# paramedic practioners



## firecoins (May 6, 2008)

This is an interesting concept.  A paramedic who is much like a Physicican Assistant, a mid level practioner with an increased scope of practise.  A pediatric trauma surgeon lecturing my medic class brought the idea up and says it will happen in NY within 15 years or so.


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## Epi-do (May 6, 2008)

What types of increases to scope of practice was he proposing?  If this does eventually come to fruition, it will be interesting to see how it develops.  

I just don't see it A) being done right or B ) being very successful, ultimately for the same reason - education.  I would hope, *at the very least*, something like this would require a bachelors degree, or even better, a masters degree (like that would ever happen 
	

	
	
		
		

		
			





 ).  And, if that somehow, miraculously did happen, how many people working in EMS would be willing to put that much time/work into gaining the required education?

I can't wait to see what Ryd, Vent, and some of the others have to say about this.


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## VentMedic (May 6, 2008)

And the education requirements would be how much for a Paramedic Practioner?  

Almost 40 years later and we don't even have a solid 1 year certificate mandatory for the Paramedic but rather 700 - 1000 hours.   How long before even an Associate's degree is the minimum?  (yes, Oregon is the exception but that doesn't have to be in EMS)   A Master's degree even in 15 years could be a stretch when gaged to the progress we have made so far. 

Typical PA program in my part of the country where a Master's is required:

http://www.med.ufl.edu/pap/apply/infopack.pdf

http://www.nova.edu/pa/

I would just like to see college A&P as mandatory for the Paramedic for starters.  

The other issue is community and clinic medicine have been attempted by a few EMS organizations.  But, just like the "BS" calls, many of the Paramedics hated it and the programs were quickly dropped.


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## Ridryder911 (May 6, 2008)

It's here, just the formality is not. The demand and number of people out-ways the number of facilities and availability that will be offered. 

Just alike physical therapist that basically jumped from an associate degree program a few years ago to a doctoral level now required in most states. 

Does this mean a Paramedic Practitioner on every EMS unit, ...NO! As well I doubt they ever will be on an EMS unit or should be. Rather, alike the "chase car, or roving EMS unit" they will be dispatched on medical cases to treat more aggressive. Non transport, and will work better hours, definitely a pay difference. For example that head laceration (simple 1'st degree lac) can be scrubbed and dermabond/steri stripped and CHI instructions given out. Foley replaced, and with the technology today a XII lead can be done, bedside cardiac lab markers, and a holter can be placed and then the patient can be seen tomorrow a.m. for a stress and ultrasound. Again, not just medicine but economics has to play in this too. Figure how much money insurance corporations will be saving by the minute for those NOT transported. ER numbers can be reduced as well as admissions. 

Yes, there will a major mind set and change from those that work the street and the practitioner. It may be more experienced providers, or those that prefer more academics. Yes, reimbursement will have to be off set to afford such individuals, in which I believe Medicare would choose to pay $2000 for a treatment than a taxi ride and then still pay for treatment. Private payers will fall in suit. 

What education level? Just alike P.A. (that still have associate to graduate degree programs) I believe it will start as a undergrad then change to grad, and alike the other health care professions the pay will follow. Again, there will be the regular Paramedic to treat emergency AMI, MVA, etc. not the same. 

We can either get on aboard or bury our head. Three new "home visit" physician services started this week in OKC..... see the trend? NREMT have already developed the blue print for testing and now is awaiting EMS Educators Society development plans to see what is next/ 

R/r 911


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## VentMedic (May 6, 2008)

I am going to extend my post just a little.

If you want to do the work of a PA, you don't have to wait for the chance of the Paramedic Practitoner becoming a reality.  PAs are found in a wide variety of specialties as are Nurse Practitioners.    

The same goes for Paramedics who want to do some of the work of nurses but don't believe they need nursing school or want to be called "a nurse".  

If you haven't already considered even a few of the prerequisites that are required to become an advanced practitioner of any type, then this is probably not the program for you.   That is unless EMS finds another quick and easy certification called Paramedic Practitioner like the 60 hr "Critical Care" Paramedic certificate.   

The profession already has a profound identity crisis with 48 different certifications.   To add more confusion again with being like that but called this and still without defining the present is just another way to further fragment a piece mill system.


