# Paramedic Practitioner? Masters degree and future of EMS



## MedicSansBrains (Sep 11, 2015)

We've all heard of nurse practitioners. We probably don't know exactly what their scope is or depth of their training but we do know that they are a vital part, along with PA's, to amplifying access to healthcare in the US. 

We also have heard or even participated in Community Paramedic programs. They help us reduce the incidents of frequent flyers and increase the access to healthcare of undeserved and immobile patients. 

So when do we take the next step and create a Master of Science in Paramedicine? Where paramedics can pursue a graduate degree and be licensed to treat more autonomously and with a larger scope in the field? 

I'd like to discuss how this or something like this will/should happen and what steps are being taken now. Education is the key to advancing our field, gaining more respect, more pay, and more of a career ladder. 

It would be great to have a place to go other than nursing or med school to advance our medicine and unique skill sets and applications.


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## Tigger (Sep 11, 2015)

While I think this is eventually a worthy goal, I think we should first concentrate on increasing the baseline education for paramedics. It is nothing short of amazing that EMS providers are afforded any sort of respect within the medical community given that many (most?) paramedics do not even a possess a two year degree in their field of study. How can we say we need masters level practitioners providing autonomous care when we struggle with the degree of autonomy that we already hold? 

It is important to not get a head of ourselves. While I would like nothing more than to eventually be able to be in some sort of graduate EMS program (masters or not), I would rather see the majority of paramedics (who serve the very vast majority of our patients) have an education that allows them to become a true part of the healthcare team.


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## MedicSansBrains (Sep 11, 2015)

Agreed agreed. Are there stats on how many practicing medics are without a degree?


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## MedicSansBrains (Sep 11, 2015)

According to LEADS II ( https://www.nremt.org/nremt/downloads/LEADSFactSheetYear2.pdf ) 60% of paramedics have received an associates degree or higher. That's an increase of 9% over last year. It's getting there. *LEADS II is sample of 1,200 medics I believe. Not as many as I'd like.

What about requiring an AAS to receive your NREMT - Paramedic? A transition over 5 years?

While I understand that many people still work as volunteers, 20% according to NREMT, but that doesn't have to hold back us setting standards for National certification.

If you want to be a volunteer paramedic you can achieve your AAS within the 5 year transition period or you can practice and be certified as an AEMT. Please no one get offended. Not saying volunteers aren't necessary or respectable. I'm sure volunteers would like the profession to advance as well.

AEMT = "LVN", EMT-P = RN in rough terms. Therefore, EMT-P requires associates. Licensed Paramedic = BSN. Paramedic Practitioner = MSN. Awesomeeeeeeeeeeee

I'd appreciate some constructive thought from my new awesome community on how we would want to progress our profession especially with thought to education and standards. Maybe we can come up with some creative solutions and game plans.


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## Carlos Danger (Sep 11, 2015)

MedicSansBrains said:


> Where paramedics can pursue a graduate degree and be licensed to treat more autonomously and with a larger scope in the field?



This level of care already exists.

It is called Physician Assistant (PA).


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## Tigger (Sep 11, 2015)

I don't think an AAS requirement is far off. Getting rid of non-college affiliated paramedic programs was a big step. If the NR wants to start requiring that to be eligible test, they now have that ability. 

As always though, I am not suggesting that increasing degree requirements will have a direct effect on patient care. There are of course plenty of paramedics who provide great care without any sort of degree and I am not attempting to discount that. However, I still think it is important as it will somewhat increase barrier to entry in this field, will hopefully provide students with learning methods to use while furthering their practice down the road, and perhaps most importantly, will do some good in terms of EMS getting a seat at the healthcare table.


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## Pond Life (Sep 11, 2015)

Remi said:


> This level of care already exists.
> 
> It is called Physician Assistant (PA).



Hi Remi, Do Physician Assistants work under the supervision of doctors or are they completely autonomous?


