# Dont get caught up in the degree hype



## platon20 (Dec 6, 2013)

There's a lot of threads on this forum about how basic EMTs need bachelors degrees, paramedics need masters degrees, etc

Going down the degree pathway is fool's gold.  

Consider the case of physicians.  By any standard they have by far the most formal training.  Over 10,000 hours of clinical training just to be a basic primary care provider.

In spite of those 10,000 hours of training, they are getting their lunch eaten by PAs and NPs with less than 1/4 that training.

The same thing will happen to EMT/parameds if you go down the same pathway.  You might have a fancy degree behind your name, but the market will undercut you with a cheaper provider who can do the same thing you can for much less educational cost.

If you go the degree route, you will inevitably give up control of the educational pathway to academic PhDs who have never practiced as a first responder.  I'm talking about them forcing you to take BS classes on ethics, healthcare policy, cultural competency, and other crap that has nothing to d with your job in the ambulance.


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## PotatoMedic (Dec 6, 2013)

And a NP is limited in what they can do and an PA requires an MD to be able to work since the MD must ok what they do.

And you are one of the many reasons EMS will stay as the :censored::censored::censored::censored::censored::censored::censored: child of our healthcare system.


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## DesertMedic66 (Dec 6, 2013)

Someone arguing against the progression of EMS? That's odd. The only thing that could make this even better is if you are a fire medic :rofl:


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## Medic Tim (Dec 6, 2013)

troll.....


 Tor is that you?


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## Akulahawk (Dec 6, 2013)

Nurse Practitioners are limited in what they're allowed to do. They must follow "standardized procedures" for doing what they do. PA's can (as in "may") have a fairly wide scope of practice, but it's basically up to their supervising physician as to what they're allowed to do. 

By your logic, platon20, since a provider with 1/4 of the training of a physician can eat their lunch, I would imagine that a provider with less than 1/8th of a physician's training would be able to have that physician's breakfast, lunch, dinner, and coffee too... 

You know, it's kind of interesting... Nursing requires a degree for entry into the profession. So does Occupational Therapy, Physical Therapy, Speech & Language Pathology, and so on. They all make more money than most non-Fire Paramedics. It wasn't all that long ago that Nurses couldn't do many of the things they do now... yet with additional education, they learned and expanded their scope of practice. Imagine what a bunch of well-educated Paramedics (with degrees as proof of said education) can do, knowing their MacGyvering spirit!


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## Medic817 (Dec 6, 2013)

I second Akulahawk's statement. We're moving forward as a profession. Unless you're unwilling to advance you'll get left behind.


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## TransportJockey (Dec 7, 2013)

Medic817 said:


> I second Akulahawk's statement. We're moving forward as a profession. Unless you're unwilling to advance you'll get left behind.



This. For the love of god. This. 

No one is advocating that paramedics have masters level degrees. But there are some of is here, myself included, that believe to practice in this field should require at least an Associates degree. Similar to a nurse. Or better yet something like the Aussie or Kiwi systems. 

We are not a profession. We are a vocation. We have technicians, not clinicians. That has to change.


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## Medic817 (Dec 7, 2013)

TransportJockey said:


> This. For the love of god. This.
> 
> No one is advocating that paramedics have masters level degrees. But there are some of is here, myself included, that believe to practice in this field should require at least an Associates degree. Similar to a nurse. Or better yet something like the Aussie or Kiwi systems.
> 
> We are not a profession. We are a vocation. We have technicians, not clinicians. That has to change.



Oh man TransportJockey you just repeated basically what my supervisor said today! He basically said they want to make us better clinicians than technicians. We can do so much. Unless as a profession people aim higher we won't have change but the service I just started with is pushing for it. 

Our medical director isn't just some podiatrist god knows where, he's a former paramedic of the service even has us go through an oral review (like physician oral boards) before approving us to become In-Charge Paramedics. He does it to get to know us and pushes us to become more educated in order to provide a higher level of care to our community.


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## mycrofft (Dec 7, 2013)

:nosoupfortroll:


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## mycrofft (Dec 7, 2013)

On the other hand, I recognize that a degree is not the carte-blanche to one's eventual profession, career, or string of dead end jobs.
My son has  bachelor's (two years on Deans' list) and works in an unrelated and largely physical job he's held for ten years. My daughter has one and works beaucoup vollie hrs with animals and may morph it into a teaching credential, but again, not in her BA's field.

I once read something like 68% of college grads work in fields apparently unrelated to their degrees.

So, if you are getting that degree, consider if for time and money are being well-spent for a lifetime and not a young person's fantasy. If you still want it, consider the cross-usefulness of individual class credits…and how long they last 'til you have to take them again for a different major.


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## ExpatMedic0 (Dec 7, 2013)

I still don't understand why people are so scared of even an AAS, its cheap and most medics only need 1 o 2 semesters more to complete it. Blows my mind.


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## Medic Tim (Dec 7, 2013)

ExpatMedic0 said:


> I still don't understand why people are so scared of even an AAS, its cheap and most medics only need 1 o 2 semesters more to complete it. Blows my mind.



Agreed. 

Not just the education though . Self regulation along with the higher education is what we should strive for.....BECOME A TRUE PROFESSION .... I have seen first hand what this can do to EMS ( I am in Canada ) and the level of care and professionalism has gone through the roof.


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## Medic817 (Dec 7, 2013)

mycrofft said:


> On the other hand, I recognize that a degree is not the carte-blanche to one's eventual profession, career, or string of dead end jobs.
> My son has  bachelor's (two years on Deans' list) and works in an unrelated and largely physical job he's held for ten years. My daughter has one and works beaucoup vollie hrs with animals and may morph it into a teaching credential, but again, not in her BA's field.
> 
> I once read something like 68% of college grads work in fields apparently unrelated to their degrees.
> ...



I absolutely agree but I'm not talking about getting a degree other than in our profession. That's why it's a professional degree. To be a nurse you don't go get a degree to be a paramedic.



ExpatMedic0 said:


> I still don't understand why people are so scared of even an AAS, its cheap and most medics only need 1 o 2 semesters more to complete it. Blows my mind.



Some are even integrated to take the classes while taking medic classes. I'm glad I'll have the AAS degree and work for a service that is pushing for advancement.