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## Ridryder911 (May 6, 2008)

I agree that is might be considered another "cert" but I doubt it. I personally do not see it any similar to a P.A. or NP. Will it replace the NP or PA ? It is doubtful that a P.A. or NP will want to respond to a residence for a head lacc at 0300 or feel comfortable assessing a chest pain. Doubtfully a P.A. will prefer to be attached to an EMS division in lieu of a physician working clinics and in hospitals. Again, most that enter those professions usually will be intent to work and go to school for that profession. Alike the NP that has to specialize in their regarded speciality, I believe the Paramedic Practitioner will also be an expert in their regarded field. Again, this will be a development of necessity, not because due to luxury. It is estimated that every minute 100 people turn the age of 65, in five years it will be 1000... do the math, look at the reality. Hospitals are full,  ER's are already on divert status and do we think it is going to get better? As one insurance president described of this proposal.."nip at the bud"... Again, they are considering the trillions of dollars that could be saved. 

Again, most decisions and guidance in medicine are rarely based upon the science of medicine, rather it is based upon financial statistics. Again, do the math, alike DRG's, captivated rates, Medicare is tired of paying for high dollar taxi services with nothing in return. When in fact as discussed many of these patients do not need an ER visit or diagnostic studies some just simple treatments. 

I do think that the "mills" are going to be a thing of the past. Yes, we will see a influx of them as a last ditch to make money before accreditation will be required to sit on NREMT advanced level exams. 

I doubt that most of the Paramedic Practitioner programs would be even require EMT training, rather may either prefer Paramedic or start from scratch. Again, things that will be worked out, but if we are smart we will use other programs such as R.T. to prevent re-inventing the wheel. 

I know there has even been interest in local universities in my area of putting together a program such as this. Much more than the traditional Paramedic programs, that are unfortunately considered technical/trade and blue collared. 

Again, the future is ours. I do see that there is a lot of potential problems, but I believe we are a pivoting point of EMS. I believe we can direct and participate or be left behind. I much rather at least be part of it, in case it does go forward. 

R/r 911


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## Jon (May 6, 2008)

Rid,

Why is it that every ambulance should have a paramedic... but you think that a "paramedic practitioner" is OK as a chase car?

Shouldn't every ambulance have a "paramedic practitioner"???


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## firecoins (May 6, 2008)

Ridryder911 said:


> I agree that is might be considered another "cert" but I doubt it. I personally do not see it any similar to a P.A. or NP. Will it replace the NP or PA ? It is doubtful that a P.A. or NP will want to respond to a residence for a head lacc at 0300 or feel comfortable assessing a chest pain. Doubtfully a P.A. will prefer to be attached to an EMS division in lieu of a physician working clinics and in hospitals. R/r 911



I wouldn't be too sure about that.  Many PA schools require a previous healthcare experience. Alot of EMT-Bs and Medics go on to become a PA.  Many see as the next step in the progression.  Many of the former medics find they had more responsibility as a medic than as a PA.  The former medics rarely if ever get to intubate people, run codes or handle anything serious in the same manner as PAs as they did as medics.  Some place are experiementing with PAs in the field.  Ill get more info.


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## VentMedic (May 6, 2008)

That all depends on the specialty of the PA.  We have ER PAs, Trauma PAs, General Surg PA, CV Surg PA and Cardiac PAs.   PAs with a Masters can usually get into the specialty or clinic of their choosing in many areas as can NPs.  They are already being used in some EDs to fast track and alleviate some of the load.   

Of course, Florida prefers a Masters degree in many of their professions.  This may give the PAs here more of an edge than the 2 year PAs elsewhere.  

In some of the areas mentioned above, you may not do "skills" but may have the responsibilty of covering for a group of surgeons for several patients for several days and are expected not to screw up.  That type of long term management can be very stressful with serious responsibilty especially if your background was as an EMT or Paramedic where the relationship with the patient was short term with short range treatment.   The close medical oversight and working relationship with a group of physicians can also be very different for some former Paramedics who may have had a medical director with a more distant oversight style. 

Since PAs are already established with known reimbursements, their professional organization will continue to recruit and gain strength to preserve their piece of the pie.   