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## Ewok Jerky (Sep 11, 2015)

Remi said:


> This level of care already exists.
> 
> It is called Physician Assistant (PA).


Literally


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## Ewok Jerky (Sep 11, 2015)

Pond Life said:


> Hi Remi, Do Physician Assistants work under the supervision of doctors or are they completely autonomous?


It depends on the jurisdiction. Where I work as a PA, I carry my own patient load. From new patient, work up, Dx, treatment, follow up, all the way to discharge. If I think I need need a surgeon I refer to either my supervising physician or another in the practice. Often I book the surgery and the only time my patient ever sees the surgeon is in the OR.

My colleague in the ED has the same relationship with the ED physicians.


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## Pond Life (Sep 11, 2015)

Cheers Ewok. Yup, in that case it sounds exactly like the UK practitioners that we have in some areas. We tend to have different scope of practice depending on where we work geographically and where we work within the health care pathway. The PPs and Cps have usually had a more limited scope of practices than ECPs but I think now its more about the organisation we work for than the name we adopt.
They (NHS) are now changing our names again :-( We have been Practitioner in Emergency Care, Paramedic Practitioners, Community Paramedics and Emergency Care Practitioners. 
Now we are Specialist Paramedics and that is sub divided into either Urgent and Emergency Care or Critical Care.
My mates always said I was 'special', but never in a good way.. ;-)


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## Summit (Sep 11, 2015)

Every time this idea comes up, noone can satisfactorily explain why we have to make up an entirely new degree and level of practice and enact new laws instead of using PAs and NPs.

The problem is with the current system's incentives and thus the motivation to have that role, not a lack of PA/NP or some unicorn midlevel with paramedic in the title.

That said, I totally think that an AS should be the minimum for Paramedics.


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## Chewy20 (Sep 11, 2015)

Hmmm 2.5 years to get your medic,or half the time to get your medic. Yeah I will go for the shorter one until it actually means something to hold a degree in this field. All a two year degree gives you some general core classes. You can say "well it will never happen if people keep taking the certificate route." Thats BS, departments and companies have to start the trend and not hire people until they have a degree. Which will never happen, they like their profits too much.

Until its REQUIRED for us to get a degree (hopefully 4 with pay to show for it), the field will be the joke it already is.

 To the OP. Like others have said, lets try baby steps before we talk about masters programs.


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## Tigger (Sep 11, 2015)

There a lot of ADNs looking for good jobs that probably also said "half the time, sign me up!"

And then the industry changed and they're stuck. I know BSN RNs that work in SNFs that are waiting for decent jobs to open up. Eventually that might well become the case for EMS. 

This came up on the facebooks today: http://www.wral.com/news/local/video/14892531/

DCEMS is a premier service that is competitive to get on with and I expect this trend to continue, though I don't see it happening as quickly as nursing, which has its collective act together.


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## Ewok Jerky (Sep 12, 2015)

The problem with higher education and advanced practitioners is that the more you know, the more you want to be paid. 

My friend in PA school was very gung ho all along about maintaining his P cert and still taking shifts after school. I kept telling him A)you won't have time B)even if you do have time why take a $40/hr paycut to be treated like crap and not have any of the diagnostic/treatment options available. 9 months later he works FT in primary care and hasn't taken a shift on the bus in 6 months.


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## triemal04 (Sep 12, 2015)

I don't like repeating myself...or maybe I do...  Either way I guess it's time to mention this again:



triemal04 said:


> Just as an aside, for those of you talking about "paramedic practitioners," I hope you understand how laughable that is, and how much it shows the lack of awareness about EMS, medicine, and the healthcare system in this country.
> 
> First off, do you actually understand what a PA is?  What a PA can do?  If you do, why bother trying to reinvent the wheel?
> Do you understand how difficult it would be to create a provider at that level that was actually accepted by the healthcare community AND the insurance companies AND the federal gov't (holds the medicare purse strings)?
> ...