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## mycrofft (Dec 7, 2013)

Medic817 said:


> I absolutely agree but I'm not talking about getting a degree other than in our profession. That's why it's a professional degree. To be a nurse you don't go get a degree to be a paramedic.
> 
> 
> 
> Some are even integrated to take the classes while taking medic classes. I'm glad I'll have the AAS degree and work for a service that is pushing for advancement.



Some poor souls DO try to "stair step" up some imaginary ladder in medicine. We keep telling them "GO for it!" or "Use EMT to finance your RN, MD etc".

Salute to you for the degree!!

I mention other fields because prehospital EMS is not the best paying job, and your work there is to a greater or lesser extent upon your ability to sit and drive for long periods per day, lift and transfer patients. As a "well rounded person" and not a fan(atic), you need to look down your road a little as well as take a look around you and see what is happening with your co-workers  through the years.


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## Carlos Danger (Dec 7, 2013)

I agree with the OP that education is not _necessarily_ all it's cracked up to be. College has gotten ridiculously expensive and as mycrofft pointed out, a very large percentage of people with 4-year degrees can't even find work in their fields, and many people end up having a hard time paying off their student loans. The old attitude that "more education is ALWAYS worth the investment" simply isn't true anymore (if it ever was). The relative value of a formal education is a lot less than it used to be.

However, that is very different than the issues we are facing in EMS. Educational standards in EMS are too low, period. There is a pretty strong and well-reasoned consensus that paramedics don't have nearly as much education as we should, considering the autonomy we have and the critical / invasive stuff we do. Most healthcare professionals have less autonomy and do NO invasive skills, yet are still required to have far more education than we are. Beyond the clinical aspects, many paramedics lack the basic skills in writing, communication, and interpreting research that are absolutely mandatory for the advancement of a profession. Historically, paramedics have dismissed that stuff as unimportant, yet it is exactly why every other healthcare profession has left us in dust. It is a much bigger deal than the clinical side, in terms of advancing the profession. 

The analogy between paramedics and MD's/DO's vis-a-vis their "problem" of PA's and NP's is apples and oranges. That is an issue of supply:demand and not one of education. FP and hospitalist docs are not losing their jobs to PA's and NP's. That issue is not relevant at all to paramedicine.

I think requiring an AAS is an excellent start, and it should be easy to do. Programs should require 2-semester A&P, pharmacology, physiology, and pathophysiology, as well as research, communication, etc. There is no other clinical profession that doesn't require this stuff. It would work. Paramedics would be clinically smarter and also better able to communicate and integrate into the greater healthcare industry.


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## medicsb (Dec 7, 2013)

platon20 said:


> In spite of those 10,000 hours of training, they are getting their lunch eaten by PAs and NPs with less than 1/4 that training.



No, they're not.



> If you go the degree route, you will inevitably give up control of the educational pathway to academic PhDs who have never practiced as a first responder.



Not likely.  



> I'm talking about them forcing you to take BS classes on ethics, healthcare policy, cultural competency, and other crap that has nothing to d with your job in the ambulance.



Ethics and cultural competency has nothing do with EMS?  :wacko:


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## FLdoc2011 (Dec 7, 2013)

Halothane said:


> The analogy between paramedics and MD's/DO's vis-a-vis their "problem" of PA's and NP's is apples and oranges. That is an issue of supply:demand and not one of education. FP and hospitalist docs are not losing their jobs to PA's and NP's. That issue is not relevant at all to paramedicine.



This.

I was never a medic but as someone in the healthcare arena looking at your field from the outside, if you to continue to advance your field/profession then some of the above suggestions regarding advanced degrees (doesn't have to be masters or even 4yr bachelors) I think is applicable.   At least some sort of standardized foundation with maybe a larger clinical component.  

For physicians, after 4 years of medical school at the post graduate level,  we still have to complete some sort of additional residency training (which is at least another. 3 years for fields like ER, FP, IM and even more for surgery, anesthesia, cardio, etc...). Doing residency alone there's probably over 10,000 hours of training/study not including med school.    But honestly residency is really where we learn the "art".   I could see some sort of similar combination if pre-clinical and clinical education foundation being helpful for paramedicine as well.


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## mycrofft (Dec 8, 2013)

I did not mean to sound like education is wasted. Just decide what your life course will be then commit. After screwing around in college for three years, I had to take a seven year hiatus through a factory job, marriage, unemployment, the USAF and prehospital EMS before I found myself committed to nursing college and nursing. No way to back out or divert without throwing out my life. THEN I was ready to go to school and force my way through. 

I'm saying degree-prepared prehospital EMS workers like EMT's are great, but don't stop there. If you can, go for something you can do the rest of your life; not just until you rupture a disc.


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## platon20 (Dec 8, 2013)

LMAO do you HONESTLY think that the academics that control a degree pathway for EMT/paramedics are going to stop with an AAS?

I dont think an AAS is bad.  Problem is that 10 years down the line it will turn from AAS into B.S.  Ten years after that it will turn from B.S. into M.S.  Ten years after that it will turn from M.S. into doctorate degree.  

And who gains from this the most?  It's not the EMTs/paramedics who will get saddled with tens of thousands in extra debt for very poor return on MEANINGFUL CLINICAL SKILLS.  It will the colleges/academics who laugh all the way to the bank that they were able to dupe gullible people into getting education that provides a very poor return on investment.

We need REAL education, and that means CLINICAL TRAINING, NOT ACADEMIC B.S. DEGREES.  We need vocational apprenticeship type programs where hours in an ambulance are prioritized over meaningless time in a classroom.

Ask any M.D. what they remember about organic chemistry or biochemistry and they will laugh in your face.


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## Wheel (Dec 9, 2013)

platon20 said:


> LMAO do you HONESTLY think that the academics that control a degree pathway for EMT/paramedics are going to stop with an AAS?
> 
> I dont think an AAS is bad.  Problem is that 10 years down the line it will turn from AAS into B.S.  Ten years after that it will turn from B.S. into M.S.  Ten years after that it will turn from M.S. into doctorate degree.
> 
> ...



Time spent in a classroom isn't meaningless. What do you think lays the foundation for all medical research, progress, and treatment?


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## Akulahawk (Dec 9, 2013)

platon20 said:


> LMAO do you HONESTLY think that the academics that control a degree pathway for EMT/paramedics are going to stop with an AAS?
> 
> I dont think an AAS is bad.  Problem is that 10 years down the line it will turn from AAS into B.S.  Ten years after that it will turn from B.S. into M.S.  Ten years after that it will turn from M.S. into doctorate degree.
> 
> ...