They have a strong national profession organization:
American Academy of Physician Assistants

http://www.aapa.org/

Physician Assistants in Emergency Medicine

http://www.aapa.org/gandp/issuebrief/emergency.pdf


And a specialty organization:

*The Society of Emergency Medicine Physician Assistants* 
http://www.sempa.org/

The legislative links on these sites are quite interesting.


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## Ridryder911 (May 6, 2008)

I have a passion for this because I am on a State Task Force to develop curriculum and standards, legislation for the Critical Care Paramedic and Advanced Paramedic/Practitioner. 

I think there is confusion between the difference of a Paramedic and Paramedic Practitioner. 

Yes, I believe at least one Paramedic should be on every EMS unit..period. One has to review why I and many others now have this opinion. We must review the *system*:

Sorry, nothing personally against EMT's, rather that their training is not adequate enough for the care of the seriously ill and injured. Rather they are adequately trained to sustain life until EMS arrives. There is little to no discussion of what to observe for, treatment of medical related problems. How much discussion is made on sepsis, long term illnesses, holistic care, even MRSA? Yet, we expect these providers to be an "expert" to be able to recognize, treat, and deal with these illnesses on a everyday account. It is not fair for the patient, and definitely not for the EMT. As you read many posts, most are *not* fully prepared for the job market, and most do NOT promote upwards in the profession.  

So this is why, I do wonder why most EMT's assume that they are prepared? Even as one that has more experience in various areas, than many have been alive, having multiple degrees and board certifications, I still realize my weaknesses. Enough to continue onward in my education and yes, even gain more experience. Yes, I realize that even the Paramedic curriculum is dire need for revision as well. 

So, when I read or hear of someone just completing the initial phase of EMS, just barely over First-Aid, I must say I find it complexional that one would assume they have enough knowledge and skills to qualify for more than a first response unit. As well, why in the world we as a profession would not be promoting nothing less than what is best for our patients? Kinda makes us hypocritical saying we want what is the best, unless it affects us personally. Then we will invent and circumvent to make short cuts to obtain pseudo self certifications to do the "skills" without the knowledge and philosophy that is needed. 

Back to the point, yes patients need the highest care possible. Yes, that is the Paramedic level. One should not have to await for ALS if it is where it can be delivered. I have worked systems that had ALS rendezvous, ALS tiered response, all needless increased in costs (2 units instead of one, three to four employees instead of two), delay of detailed evaluation and care. 

I believe the role of the Paramedic Practitioner will be expanded more into diverse health care, than just focusing upon life threatening emergency treatment. Truly Para-medical care. Focused on making triage decisions upon whom needs stretcher transport, and ones that can be treated at home. Again, the emphasis soon not everyone will be able to receive emergency care in the major emergency departments in a timely manner. At this time it is expected to have to wait the minimum 128 minutes to be evaluated in a emergency department in the U.S. What do expect this will be.. let's say in five years?   

Can we (EMS) provide some general urgent care? I believe with some more in-depth education (not training) and formal board certifications/license we could accomplish a needed avenue. These practitioners will not be focused upon strictly stabilizing for transport, rather triaging life threatening events from non-life threatening illnesses. Perform detailed assessments in the home/field setting and having the knowledge and ability to treat injuries, illnesses until they can be seen by either a PCP or minor emergency care center. For example, lacerations that can be either closed by simple closures (Dermabond, staples, steri-strips), placing a true orthopedic splint on a nonangulated potential fracture until further evaluation, etc. If there is a true emergency they will have the knowledge and experience to handle accordingly, so there is no delay in care. 

Again, discussing with insurance payers, many feel that they are paying for expensive taxi rides. I have to admit, it is hard to justify thousand dollar ambulance ride with two basic EMT's and the only care was a set of vital signs and oxygen administration. Some states are now developing medicaid Med-Rides, vans staffed with with two EMT's for non-emergency transports (long term illness, non-emergency situations-clinic appointments, etc). Refusing to pay for EMS services when not needed. Understandably; this is needed to reduce costs but as well will decline non-EMS transports thus reducing income for many EMS systems too. Again, most EMS depend upon other avenues than emergencies for revenue... remembering those that get stabbed and shot, usually do not have BC/BS. 
So, I see the practitioner fulfilling multiple roles. Preventing needless transfers to a crowded ER. Reducing costs to patients and payers. Improvement of care to the patient. An alternate avenue for EMS providers, and a career ladder for those in EMS. 