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## SandpitMedic (Sep 12, 2015)

Tigger said:


> There a lot of ADNs looking for good jobs that probably also said "half the time, sign me up!"
> 
> And then the industry changed and they're stuck. I know BSN RNs that work in SNFs that are waiting for decent jobs to open up. Eventually that might well become the case for EMS.



This, like Paramedic vacancies, vary greatly depending on where you are located.
Out "West" anyone who can put RN after their name can be making 6 figures or damn close to it, and have sign on bonuses, relocation allowances, etc etc.

Supply... and demand.

I'm headed the PA route, personally... As to, not reinvent the wheel


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## ExpatMedic0 (Sep 12, 2015)

the mid level provider level for paramedics already exist regionally with varying results of success in the UK and Australia. It may or may not happen one day in the U.S. but it will comes down to the demand for it when selling the concept to stakeholders and policy makers along with making it work with the healthcare reimbursement system. Paramedics in the U.S. working in emergency response, critical care transport, and community paramedicine, are all grossly underpaid and inadequately educated for entry level practice. With that being said many paramedics are teetering on the edge of earning their degrees and I agree with you a transition system should exist to make it a minimum national standard at some point.


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## zzyzx (Sep 12, 2015)

I like the OP's enthusiasm for wanting more education and expanding the role of paramedics. As others have said, we should first take baby steps. A good start would be to require all medic schools to require the prerequisites of anatomy, physiology, microbiology, and basic psyche.


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## Tigger (Sep 12, 2015)

SandpitMedic said:


> This, like Paramedic vacancies, vary greatly depending on where you are located.
> Out "West" anyone who can put RN after their name can be making 6 figures or damn close to it, and have sign on bonuses, relocation allowances, etc etc.
> 
> Supply... and demand.
> ...


Not in this part of the "west." Certainly there are regional variations, but things are changing.


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## MedicSansBrains (Sep 12, 2015)

Ok. So everyone agrees a "Paramedic Practitioner" is a stupid idea. 

Also, everyone agrees getting an Associates Degree is a good idea. 

What do y'all think about Bachelors? @ExpatMedic0 I see that you have one of those.


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## Summit (Sep 12, 2015)

Start with associates. Get the nation standardized.Do that first. go from there.


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## DPM (Sep 12, 2015)

The difference in time commitment between an associates degree and a well regarded paramedic program isn't great. Now that all Paramedic programs have to be accredited with higher education institutions, it shouldn't be hard. Add the A&P, physiology, chemistry etc that we really should be getting any and you're golden. 

Personally, I think that higher education is always a good thing. We need degrees, especially for if / when we eventually move on from working in the field. A degree that is useful and relevant to our field shouldn't be too much to ask for. Plus, with advanced education and training we could expand the paramedic scope of practice and be better providers.


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## MedicSansBrains (Sep 12, 2015)

I agree and thought that a scope of practice expansion was the natural evolution of things with Community Paramedicine.

Filling in those gaps in our communities and also reducing wasted resources for a lot of systems and ERs without a good outcome for the patient.

In my mind this means a scope increase and having a team of specialized providers out there following up, Dx, treating, and prescribing in the field all while getting reimbursed.

If you don't think this is the evolution of things please explain. If you do what is the solution? Another cert like CCP or hiring PA's and NP's in systems.


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## MedicSansBrains (Sep 12, 2015)

Summit said:


> Start with associates. Get the nation standardized.Do that first. go from there.


It's a little "no child left behind" isn't it?


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## cprted (Sep 12, 2015)

MedicSansBrains said:


> It's a little "no child left behind" isn't it?


No, not at all. Do you know what the "No Child Left Behind Act" entailed?  Requiring a 2 year diploma from an accredited college for licensure as an EMT-P is really nothing like imposing standardized testing throughout the public education system and tying the availability of federal funds and the use of said funds to the results of those tests.  Not even close to the same thing.