What we need is a really solid understanding of 3 things: Normal physiology, pharmacology and pathophysiology. When I first became a Paramedic, I had a reasonably decent understanding of 2 of those things. One of the prerequisite courses I had to take for RN school was microbiology. Ask me what I remember about it, and I'll tell ya that I learned a lot about growing little bugs. Ask me about how it applies to Nursing, and I'll tell ya that I know it takes a few days to get bugs identified and determine their sensitivity to antibiotics. Also some bugs like different growth media, so you may have to use different collection tubes to ensure optimal growth, because some media may inhibit their growth and thus you'll have a false negative.

But with all the schooling behind me, I can certainly say that I'm not a worse provider for it. If I'm coming from a facility where they've somehow managed to get a bunch of labwork done before calling me, it makes it a whole lot easier for me to determine what my treatment plan will be, knowing what's going on from that standpoint, in conjunction with my physical exam. 

Don't get me wrong, we still very much need vocational time too. We absolutely must know how to actually do the job when we finish school. We should be able to graduate from school and hit the streets, being safe, capable providers with minimal orientation to the specific working environment. It also takes a new medic a good year or two to really settle into the role, but at least we can get them out the door and able to practice in a safe manner until they find their own way.


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## the_negro_puppy (Dec 9, 2013)

In most of Australia a Bachelors degree is now required to be a Paramedic, with a Masters to work at the highest level (intensive care, helicopter etc)


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## JPINFV (Dec 9, 2013)

platon20 said:


> In spite of those 10,000 hours of training, they are getting their lunch eaten by PAs and NPs with less than 1/4 that training.



1. How many poor doctors do you know?
2. How many unemployed doctors do you know.
3. The unsupervised/undersupervised midlevel pyramid is going to come crashing down the first time one of them gets sued for malpractice. 
4. In properly supervised practices, the attending makes bank while his team sees more patients. Of course this requires a change from physician as a medical provider to physician as medical supervisor, which is not what most physicians go to school for.


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## ExpatMedic0 (Dec 9, 2013)

platon20 said:


> We need REAL education, and that means CLINICAL TRAINING, NOT ACADEMIC B.S. DEGREES.  We need vocational apprenticeship type programs where hours in an ambulance are prioritized over meaningless time in a classroom.



I think you have some misconceptions about "real education."

Correct me if I am wrong here, but a professional degree would be considered a terminal degree in a work related job that teaches you a foundation of academic skills needed to move onto the practical aspect of the degree, which is to do the job (often including long internships or training outside a classroom for the learning of a trade) an example of this would be medicine, resulting in the terminal professional degree of an MD. Is this not "real education?"

I believe what your referring to is an academic degree on the other hand, which would be considered more scholarly in nature. Normally focusing on research and dissertation for its terminal degree path. This type of degree generally does not  include long internships, nor does it teach you a specific hands on work related skill as does a professional degree. An example of a terminal degree like this would be a PhD in say, well... Philosophy for example.

As long as Paramedic remains the major it would be considered a "professional degree" and would most likely extend our current internships and clinical hours for clinical based paramedic degree programs. This is what it has done in Australia, the UK, South Africa, Canada, and every other English speaking 1st world country. Those guys do not sit in a classroom for 3-4 years, they spend a large portion of there degree time learning (if I may be so bold) the art, of paramedicine, or as you may prefer, the trade. 

What minimum standards we have for the industry right now is a vocational tech trade. Practical examples of our current colleagues would include a barber(barber school actually requires more hours than paramedic school),bicycle mechanic, ect.


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## WTEngel (Dec 9, 2013)

The OP in this thread just wreaks of the "your education is all fine and dandy, but street smarts is what saves patients..." mentality.

You may think you're saving patients OP, but you're likelymtomundereducated to even know the ones you're killing, or how you're killing them.

I am not saying lack of a degree leads to killing patients, but the attitude of "everything I need to know I learned in paramedic school" is short sighted and is in large part what is responsible for the failure of EMS in America to step up as a profession.

Regarding your point about physicians not remembering anything about organic chemistry, you've missed the boat entirely, most likely because you've never sat in a course like organic or biochemistry.

These courses are not designed for the student to leave remembering everything about organic, biochem, genetics, or whatever the case may be. They create a foundation, and teach you how to "learn" when there is no professor present (better known as RESEARCH) and be able to seek and find answers when there is no one to hold your hand...all essential skills for a physician, or any other healthcare PROFESSIONAL. Why EMS has not caut onto this, I can not understand. 

I began as a vocationally trained paramedic, with no intention of ever getting a degree. I even made it as far as flight medicine before I went back to school. I was even regarded as a "sharp" medic in many circles. I was still too stupid to "know what I did not know." It wasn't until I went back to get my BS and my MS that things started to really fall into place.

There is an old saying, that a little bit of education is a dangerous thing. This rings very true, because the less education you have, the less aware you are of the enormous amount that you do not know. There is also a saying, "the more I learn, the less I know." This is also true, as the further you go with your education, the more aware you are of how complex the processing of caring for and healing human beings really is. 

I encourage all of my colleagues and friends to complete a BS. The importance of this degree will likely not be realized until you've completed it.


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## fma08 (Dec 9, 2013)

platon20 said:


> There's a lot of threads on this forum about how basic EMTs need bachelors degrees, paramedics need masters degrees, etc
> 
> Going down the degree pathway is fool's gold.
> 
> ...


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## Christopher (Dec 9, 2013)

platon20 said:


> If you go the degree route, you will inevitably give up control of the educational pathway to academic PhDs who have never practiced as a first responder.  I'm talking about them forcing you to take BS classes on ethics, healthcare policy, cultural competency, and other crap that has nothing to do with your job in the ambulance.



You apparently have no idea how a degree program works...and this is coming from a software engineer who worked without a degree for many many years.

This is a great example of why low wages are Ok for EMS.


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## Christopher (Dec 9, 2013)

platon20 said:


> We need REAL education, and that means CLINICAL TRAINING, NOT ACADEMIC B.S. DEGREES.  We need vocational apprenticeship type programs where hours in an ambulance are prioritized over meaningless time in a classroom.



An academic paramedic will eat your lunch every day of the week, and twice on Sunday.

"Street smarts" means Experience Based Education, which is only as good as your experience. Why not learn that up front in class instead of on your patients as part of a hard knocks OJT?