Yes, it will be a long hard road. Nothing good and lasting has ever been achieved easily, something that most in EMS does not comprehend.

R/r911


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## firecoins (May 7, 2008)

Ridryder911 said:


> I have a passion for this because I am on a State Task Force to develop curriculum and standards, legislation for the Critical Care Paramedic and Advanced Paramedic/Practitioner.
> 
> I think there is confusion between the difference of a Paramedic and Paramedic Practitioner.
> 
> R/r911



Okay, I am game.  Define Paramedic Practioner and contrast that with Paramedic.  

Could a Physician Assistant with a Bachelors or Masters fill this role? Or would the Paramedic practioner be a separate role?


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## Guardian (May 7, 2008)

This is a fascinating thread.  It’s hard to imagine these changes considering we have a hard time fulfilling our responsibilities now.  Nevertheless, it’s good to see people are thinking about what are business will look like 20 years from now.  I just wish there was more incentive for me to stay in ems now.  The quicker these changes get implemented, the better.

Oh, and I think using the aging baby boomer crisis to our advantage is about as cutting edge as it gets.  There needs to be changes so that the system can handle the influx.  We might as well be apart of those changes.


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## Ridryder911 (May 7, 2008)

firecoins said:


> Okay, I am game.  Define Paramedic Practioner and contrast that with Paramedic.
> 
> Could a Physician Assistant with a Bachelors or Masters fill this role? Or would the Paramedic practioner be a separate role?



As one that has entered both the P.A. and NP route, I can truthfully describe that they could work in the field, with additional education (Paramedic education) but doubt they will. Yes, some will venture into a "house call" arena but truthfully without lab, radiology most are not effective in the diagnosing skills without the luxury. As well, the main point is the financial setting. I know of NO P.A.'s or NP's that are not making at the least a 6 figure salary, to even start out. They are in high demand around in my area, and most prefer NOT to work in emergency departments being stuck in fast track or minor emergency departments, and when a complicated or serious case does arrive they have to immediately turn it over to the physician. 

Many years ago, my college attempted to have a P.A. to Paramedic and vice versa but was not successful. Again, most were focused for in hospital care and found they really had no desire to work in a prehospital environment. Again, one needs to be reminded many P.A. attaches themselves (in which they have to be associated with a physician) to surgeons (orthopedic, cardiovascular, etc) to perform pre-physicals, follow up care, write new orders, and many go non-critical for example dermatology, etc. Where as the nurse practitioner in some states operate under their own license and not required to be associated with a physician, most do for admission privileges, etc.. No joking as described, NP's will have to be Doctors by the year 2012, requiring a Doctoral level for license, so yes it will be Dr. Nurse. Like vent described the billing and reimbursement is similar to a physician. The point, I doubt that EMS will be able to compete in salaries. Yes, I feel that the salaries will be much more than field personnel but not in the lower to middle six figure income range in comparison to PA's and NP's. 

I do believe that the Paramedic Practitioner will be specialized. Where other medical professions teach basic medicine *then* specialize, we will need to teach the basics (bio-chem, micro, general medicine). Yes, alike many other roles or therapist they will have to start out as a minimum undergrad level and finally may move up to a grad level. I do believe they too will have a broad focus of care, similar to nursing role but where nursing lacks to teach emergency care, they will have the expertise. Also, I believe we will start seeing specialty Advanced Paramedics. Alike our counterparts of nursing, why not have someone that is specialized, such as in neonates, or truly critical care? Would it not make sense to have Paramedics that work upon these type of patients, have intense training and education, required work experience, then be formally tested and accredited? This would not be in comparison of the multiple levels of EMT, because they are already at a proficient higher level but are focusing upon one area. 