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## MedicSansBrains (Sep 12, 2015)

cprted said:


> No, not at all. Do you know what the "No Child Left Behind Act" entailed?  Requiring a 2 year diploma from an accredited college for licensure as an EMT-P is really nothing like imposing standardized testing throughout the public education system and tying the availability of federal funds and the use of said funds to the results of those tests.  Not even close to the same thing.


Yeah it is if you aren't so concerned with demonstrating your understanding of a failed educational policy. Sounds like an understanding of someone who was victimized by said policy. 

Rather than focusing so much on the laggards and being so concerned with bringing them up to a minimum standard maybe we should also have a large focus on advancing the leaders and keeping forward progress. You can do both.


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## cprted (Sep 13, 2015)

MedicSansBrains said:


> Yeah it is if you aren't so concerned with demonstrating your understanding of a failed educational policy. Sounds like an understanding of someone who was victimized by said policy.
> 
> Rather than focusing so much on the laggards and being so concerned with bringing them up to a minimum standard maybe we should also have a large focus on advancing the leaders and keeping forward progress. You can do both.


Stunning.

A) I'm Canadian, so no, I wasn't victimized by the American public education system.
B) I have a bachelor's degree already and my second degree is 2/3 complete.

Make sure it's loaded before you go shooting it off.


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## MedicSansBrains (Sep 13, 2015)

Oh great a Canadian commenting on the effects of American educational policy. So much better.

I'm from Texas. I'm very aware whether or not it's loaded and how to shoot it.

Thanks for contributing to the conversation in such a profound way of how to further American paramedicine.


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## Jim37F (Sep 13, 2015)

Well that escalated quickly....


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## cprted (Sep 13, 2015)

I didn't realize the coat of arms on my passport was also a functional block in my brain, preventing me from having any knowledge of things outside the borders of my own country ... the things you learn on the internet ...


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## Summit (Sep 13, 2015)

MedicSansBrains is living up to his screenname again... my suggestion was borne of the successful incremental strategy of nursing.
cprted is worth listening to. I'd be happy to take advice from Canada on what we should do with EMS because their system is one we could emulate.


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## zzyzx (Sep 13, 2015)

: 18895"]Well that escalated quickly....[/QUOTE]

Yeah, and how can we ever be seen as professionals when we act like this?


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## DPM (Sep 13, 2015)

Summit said:


> ...cprted is worth listening to. I'd be happy to take advice from Canada on what we should do with EMS because their system is one we could emulate.



I believe the UK is moving towards a Bachelors for all paramedics, with a system in place allowing current non-degree medics to turn their current credentials into a degree. Australia offers a diploma (like an associates degree) and a bachelors, as does New Zealand and Canada. Why are we determined to accept only the bare minimum of education?

I'll get a lot of heat for this, but I've always wondered if the strongest opponents are so anti education because they're worried that they wouldn't be able to make the new standard. We can't dream of RSI and better wages if we're only willing to commit to 9 months of night school.


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## MedicSansBrains (Sep 13, 2015)

@Summit I know where your suggestions were borne. Don't agree with it because it and sounds like you don't either based on your evidence. Masters and Doctoral programs existed way before ADN was a mandatory standard. It was actually all over the place. My great grandmother had her masters in nursing in the 50's.

@cprted still haven't contributed anything to the furthering of Paramedicine as a profession. Just wah wah about you being picked on.


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## MedicSansBrains (Sep 13, 2015)

DPM said:


> I believe the UK is moving towards a Bachelors for all paramedics, with a system in place allowing current non-degree medics to turn their current credentials into a degree. Australia offers a diploma (like an associates degree) and a bachelors, as does New Zealand and Canada. Why are we determined to accept only the bare minimum of education?
> 
> I'll get a lot of heat for this, but I've always wondered if the strongest opponents are so anti education because they're worried that they wouldn't be able to make the new standard. We can't dream of RSI and better wages if we're only willing to commit to 9 months of night school.


thanks for contributing an opinion on subject


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## SandpitMedic (Sep 13, 2015)

Well in Northern Ca and Nevada these RNs are making bank. (And there is a huge shortage of staff).

