though - I mean, barring a legislative mandate to pay more, you can just hire somebody else!


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## MikeC (Apr 27, 2017)

WyMedic said:


> Reading these kinds of threads makes me want to get out of the profession. It's like I get this feeling that I'm not a "professional" and that the perception of EMS as, poorly trained, certification only, taxi drivers by the health care system is never going to change. I try to stay resilient but part of me really thinks that I am going to fall into that category of medics that leave after less than 5 years for that reason.


 
I didn't spent much time with making that decision either, especially with how so many paramedics come across regarding their own profession. There is kind of a doom and gloom prognosis, bitterness seems to run rampant with those long-term in the profession, etc.

As for respect, I don't see any disrespect from Physicians or Nurses regarding emergency workers. Just the opposite actually. Maybe it's just the local area.

This area is hurting for ALS workers, and is even paying for school at some companies, but I have a much better opportunity working in nursing in which I got accepted to starting this fall.

In the state I'm in, RNs can sit for the paramedic test and run EMS as an ALS provider.  As I enjoy the emergency side of things, I see myself working as either a volunteer or as needed bases as ALS, but the career projection is nursing school not paramedic.


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## WyMedic (May 16, 2017)

MikeC said:


> I didn't spent much time with making that decision either, especially with how so many paramedics come across regarding their own profession. There is kind of a doom and gloom prognosis, bitterness seems to run rampant with those long-term in the profession, etc.
> 
> As for respect, I don't see any disrespect from Physicians or Nurses regarding emergency workers. Just the opposite actually. Maybe it's just the local area.
> 
> ...


I think that's completely reasonable. I really wish that someone had told me years ago that as a nurse I could just sit for the paramedic exam and get certified, I would have done that. I work for a fire based agency (I know I know, they are the devil) but at least my pay and retirement benefits make it more worthwhile. I've looked at PA school some but it just seems so dang competitive that I don't know if I will stand a chance of getting in even with the required science and bachelor's degree. 

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