This has many advantages. To keep EMS going, we MUST continue to have a career ladder. These rungs will allow those that have a desire to move upward in education, pay, and actually have long term goals within the system, all in the while providing an essential service. If we do not start creating such positions, we will see an influx of patients that will not be managed, EMS systems that will be financially ruined or out of service, very few that will ever even consider entering EMS as a profession. Why enter and stay in EMS if Paramedic is the most one can be and never to be able to move upward? 

I know enrollment in my area has decreased remarkably even though the pay has drastically increased. The reasons most give is EMS is too short of career.. no life after Paramedic. In which is true..either management or education, where the vacancies are limited or pay is poor.. Or to leave and go into another medical profession, then why not just start out and do that in the beginning? Where many have found out they only saved a semester being a Paramedic and have spent additional years, and costs. Fire Service has a lot to offer, but alike many promote past the Paramedic position and then leave that position. 

Again, this will not be an easy route. There will be many obstacles and it will not be for every system. I do believe that it will be adventitious for many systems, rural and metro alike. As one that was totally against it in the beginning, I have seen the possibility and potential of such a program. 

EMS is in crisis mode folks, either we start developing programs to supplement our profession or watch it die. We can offer a answer to many of the problems in health care, primary to the increasing aging. If we do not do it, someone else will do it for us. 

R/r 911


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## VentMedic (May 7, 2008)

> This has many advantages. To keep EMS going, we MUST continue to have a career ladder. These rungs will allow those that have a desire to move upward in education, pay, and actually have long term goals within the system, all in the while providing an essential service. If we do not start creating such positions, we will see an influx of patients that will not be managed, EMS systems that will be financially ruined or out of service, very few that will ever even consider entering EMS as a profession. Why enter and stay in EMS if Paramedic is the most one can be and never to be able to move upward?



I must respectfully disagree with you on some points here.

The Paramedic Practitioner is being viewed as successful in some countries but their educational base was already 2 -4 years in length as a Paramedic.  The additional training for Paramedic Practitioner was not a far stretch.

Just as many of the educational requirements and access to higher education  that have detoured people from getting even a two year degree with even the basic sciences to improve their knowledge as a paramedic or support the EMS quest for educational standards, this also could prevent some from entering the field.    There are parts of the country that can not keep even BLS services going or provide any type of ALS.   Often in some regions, besides the tax base, Paramedic programs at even the minimum amount of training are not available.   You are now proposing a college level program that may only be offered at 1 or 2 universities in each state.   How practical is that for an older Paramedic to attend?   If they entered the program at the beginning, they will essentially be doing what many PAs are with an Emergency Medicine specialty. And, these new Paramedic Practitioners may also be entering without any field previous field working experience.   So the argument is the same both ways without an advantage of one over the other except one is here and established to provide immediate benefits to healthcare at the advanced level. 



> Many years ago, my college attempted to have a P.A. to Paramedic and vice versa but was not successful.



Seriously!  Why would PAs want to go into a profession that is associated with "hours" of training when their programs have their own specialty tracks for EM?   And, what were the prerequisites for the PA program that may have side tracked the Paramedic?   It is just shear arrogance to think that those that do not have  the "title of Paramedic" can not perform the same emergency medical skills. Heavy rescue skills are different but not unobtainable either just because you don't have the title of Paramedic.  They already have a higher educational background. All they need is  extra "training" in that focus area. They also don't need to attend a "paramedic school" to get advanced skills.  I think other professionals have already demonstrated this in HEMS and other out of hospital transport situations. Our CCT RNs did not go to paramedic school to learn intubation, chest decompression or perfect their ACLS skills.  Our specialty team members did not go to paramedic school in order to be able to fly critical babies and children long distances from other countries.   PAs and NPs that have gone to work for organizations in 3rd world countries have also proven their adaptability. 



> The point, I doubt that EMS will be able to compete in salaries. Yes, I feel that the salaries will be much more than field personnel but not in the lower to middle six figure income range in comparison to PA's and NP's.



Both the PA and NP programs have long ago seen this coming and have started tailoring and promoting their programs to better serve in emergency medicine and clinics more on the front line.   These programs are already established with solid educational backgrounds that puts them in a good stance for many directions.  The "title" paramedic may not make a person better suited for a job if the training is the same.   If a Paramedic Practitioner has similar education and is doing similar work as the PA or NP, do you not think there will be the some grumbling and dissatisfaction about wages?   Again, why should someone who wants to keep the title of "Paramedic" settle for less because of the area they work?   PAs are already going into EMS direction but establishing their wage base and job description as they go.  