I won't disagree that we need more clinical training, and perhaps a vocational model is not a bad way of doing it. Just if you think I'm going to choose a vocational paramedic over a degree based paramedic when I'm looking to pay providers at my service. Ha ha ha, you are funny.

Technicians using a vocational approach is probably a perfect model. Top them out at the EMT clinical set, akin to ER Tech's.

Clinicians using an academic approach would supplement them and provide the coordinated and effective care missing from the vocational side.


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## VFlutter (Dec 9, 2013)

platon20 said:


> Ask any M.D. what they remember about organic chemistry or biochemistry and they will laugh in your face.



Ask any (Most) Paramedic what Amiodarone and Grapefruit juice have in common and they will give you a blank stare....


We still have a Diploma nursing program in our city, one of the last few in the country. We will get a diploma RN at our hospital every once in a while. While they are competent and can safely do their job I would definitely not consider them experts nor exceptional. There is a substantial knowledge gap and  it is evident. All skills very little knowledge.


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## Handsome Robb (Dec 9, 2013)

Somebody ban this toolbag.

This is the exact type of person we DONT need in or around EMS.

You know Plato*O*n has two "O"s btw.


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## Christopher (Dec 9, 2013)

Chase said:


> Ask any (Most) Paramedic what Amiodarone and Grapefruit juice have in common and they will give you a blank stare....



Both have the same level of evidence for the treatment of VF/VT?


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## Handsome Robb (Dec 9, 2013)

Christopher said:


> Both have the same level of evidence for the treatment of VF/VT?



That's what I was going to say.


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## JPINFV (Dec 9, 2013)

p450 inhibitors?


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## JPINFV (Dec 9, 2013)

platon20 said:


> Ask any M.D. what they remember about organic chemistry or biochemistry and they will laugh in your face.



Here's the thing about the foundational sciences. Can I recall every step of the Krebs cycle from memory? Nope. Can I sit down and push electrons around or answer synthesis problems? Nope.

Do I still remember the underlying concepts from both? Yes. ...and those underlying concepts are what helps me interpret the medical world and new medical literature. Just because people lose the specifics of a course because they no longer use them doesn't mean that the broader understanding is lost.


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## VFlutter (Dec 9, 2013)

JPINFV said:


> p450 inhibitors?










MAGIC RACKS in GQ


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## Flightguy (Dec 9, 2013)

My head hurts after reading this.


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## Handsome Robb (Dec 9, 2013)

So...with the OPs argument we should just abolish all medical schools and have Doctors and Surgeons learn OTJ...

Since:


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## Meursault (Dec 9, 2013)

platon20 said:


> In spite of those 10,000 hours of training, they are getting their lunch eaten by PAs and NPs with less than 1/4 that training.



Oh god there's a full-on incursion of SDN trolling. Someone find the leak.


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## Handsome Robb (Dec 9, 2013)

Dont NPs and PAs require physician oversight? Even if thats just an MD that swings by the clinic once a month and is available for consults?

Doesn't exactly sound like NPs and PAs are eating anyone's lunch.


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## JPINFV (Dec 9, 2013)

Robb said:


> Dont NPs and PAs require physician oversight? Even if thats just an MD that swings by the clinic once a month and is available for consults?
> 
> Doesn't exactly sound like NPs and PAs are eating anyone's lunch.


 

1. Some places allow NPs to practice without any oversight. 

2. "Oversight" has pretty much the same range as "EMS medical director." Some places the physician will review every case, some places the supervising physician is an absentee landlord.


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## Carlos Danger (Dec 9, 2013)

"The more you learn, the less you know."

Truer words have never been spoken about education. The farther I get in my formal training and the more experience I gain, the more I realize how minuscule my understanding really is. That goes for both clinical and non-clinical things.


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## DrParasite (Dec 9, 2013)

Akulahawk said:


> One of the prerequisite courses I had to take for RN school was microbiology. Ask me what I remember about it, and I'll tell ya that I learned a lot about growing little bugs. Ask me about how it applies to Nursing, and I'll tell ya that I know it takes a few days to get bugs identified and determine their sensitivity to antibiotics. Also some bugs like different growth media, so you may have to use different collection tubes to ensure optimal growth, because some media may inhibit their growth and thus you'll have a false negative.


There are gram positive and gram negative cells, depending on how soluble their cell walls are.  we used metholyn blue dye to determined how lipidsoluable the cell walls were.  certain antibiotics won't work on certain illnesses, because of how strong the cell walls were

we also learned about the kreb cycle, the process from which ATP -> ADP + Energy, and we grew stuff on petry dishes, and we weren't supposed to sneeze on the petry dishes and then grow them because we could unleash a new strain of tebucothrax that will infect everyone.  Also went over DNA, RNA, and that mitocondria were the power houses of the cells, and there is a smoother and rough endoplasmic curriculum.  Not bad for taking micro 6+ years ago.





mycrofft said:


> I once read something like 68% of college grads work in fields apparently unrelated to their degrees.


Syracuse University, Class of '03, Bachelors of Science in Information Systems & History, currently working as a dirty button pusher for a hospital based EMS system, in a job title that barely requires a high school diploma. 





Christopher said:


> "Street smarts" means Experience Based Education, which is only as good as your experience. Why not learn that up front in class instead of on your patients as part of a hard knocks OJT?


what do you think residency is? yes, they get education up front, but the residency part is OJT on live patients.





Robb said:


> Somebody ban this toolbag.
> 
> This is the exact type of person we DONT need in or around EMS.


Why? he has his right to his opinion.  you might disagree with it, but his point of view is no less valid than yours is.

I happen to agree with him.  getting a degree in EMS is incredibly over rated, because of how the degree process is designed, especially for an entry level position.  for supervisory people, sure, but judging from my experience of ADNs vs BSNs, the BSNs aren't much better; they are just more in debt and better positions to become  MSNs, should they decide to do so in 10 years.  

If you have EVERY course in the paramedic degree being directly relevant to the  paramedic program, and actually increases a person's knowledge, assessment and clinical interventions, then I will be at the head of the line to support a bachelors degree for every paramedic, and say every current paramedics needs to go back to school to maintain their paramedic cards (yes, if you going to make the newbies do it, because it benefits the profession and our patients, than the old guys need to do it too).  But I don't see that happening anytime soon, so I will stick by my original opinion, that a degree is overrated, and a vocational course where all the content directly responsible to paramedicine is better for patient care..