My reply is to @Tigger
Yeah it is variable though, even in the West.

(This thread got red hot real quick).


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## ExpatMedic0 (Sep 13, 2015)

MedicSansBrains said:


> Ok. So everyone agrees a "Paramedic Practitioner" is a stupid idea.
> 
> Also, everyone agrees getting an Associates Degree is a good idea.
> 
> What do y'all think about Bachelors? @ExpatMedic0 I see that you have one of those.


I think its a good idea for some, it depends on what your career and education goals are. I actually submitted a manuscript to JEMS which has been going through a review and editorial process for months now about this very topic. I am not sure if they will decide to publish it or not but I hope they do and I'll keep you up to date if they do. A couple points I made was regarding learning lessons from other allied health professions. One that I mentioned was certified athletic trainers who made bachelor's degree the minimum national standard for entry level practice. The other I touched on was respiratory therapist having an associate's degree as a minimum. The reality is, with the newer NREMT accreditation standards, most paramedics either get an AAS or are teetering on the edge of earning one and can complete an associate's degree in about 2 semesters, even completely online while working. The question many will ask is why?
If extrinsic motivation is the primary factor for the paramedic, convincing them to complete a degree may be unnecessary and a lackluster concept at best. However, in my opinion (speaking strictly andecotatly of course), I think we are seeing a large number of newer paramedics who are motivated at least in part, by Intrinsic motivational factors. That is what will make the degree a reality one day and that is what will push this vocational trade to a true profession in the United States in the future.
In terms of midlevel providers with masters degrees, I don't think its a bad idea and it could happen one day in the U.S. but not until we expand the traditional paramedic education and role of a paramedic a bit further. We also  need to acquire more EMS providers with higher education in research and policy making activities. I think the majority of paramedics getting masters degrees in the majority of countries are getting them as non-clinical degrees, like the one I am working on, or a better example would be an MPH


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## Carlos Danger (Sep 13, 2015)

MedicSansBrains said:


> Oh great a Canadian commenting on the effects of American educational policy. So much better.
> 
> I'm from Texas. I'm very aware whether or not it's loaded and how to shoot it.
> 
> Thanks for contributing to the conversation in such a profound way of how to further American paramedicine. Troll somewhere else tool.



You are quite misdirected here, sir.

First, cprted has been posting and contributing here since well before you came along. He is well educated and always contributes positively. If you choose to dismiss his input just because he's Canadian, it will be your loss.

Second, you should probably recognize that the EMS system found in parts of Canada is considered a model by many who want to see educational standards for American paramedics dramatically increased. So again, dismissing someone who is _from_ that system and is willing to give input here is probably not smart.

Thirdly, the point that cprted and Summit are making - that you inexplicably seem to take offense to - is actually very reasonable. The harsh (and rather obvious) reality is that we simply are *not* going to move directly from a system that doesn't even require an associate's degree for entry and where we can't bill for medical services, to one that requires a master's level education and professional licensure and allows us to write scripts and do dispositions on scene. Too little standardization still exists, too little professional infrastructure, and too much institutional resistance to significant increases in educational requirements. We have a lot of ducks to get lined up before we can even think about this in a serious way, and starting to improve standardization by getting everyone to the AS level is a really good place to start. So, if you just want to have theoretical discussions on how cool it would be to have a PA/NP - level "paramedic practitioner", fine - mentally masturbate about that all day long. But if you really want to see big changes, then I suggest you instead have a conversation about _realistic_ things that we can support and promote now, that will at least move the profession in the general direction of being able to produce practitioners.

Lastly, don't get offended so easily. Someone disagreeing with you is not "attacking" you.


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## triemal04 (Sep 13, 2015)

zzyzx said:


> Yeah, and how can we ever be seen as professionals when we act like this?


Yes, yes, and yes some more. 