> Alike our counterparts of nursing, why not have someone that is specialized, such as in neonates, or truly critical care? Would it not make sense to have Paramedics that work upon these type of patients, have intense training and education, required work experience, then be formally tested and accredited?





> I do believe they too will have a broad focus of care, similar to nursing role but where nursing lacks to teach emergency care, they will have the expertise.



No it would not make much sense because care in those areas have a different focus for long term management and not the short term treatment training of even an advanced Paramedic Practitioner.  Also, if you are working in that area, Nurses and other providers are trained for emergencies in that area.  A Paramedic is not required to save the day.   Again, NPs and PAs are already established in those areas because they have chosen that specialty. And these are truly specialized areas.  Neonatal NPs usually have many years as a Neonatal RN before advancing.  I would not feel comfortable with someone taking care of babies in my family who might need an NICU who was a jack of all but master of nothing.    There is also a good supply of RNs wanting these positions who do have the educational background that is geared to in hospital care.  Specialty units usually don't have a large turnover of employees either. 

Rid, your proposals are again putting the Paramedic into roles that are already established by other professionals.  Why keep reinventing the wheel and getting into the hospital setting?  I thought the Paramedic was to be specialized outside of the hospital or in the ED?  Why is it so important that you discourage people from going with the many opportunities with different titles that are available and advancing just to hang on to the title of Paramedic?   Why not keep the focus toward pre-admission to the hospital?   Too much fragmentation may just create the same problems we have now.   

At least for the next decade, I am more in favor of supporting the programs that are already in existence that can be immediately beneficial to the health care system.   Funding is already being put into the NP and PA programs to put out physician extenders with adequate training to alleviate some problems.  By attempting to establish ANOTHER profession that will be duplicating services only distracts from the situation at hand.  Essentially this is just coming down to a title issue with keeping "paramedic" to be different but the same as other established professions.  Does this argument sound similar to the Paramedic wanting to work in the hospital setting doing the job functions of degreed professionals but still wanting to be called "Paramedic"?     You yourself have stated in other threads, "if you want to be a nurse, go to nursing school".    



> The reasons most give is EMS is too short of career.. no life after Paramedic.


There is definitely life after "Paramedic" but one also has to start working on the prerequisites to that life while still a paramedic.  With the experience one has achieved, it can be transferred with the help of education to many fields. Of course, the "title" Paramedic might not be there but that is expected when advancing one's education.  And yes, education is still a good avenue if you have the higher education.  For a two year EMS degree program to be viable, it needs instructors with at least 1 - 2 levels of higher education.  The pay is decent at that level.  Granted, maybe Oklahoma's educational system is low paying but from your universities' websites, the pay doesn't look that shabby either.  

I am also in favor of not forgetting the Paramedic as it is now to provide standardization and access to better accredited programs.  Florida, as other states, has over 50% medic mills which are not accredited and some may not become accredited.  The community college systems are geared for offering accredited certificate programs as well as degrees.   If EMS is to survive at the street level, they must also get some to believe that with a degree, pay and opportunities will increase as it has for other professions with recognition at the state and Federal levels.    This goal is obtainable but also in the distant future.


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## firecoins (May 7, 2008)

Ridryder911 said:


> Many years ago, my college attempted to have a P.A. to Paramedic and vice versa but was not successful. Again, most were focused for in hospital care and found they really had no desire to work in a prehospital environment. R/r 911



Most PAs with a desire for EM already have an EMS backround.  In fact, previous medical experience has either been required or increase your competitvness 10 fold depending on the program you apply to.  

Washington D.C. has hired PAs to help reduce transfer of care issues between buses and ERs.  Other places are experimenting with PAs in prehospital environments to help reduce transports to the ER. 

As far as salary goes, this profession will probably only exist in urban 911 settings.


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## VentMedic (May 7, 2008)

firecoins said:


> Most PAs with a desire for EM already have an EMS backround.  In fact, previous medical experience has either been required or increase your competitvness 10 fold depending on the program you apply to.