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## platon20 (Dec 9, 2013)

If you offered me classroom education at an AFFORDABLE PRICE that is non-mandatory, then yes I would take it.

Education for its own sake is good.  But colleges/universities arent providing education for its own sake, they are providing it for a profit.  A profit that YOU are going to pay for in the form of MASSIVE student debt.

Think about who would be calling the shots in such a degree based "profession."  It would be academics, like the people on this thread who believe that a paramedic needs to know that campylobacter only grows on chocolate agar at 37 degrees celsius or higher.  

You turn the training pathway over to academic PhDs who havent been on an ambulance in 30 years and you are going to get a ton of minutiae.  Dont get me wrong, does it help me to know that oxygen is the terminal electron receptor in the electron transport chain?  Sure.  But does it help me to know that fact in the context that I have to dump 30-100k in tuition costs to obtain minutiae like that?  Nope.


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## Brandon O (Dec 9, 2013)

platon20 said:


> Dont get me wrong, does it help me to know that oxygen is the terminal electron receptor in the electron transport chain?  Sure.  But does it help me to know that fact in the context that I have to dump 30-100k in tuition costs to obtain minutiae like that?  Nope.



It would probably help filter out a certain caliber of person, at least.


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## WTEngel (Dec 9, 2013)

If you're $100k in debt from finishing a BS, that's nobody's fault but your own. Yeah, college isn't cheap, but there's no need for the dramatic exaggeration. I'll be through with medical school and spend around $80k total from undergraduate through OMS-4, and no, I didn't have any scholarships.

The fact of the matter is education isn't about learning facts, which is what everyone seems to be equating it to. Memorizing a set of facts may be the way you have learned so far, but that's not education.

Education is about encouraging higher order thinking, developing the ability to think critically and evaluate a situation from multiple angles, including but not limited to an academic angle.

You're entitled to your opinion, unfortunately I think you will find that you're on the wrong side of history with this issue.

Look at every other developed country and compare the EMS system education requirements. America is behind, as it is with just about every other educational benchmark. Go ahead and cling to the idea that technical skills are the only thing worthy of spending time on. That's so very "merica!" of you.


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## platon20 (Dec 9, 2013)

Brandon O said:


> It would probably help filter out a certain caliber of person, at least.



There are much better ways to filter people that work better and are cheaper than dumping 30k in a classroom so a PhD can lecture you on the intricacies of aquaporin water channels and their role in the regulation of SIADH


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## WTEngel (Dec 9, 2013)

And BTW, that's $80k total, 4 years BS, 1 year MS, and 4 years OMS. I say again, $100k in debt is ridiculous, and anyone who falls for it is a fool.


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## platon20 (Dec 9, 2013)

WTEngel said:


> And BTW, that's $80k total, 4 BS, 1 MS, and 4 OMS. I say again, $100k in debt is ridiculous, and anyone who falls for it is a fool.



By your location in Ft Worth, I assume you attend TCOM.

According to their website, their tuition cost per year is 18k per year and their total cost of attendance is 44k per year.  That comes out to 72k and 177k for 4 years.

If your numbers are to be believed that means you only paid 8k for your entire bachelors and masters programs.

Can you cite a single 4 year college in the United States in which the cost of attendance is only 8k without scholarships?  I dont think so.

Your numbers are NOT typical.  

http://web.unthsc.edu/info/200679/admissions_and_outreach/1536/costs_and_financial_aid


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## Brandon O (Dec 9, 2013)

platon20 said:


> There are much better ways to filter people that work better and are cheaper than dumping 30k in a classroom so a PhD can lecture you on the intricacies of aquaporin water channels and their role in the regulation of SIADH



Not really. Positions with lower standards earn less money, and hence don't attract high-quality applicants. There are exceptions, such as the sort of long-suffering overqualified folks who spend time on forums like this, but that's not the rule.

And if your goal is to perform basic, protocol-driven life support on acute emergencies, your job may not be around much longer. Most emergency medicine (in all settings) now consists of managing chronic problems in complex patients; EMS isn't far behind on that curve; and you cannot do that job without an adequate didactic foundation.

I suppose you can learn about aquaporins in an ambulance. (In fact, I used to torture my new partners with exactly that sort of thing.) Kinda awkward when you're not facing each other though. Buildings are nice.


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## Akulahawk (Dec 9, 2013)

platon20 said:


> If you offered me classroom education at an AFFORDABLE PRICE that is non-mandatory, then yes I would take it.
> 
> Education for its own sake is good.  But colleges/universities arent providing education for its own sake, they are providing it for a profit.  A profit that YOU are going to pay for in the form of MASSIVE student debt.
> 
> ...


Think about this: those "academic" types are the ones you call when you need an order for something because it's not in your protocols. If we, as a group, increase our educational base, we can expect that our protocols will eventually match what we're capable of doing. While we won't likely be in the same realm as PA providers, we'll have a lot more autonomy in what we do, and possibly function more under general guidelines that we can tailor to fit a specific situation than some more rigid protocols. We can be protocol monkeys or not. Also, the more we learn, the more we'll be able to branch out into other areas of care. While we may rail against the nurses, remember that they've blazed a trail. All we have to do is copy what they've done and apply it to our own circumstances. 

If you want nursing and paramedicine to be on equal footing, academics have to be brought up to a significantly higher standard.


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## Christopher (Dec 9, 2013)

DrParasite said:


> what do you think residency is? yes, they get education up front, but the residency part is OJT on live patients.



Residency and EMS's learning-as-you-go are like apples and ducks.


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## EpiEMS (Dec 9, 2013)

platon20 said:


> There are much better ways to filter people that work better and are cheaper than dumping 30k in a classroom so a PhD can lecture you on the intricacies of aquaporin water channels and their role in the regulation of SIADH



I'd be hard-pressed to think of one. Higher entry requirements to the field are the best way to increase wages, for one.


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## WTEngel (Dec 10, 2013)

You have to pay to live either way, so you can't use the 44k figure. 

18k per year to OMS-4 is 72k

I spent 3k at community college and knocked out 4 semesters of undergrad.

Flat rate tuition at 4.5k per semester for any amount of hours you want allowed me to complete my next two years in only 3 semesters.

All said that's 88.5k.

I spent 13k on my MS, so no we're at 101.5k.