Someone else made the comment that maybe one of the reasons that some people are against increasing the educational requirements is because they know they wouldn't be able to hack it.  I'd say this thread, as always with this topic, is a prime example of that, as well as the other big reasons:  people are lazy, only want to be the "cool guys" and don't understand the American medical system.

Honestly, it's times like this that I am very glad that there is NOT a real nationally standardized paramedic level and practice; I don't want to have to step backwards to fit in.


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## johnrsemt (Sep 13, 2015)

Biggest problem is cost:  No service that I know about pays extra if a paramedic has a degree.
When I went through Paramedic school in 2003-2004 it was about $6,000 (that my FD that I was PT at paid for)  same class with an A.S. Degree (students attended same classes I did for the paramedic part) was $11,000.   If we don't get an award at the end it is hard to push for everyone to pay more for it.

In Canada, and Australia and NZ ( I have heard this anyway, no personal experience) they have different levels of EMS, and have degree requirements for the different levels, but they get paid alot more for each level/degree;  that way it is worth taking the extra classes.

I am working on my general Ed to get my AS degree, but just as something to do cause I am bored on my 5 days off each week.  Not because it is a requirement or that I am learning anything extra that will help me be a better paramedic.  Knowing all of the bones in the body doesn't help me out any:  I can't go to the ED with a patient and tell the doctor which bone in their hand or foot they  broke without a x-ray.


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## zzyzx (Sep 13, 2015)

"I am working on my general Ed to get my AS degree, but just as something to do cause I am bored on my 5 days off each week. Not because it is a requirement or that I am learning anything extra that will help me be a better paramedic. Knowing all of the bones in the body doesn't help me out any: I can't go to the ED with a patient and tell the doctor which bone in their hand or foot they broke without a x-ray."

I think in the future you will be surprised to find that all this knowledge that you are now learning, and that you at first didn't think was useful, will pay off by making you more knowledgeable about the larger world of medicine, and you will thereby be a smarter, better paramedic, a real professional. 

In paramedic school they teach you the basics, which means you learn one thing and that thing is something that you can directly use day to day. To get beyond just knowing the basics, you have to learn a lot more things that  initially may not seem all that important. However, once you piece together all these bits of knowledge and you have a better understanding of medicine, you will know things that will make you better at what you do every day. Think of basic paramedic schooling as a very direct way of learning, but to go way beyond that you need to learn things in a more indirect way.


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## DPM (Sep 13, 2015)

If McDonalds workers can get higher wages, EMS providers with higher education can do the same. Just because they WANT to pay is peanuts, doesn't mean they HAVE to. 

As far as cost goes, making an AS in Paramedicine could well be cheaper than the current module. 60 units x $50 is only $3,000. The units would have to be over $100 each to come close to the amount I paid, and over $300 each for a different school in my area. 

Private post secondary higher education, aka Medic Mills, do not help our profession. This would be an easy transition with great benefit.


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## SandpitMedic (Sep 13, 2015)

Look, where you went to school is not the issue. I do concur that the minimum standard should be an associates degree.
However:
The only limitations you have are the ones you place on yourself. 
You have to be willing to go beyond your bubble and seek out opportunities that others will not.
It all comes down to personal motivation and ambition.


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## Tigger (Sep 13, 2015)

I don't know why there is so much hostility in this tread, but it will not be tolerated moving forward.

Competitive services are starting to want degrees. Some (two sadly) states require it. There are in fact agencies that pay extra for a degree (one of my tiny part time employers does, and we are not alone). Slowly but surely, it will behoove paramedics to at least have an associates degree. And those that have degrees first will be the ones that work for the respected agencies and get the leadership promotions. It may not have been that way in the past, but that is hardly a reason to not seek more education. It's an investment in yourself.


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## EMTinCT (Sep 13, 2015)

Grandma went to a Nurses Practitioner who nearly killed her. I just wasn't impressed with the Np as she seemed uncertain and unskilled. The Np wrote a prescription for twice the lethal dose of a muscle relaxant. The pharmacist refused to fill it and called the Np to explain.