Exactly, however, PAs have diverse medical backgrounds which allows for them to specialize in the track they desire.  The same with NPs who can come from various nursing experiences to go with the track they feel they are most suited for.   Again, the entry level educational requirements have derailed many Paramedics from approaching the PA field.  

The PA is not exactly a stranger to the EM field.   They may not ride ambulances but rarely are their advanced skills or knowledge needed where a field paramedic is more than capable of handling the patient on scene.  I think Paramedics also used this argument when Doctors were used on ambulances in several EMS agencies.   Hence, the PAs never pushed further into that direction.   




firecoins said:


> As far as salary goes, this profession will probably only exist in urban 911 settings.



PAs and NPs have been extremely popular in rural EDs and clinics for many years. Rural America is not always an attractive area to recruit qualified physicians. Many small hospitals would not have been able to survive the influx of patients if more clinics had not been established and if physician extenders had not be utilized to enable the physician to handle a growing work load even in rural America.   Physician Extenders (PAs, NPs) have also been able to put together outreach programs for clinic services with grants for migrant farm camps in some areas.   They have their own political machines in place to gain support.  EMS has failed in this area by being too divided toward any cause.    EMS has spent more time worrying about "titles" and what people will call them than how to better educate themselves to better serve the public.   

The availability of the proposed Paramedic Practitioner program would benefit primarily those in the vicinity of major colleges.    That has also limited the number of NPs and PAs although their numbers are gradually increasing by decades of proven worth and maintaining a steady course in improving their educational requirements. 

The next issue would getting licensure with approved statutes to pass at the state level. Many states are still in the process of defining EMT and Paramedic.  Are the state agencies capable of handling a more advanced practitioner without coming under scrutiny as with the incidents with the California State EMSA and its irregularities in oversight.    At a time when some agenies are lobbying for improved statutes and educational standards for the "regular" paramedic, would introducing another professional title into the mix distract from the issues that in the present in the EMS profession.   We still have a long way to go from 700 hours to a 4 year degree that may or may not be accessible to everyone in a given region or in some states.   

Not every healthcare profession is well paying, yet those that pursue a career will do what they must if that is their dream. PT was not always well paying but they continued to increase their educational requirements toward a doctorate.  Today they are in demand with a decent wage.   If anyone remembers the salaries of RNs 10 years ago or even in some places today, know it has not always been a well paying profession.   Even in parts of Florida, some RNs still make less than $40K per year while the cost of living is more towards $80k.  If you are a member of a FD or county EMS agency in those areas, you probably are making more than the RNs.   Higher education and wages do not always go together but education helps to make a statement about professionalism.


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## rmellish (May 8, 2008)

firecoins said:


> Most PAs with a desire for EM already have an EMS backround.  In fact, previous medical experience has either been required or increase your competitvness 10 fold depending on the program you apply to.



Well, from what I've witnessed at one school as a pre-PA student, most pre-PAs have absolutely no medical experience prior to entering college, then get their EMT-B cert to help them gain admission to the professional (master's) phase. 

Of 12 possible experience points:
EMT-P / RN is worth 10 
EMT-B / LPN is worth 8
Lifeguard is worth 6
Candystriping is worth 2

contrast this with the GPA points awarded, where your GPA is multiplied by 10 (max being 40)

Experience does not play as large a factor as you suggest at my PA program. 

Also, although many applicants to the PA program get their EMT-B, very few ever ride an ambulance after their clinical hours are completed and they get the letter from the state.

I certainly cant speak for all the PA programs out there though.


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## firecoins (May 8, 2008)

rmellish said:


> most pre-PAs have absolutely no medical experience prior to entering college


college doesn't require medical experience.  I went to college w/o experience.  




> Experience does not play as large a factor as you suggest at my PA program.


This is an unfortunate trend in the PA world.  From a profession designed to assimilate military medics/corpsman into the civilian medical world to just another degree program.  But times change.


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## rmellish (May 9, 2008)

firecoins said:


> college doesn't require medical experience.  I went to college w/o experience.



I'm not implying that it does, I just thought I would put my .02 in as far as what I'm seeing at one PA program.


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