It isn't the 80k I originally quoted, but at only 1.5k more than your "100k" price for a BS, I think it's safe to say that you're grossly exaggerating the minimum cost. Anyone who spends that much does so because they want to, or we're not smart enough not to.

Like i said, I'm not factoring in the cost of living, you pay that whether you're in school or not, so you "total cost of attendance" rate is flawed.

The bottom line is education, while not cheap, is affordable.



People who jack around and spend 5 or 6 years on a BS tend to go into debt a bit more significantly, but that's no fault of the institution (other than failing to kick them in the butt to graduate.)

I'm not here to debate the cost of education, I'd rather debate the cost of no education. You can't really put that into dollars and cents, but over the course of a lifetime it is significant.


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## mycrofft (Dec 10, 2013)

Chase said:


> Ask any (Most) Paramedic what Amiodarone and Grapefruit juice have in common and they will give you a blank stare....
> 
> 
> We still have a Diploma nursing program in our city, one of the last few in the country. We will get a diploma RN at our hospital every once in a while. While they are competent and can safely do their job I would definitely not consider them experts nor exceptional. There is a substantial knowledge gap and  it is evident. All skills very little knowledge.



Did you mean "Certificate" program? Degrees in nursing are common, and can even extend to a doctorate. I have a whole issue with nursing students going straight to a MSN and then taking over a department, though.


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## Handsome Robb (Dec 10, 2013)

how do I ignore people?


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## WTEngel (Dec 10, 2013)

This is SDN caliber trolling for sure.

Low post count, pushing all the right buttons...

Worst part is I'm still falling for it. Oh well.


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## mycrofft (Dec 10, 2013)

I am not totally at odds with the OP. I remember being at that mindset sometimes. But I am not anti-education and do not think more education makes you a worse field worker. 

If we have a degree we tend to feel it is important. We put a lot of time into it and if you (want to) get past constantly reacting to protocols (i.e., being a technician) then higher level reasoning and knowledge come in handy for decision making, science to make change in the career field, or just knowing what is significant to find and record on a scene.

There are means to get help with medical education costs, look into government programs. There are schools and areas with higher costs of education and living, versus places with lower ones. Shop around.

I forget who answered that practical education is paramount. As a former EMT going through the angst of nursing college, I often felt that way, and felt like that afterwards when I was still learning "the real deal" on my jobs. But there is no way to get that experience crammed into four or eight years. I think much more practicum needs to be availed, and "working ambulance " while or before going to a higher level of training is one way to see a lot you will not learn in class; class will help you sort out "Wha' happened?".


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## platon20 (Dec 10, 2013)

mycrofft said:


> I am not totally at odds with the OP. I remember being at that mindset sometimes. But I am not anti-education and do not think more education makes you a worse field worker.
> 
> If we have a degree we tend to feel it is important. We put a lot of time into it and if you (want to) get past constantly reacting to protocols (i.e., being a technician) then higher level reasoning and knowledge come in handy for decision making, science to make change in the career field, or just knowing what is significant to find and record on a scene.




I'm not anti-education either.  But when "education" means pulling you out of clinical/field training and strapping tens of thousands of debt on your shoulders with NO EVIDENCE TO INDICATE THAT IT CREATES SUPERIOR PARAMEDICS then yes, I'm against it.

Your 2nd paragraph is spot-on.  Med students and doctors have "bought into" their degree hype and so therefore they think they are superior to everyone else.  But the research says that's NOT TRUE.  In fact, they cant cite one study that shows that physicians outperform midlevels in clinical areas.

There are dozens of studies showing equivalence between midlevels in every clinical arena from primary care clinic, to ER, to ICU.  There are NO studies showing that physicians are superior to midlevels.  

There are many many ERs in rural areas that have ONLY midlevels with no doc on site at all.  

Blowing an extra 50k on "education" to do the same stuff that a midlevel can do at half the cost is ridiculous.


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## platon20 (Dec 10, 2013)

Christopher said:


> Residency and EMS's learning-as-you-go are like apples and ducks.



This is correct, but the way to fix it is to make EMS training MORE like residency.  Not to turn EMS into some kind of "med school lite" where we spend hours on topics that mean little in terms of clinical relevance in the field.  

If I have a 50 year old dude in the field with altered mental status and a sodium level of 105, does it really matter whether I know what the proper workup is to rule out SIADH?  Does it matter if I know WHY giving a 0.9 percent NS bolus will make his sodium level WORSE?  

Ask any PRACTICING DOCTOR what shaped their real education and they will tell you residency is everything.


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## Handsome Robb (Dec 10, 2013)

platon20 said:


> I'm not anti-education either.  But when "education" means pulling you out of clinical/field training and strapping tens of thousands of debt on your shoulders with NO EVIDENCE TO INDICATE THAT IT CREATES SUPERIOR PARAMEDICS then yes, I'm against it.
> 
> Your 2nd paragraph is spot-on.  Med students and doctors have "bought into" their degree hype and so therefore they think they are superior to everyone else.  But the research says that's NOT TRUE.  In fact, they cant cite one study that shows that physicians outperform midlevels in clinical areas.
> 
> ...



Have you looked at how the rest of the developed world does EMS?

Outside of a few countries we have the lowest education requirements for prehospital healthcare providers.


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## Wheel (Dec 10, 2013)

platon20 said:


> This is correct, but the way to fix it is to make EMS training MORE like residency.  Not to turn EMS into some kind of "med school lite" where we spend hours on topics that mean little in terms of clinical relevance in the field.
> 
> If I have a 50 year old dude in the field with altered mental status and a sodium level of 105, does it really matter whether I know what the proper workup is to rule out SIADH?  Does it matter if I know WHY giving a 0.9 percent NS bolus will make his sodium level WORSE?
> 
> Ask any PRACTICING DOCTOR what shaped their real education and they will tell you residency is everything.



I don't think anyone here would advocate for less field time. I don't think it's too much to ask for a paramedic to have a better understanding of physiology, and I think paramedics should have more/longer rotations in a variety of specialties (similar to nursing). If this came to pass, along with a requirement for an associates degree and an option for a bachelors, ems could successfully lobby for reimbursements similar to nursing and RT. You might see an increase in community paramedic pilot programs and higher pay because of this. Why would it be such a problem for ems to come to equal footing with the rest of the allied health fields?


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## Sandog (Dec 10, 2013)

JPINFV said:


> Here's the thing about the foundational sciences. Can I recall every step of the Krebs cycle from memory? Nope. Can I sit down and push electrons around or answer synthesis problems? Nope.
> 
> Do I still remember the underlying concepts from both? Yes. ...and those underlying concepts are what helps me interpret the medical world and new medical literature. Just because people lose the specifics of a course because they no longer use them doesn't mean that the broader understanding is lost.



I don't know. I had molecular biology class and all I can remember is that you got this little protein molecule enzyme thingy that goes to a little cell and say's "Hey bud, let's party" and the cell opens its little cell door and other little molecules run in and out the door. 

On the chemistry side, if you ask me about acid/base titration, I am like, "Is that when the clear liquid turns pink?" :wacko:


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## JPINFV (Dec 10, 2013)

WTEngel said:


> This is SDN caliber trolling for sure.
> 
> Low post count, pushing all the right buttons...
> 
> Worst part is I'm still falling for it. Oh well.




Get the heck out of the pre-allo/osteo section. Heck, I rarely venture far out of the clinical rotations and EM forum now. Trolling in those places are virtually non-existent.


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## JPINFV (Dec 10, 2013)

Sandog said:


> I don't know. I had molecular biology class and all I can remember is that you got this little protein molecule enzyme thingy that goes to a little cell and say's "Hey bud, let's party" and the cell opens its little cell door and other little molecules run in and out the door.



So you have the basis of understanding how drug agonists/antagonists works besides, "Beta blockers lower the heart rate."



> On the chemistry side, if you ask me about acid/base titration, I am like, "Is that when the clear liquid turns pink?" :wacko:


You know what an acid is right? You know what denaturing is, right? So, you have a fairly good idea why acid/alkalosis is bad, right?

You understand chemical equilibrium? So you understand if you push a reaction by increasing/removing a reactant pushes an equilibrium to the right or left? Pretty much the basis for renal physiology and acid/base homeostasis.


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## JPINFV (Dec 10, 2013)

platon20 said:


> This is correct, but the way to fix it is to make EMS training MORE like residency.  Not to turn EMS into some kind of "med school lite" where we spend hours on topics that mean little in terms of clinical relevance in the field.



Residency is useless without the basis of medical school. If the only thing needed was residency then we wouldn't have medical school... we'd have residency. 




> If I have a 50 year old dude in the field with altered mental status and a sodium level of 105, does it really matter whether I know what the proper workup is to rule out SIADH?  Does it matter if I know WHY giving a 0.9 percent NS bolus will make his sodium level WORSE?


If EMS wants to act like a technician, then they shouldn't be surprised when they're treated like a technician.


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## Sandog (Dec 10, 2013)

I was sorta joking JPV, I am all for school and think it is a good thing and anyone who says different is only fooling themselves. There are many professions like engineering, Chemical science, biological science to name a few that you can not even get into without a degree, there are exceptions once in awhile, but not often.

But I got to tell ya, I think my brain is full, as soon as I take a new class, all the stuff I learned before just goes poof...


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## ExpatMedic0 (Dec 10, 2013)

I don't know, maybe the OP is right. Maybe I should drop out of university, and just work for AMR and ask they place me with an FTO for an extended period of time. Preferably one with no higher education who can teach me the art of medicine he/she has learned by saving lives at 60 miles per hour, watching emergency, and by having the tried and true "that's the way we have always done it" 
Obviously there is no future in higher education, degree earners do not make any more money or have any better career aspects. Clearly a profession does not need degree's to advance or conduct its own scholarly professional research, advocate, create policy's, ect. We have nurses and doctors that can do that for us and shape the hero vocation we are also so blessed to be a part of. Although apparently, we should actually be using PA's and NP's instead of doctors, but you get the point.


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## Sandog (Dec 10, 2013)

Would that be sarcasm or patronizing, or a combination of both? 

Sarcazing. :blink:


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## MrJones (Dec 10, 2013)

Wheel said:


> ...Why would it be such a problem for ems to come to equal footing with the rest of the allied health fields?



Eastern Kentucky University, which offers an Associates and three different Bachelors Degree programs in paramedicine through it's Emergency Medical Care (EMC) Department, has a College of Health Sciences and a College of Justice and Safety. The EMC Department is located in the latter College.

_That's_ why it would be such a problem.


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## Brandon O (Dec 10, 2013)

platon20 said:


> If I have a 50 year old dude in the field with altered mental status and a sodium level of 105, does it really matter whether I know what the proper workup is to rule out SIADH?



No?



> Does it matter if I know WHY giving a 0.9 percent NS bolus will make his sodium level WORSE?



Yes?


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## WTEngel (Dec 10, 2013)

ExpatMedic0 said:


> I don't know, maybe the OP is right. Maybe I should drop out of university, and just work for AMR and ask they place me with an FTO for an extended period of time. Preferably one with no higher education who can teach me the art of medicine he/she has learned by saving lives at 60 miles per hour, watching emergency, and by having the tried and true "that's the way we have always done it"
> Obviously there is no future in higher education, degree earners do not make any more money or have any better career aspects. Clearly a profession does not need degree's to advance or conduct its own scholarly professional research, advocate, create policy's, ect. We have nurses and doctors that can do that for us and shape the hero vocation we are also so blessed to be a part of. Although apparently, we should actually be using PA's and NP's instead of doctors, but you get the point.



In all fairness, you probably were never gonna be that great anyway... lol 

I'm probably headed for the same fate. No sense in completing my higher ed. Now that I figured how much it really cost, anyone who spends 100k to get themselves to the point where they can earn 250-300k a year, and <gasp> actually make decisions, is clearly making a bad choice.

And the point the OP is making about mid levels spending slightly less on school and making nearly half of what a physician makes is totally correct.

Extrapolate that out over a 25 year career and I'm only losing literally millions of dollars by making the choice to not go to school. 

Thank you OP for making sense out of the most bass ackwards idea I've ever seen.


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## ExpatMedic0 (Dec 10, 2013)

WTEngel said:


> In all fairness, you probably were never gonna be that great anyway... lol



:sad:


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## TransportJockey (Dec 10, 2013)

MrJones said:


> Eastern Kentucky University, which offers an Associates and three different Bachelors Degree programs in paramedicine through it's Emergency Medical Care (EMC) Department, has a College of Health Sciences and a College of Justice and Safety. The EMC Department is located in the latter College.
> 
> _That's_ why it would be such a problem.



But then you have programs like the UNM School of Medicine, EMS Academy. It's a branch of the department of emergency medicine. It offers a BS in paramedicine.


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## MrJones (Dec 10, 2013)

TransportJockey said:


> But then you have programs like the UNM School of Medicine, EMS Academy. It's a branch of the department of emergency medicine. It offers a BS in paramedicine.



That's as it should be. And when most, if not all, state flagship medical schools offer a paramedicine program I'll believe that we're on the path to equal footing with the rest of the allied health fields.


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## platon20 (Dec 10, 2013)

MrJones said:


> That's as it should be. And when most, if not all, state flagship medical schools offer a paramedicine program I'll believe that we're on the path to equal footing with the rest of the allied health fields.




Screw that.  Why settle for allied health when you can tell people that you graduated from medical school?

Think that's ridiculous?  Well thats exactly what the PA grads do at schools where the PA program is organized under the school of medicine.


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## Handsome Robb (Dec 10, 2013)

platon20 said:


> Screw that.  Why settle for allied health when you can tell people that you graduated from medical school?
> 
> Think that's ridiculous?  Well thats exactly what the PA grads do at schools where the PA program is organized under the school of medicine.



Blanket statement much?


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## WTEngel (Dec 10, 2013)

platon20 said:


> Screw that.  Why settle for allied health when you can tell people that you graduated from medical school?
> 
> Think that's ridiculous?  Well thats exactly what the PA grads do at schools where the PA program is organized under the school of medicine.



Yeah, they didn't graduate from medical school, and they don't tell people that. Any PA that does is a liar, and most every PA I've met is proud to have graduated from PA school, and not med school.


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## MrJones (Dec 10, 2013)

platon20 said:


> Screw that.  Why settle for allied health when you can tell people that you graduated from medical school?
> 
> Think that's ridiculous?  Well thats exactly what the PA grads do at schools where the PA program is organized under the school of medicine.



_That's_ not what I think is ridiculous....


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## mycrofft (Dec 10, 2013)

platon20 said:


> I'm not anti-education either.  But when "education" means pulling you out of clinical/field training and strapping tens of thousands of debt on your shoulders with NO EVIDENCE TO INDICATE THAT IT CREATES SUPERIOR PARAMEDICS then yes, I'm against it.
> We've established that cost is variable as is resultant quality. But as a rule your better education will cost more than a certificate or diploma mill will.
> 
> Your 2nd paragraph is spot-on.  Med students and doctors have "bought into" their degree hype and so therefore they think they are superior to everyone else.  But the research says that's NOT TRUE.  In fact, they cant cite one study that shows that physicians outperform midlevels in clinical areas.
> ...



Have you never lost a patient because you just didn't have what you needed at the time? Raising the level of education and preparation across the board, while not possible due to political economic and sociological reasons, is still something to aim for. Controlling the costs of training is another matter.


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## JPINFV (Dec 10, 2013)

WTEngel said:


> Yeah, they didn't graduate from medical school, and they don't tell people that. Any PA that does is a liar, and most every PA I've met is proud to have graduated from PA school, and not med school.




My masters degree is from Tufts University School of Medicine. There's a reason, however, that I never identify the School of Medicine part when people ask where I went.


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## JPINFV (Dec 10, 2013)

platon20 said:


> There are dozens of studies showing equivalence between midlevels in every clinical arena from primary care clinic, to ER, to ICU.  There are NO studies showing that physicians are superior to midlevels.



So I assume that if you ever need open heart surgery, you'd be happy if an unsupervised midlevel did it? If you were ever rushed to the hospital in sepsis, you'd be happy with a midlevel every step of the way without a physician laying eyes on you even once? After all, midlevels are the same as physicians, right?


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## JPINFV (Dec 10, 2013)

Also...


> *RESULTS: *
> 
> Of the encounters documented, 83% were with PCPs,  13% were with covering physicians, and 5% were with midlevel providers.  In multivariable analysis, the odds of medication intensification were  49% (P < 0.0001) and 26% (P < 0.0001) higher for PCPs than for  covering physicians and midlevel providers, respectively, whereas the  odds of lifestyle counseling were 91% (P < 0.0001) and 21% (P =  0.0015) higher. During visits with acute complaints, covering physicians  were even less likely, by a further 52% (P < 0.0001), to intensify  medications, and midlevel providers were even less likely, by a further  41% (P < 0.0001), to provide lifestyle counseling. Compared with  PCPs, the hazard ratios for time to the next encounter after a visit  without acute complaints were 1.11 for covering physicians and 1.19 for  midlevel providers (P < 0.0001 for both).
> *CONCLUSIONS: *
> ...


http://www.ncbi.nlm.nih.gov/pubmed/23230095


> *RESULTS: *
> 
> The PCPs included 64 physicians, 21 NPs, and 7 PAs.  Patients treated by physicians and midlevel providers did not differ in  their mean visit BP, number of chronic conditions, age, or number of BP  medications. Controlling for current and past BP readings and patient  characteristics, physicians were significantly more likely than midlevel  providers to initiate a treatment change for elevated BP at a visit  (53.8% vs 36.4%; P = .001). After controlling for additional  visit-specific factors, practice style, measurement, and organizational  factors, physicians were still more likely to initiate a treatment  change (52.5% vs 37.5%; P = .02).
> *CONCLUSIONS: *
> ...


http://www.ncbi.nlm.nih.gov/pubmed/19514803


Generally the softer side (i.e. "patient satisfaction") is what's measured. Sure, midlevels might be able to make the patient more satisfied than physicians, but that isn't going to reduce their BGL or their blood pressure. I'd rather be unhappy with my physician and have functioning kidneys than be happy with a midlevel and kill my kidneys with HTN or DM.


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## WTEngel (Dec 10, 2013)

JPINFV said:


> My masters degree is from Tufts University School of Medicine. There's a reason, however, that I never identify the School of Medicine part when people ask where I went.



Exactly. I'm in the same boat... Wouldn't ever cross my mind to tell people I got my masters from the school of medicine. 

The OP is just grasping at straws here anyway...PAs technically graduate from the school of physician assistant studies, even if that school is organized under the college of medicine.


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## JPINFV (Dec 10, 2013)

WTEngel said:


> Exactly. I'm in the same boat... Wouldn't ever cross my mind to tell people I got my masters from the school of medicine.



What grinds my gears more is the people who claim to be UCLA alumni because they went there for paramedic school. Yea... sorry... the UCs don't hand out degrees below bachelors.


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