A few months later we went to the ER where grandma was seen by a smart guy in a white coat. He was cool, calm, and collected. He knew his stuff. We kept calling him doctor but it turns out he's a PA. A what? A PA, I told grandma. Grandma still calls him doctor but it turns out he really is a PA but he just knows his stuff super well. 

I'd be happy for him to come to our house and take care of her. If the Np showed up I'd call the cops.


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## Tigger (Sep 13, 2015)

EMTinCT said:


> Grandma went to a Nurses Practitioner who nearly killed her. I just wasn't impressed with the Np as she seemed uncertain and unskilled. The Np wrote a prescription for twice the lethal dose of a muscle relaxant. The pharmacist refused to fill it and called the Np to explain.
> 
> A few months later we went to the ER where grandma was seen by a smart guy in a white coat. He was cool, calm, and collected. He knew his stuff. We kept calling him doctor but it turns out he's a PA. A what? A PA, I told grandma. Grandma still calls him doctor but it turns out he really is a PA but he just knows his stuff super well.
> 
> I'd be happy for him to come to our house and take care of her. If the Np showed up I'd call the cops.


I would hardly say that this indicative of the quality care of provided by NPs. There are bad providers of all levels.


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## Carlos Danger (Sep 13, 2015)

EMTinCT said:


> Grandma went to a Nurses Practitioner who nearly killed her. I just wasn't impressed with the Np as she seemed uncertain and unskilled. The Np wrote a prescription for twice the lethal dose of a muscle relaxant. The pharmacist refused to fill it and called the Np to explain.
> 
> A few months later we went to the ER where grandma was seen by a smart guy in a white coat. He was cool, calm, and collected. He knew his stuff. We kept calling him doctor but it turns out he's a PA. A what? A PA, I told grandma. Grandma still calls him doctor but it turns out he really is a PA but he just knows his stuff super well.
> 
> I'd be happy for him to come to our house and take care of her. If the Np showed up I'd call the cops.



This is one of the dumbest things I've ever read on this forum.

I've met plenty of stupid paramedics. Does that mean all paramedics are stupid? Of course not.

2x the lethal dose? I call BS on that, anyway.


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## EpiEMS (Sep 13, 2015)

Summit said:


> Start with associates. Get the nation standardized.Do that first. go from there.



This, a thousand times, this. Standardizing a baseline is totally the way to go.



johnrsemt said:


> Biggest problem is cost:  No service that I know about pays extra if a paramedic has a degree.
> When I went through Paramedic school in 2003-2004 it was about $6,000 (that my FD that I was PT at paid for)  same class with an A.S. Degree (students attended same classes I did for the paramedic part) was $11,000.   If we don't get an award at the end it is hard to push for everyone to pay more for it.



I would say that the cost issue is more that they see no incremental value-add provided by a degree. It's not like having a degree expands your scope (or their ability to bill). On the other hand, for example, an ER having a PA or NP allows them to bill more, while a paramedic is a paramedic as far as billing is concerned, no?


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## DPM (Sep 14, 2015)

@SandpitMedic - first off, congratulations are due. You've made the most of things, and clearly put in the work and soon you'll reap the rewards. 

But do you think that a well educated paramedic should be the standard, or the exception? 

I'm also pursuing higher education, as I'm sure many on this thread are, but as long as the industry standard is night school and the bare minimum of CE's then we're doing ourselves a disservice.


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## Akulahawk (Sep 14, 2015)

johnrsemt said:


> I am working on my general Ed to get my AS degree, but just as something to do cause I am bored on my 5 days off each week. Not because it is a requirement or that I am learning anything extra that will help me be a better paramedic. *Knowing all of the bones in the body doesn't help me out any*: I can't go to the ED with a patient and tell the doctor which bone in their hand or foot they broke without a x-ray.


Anatomy in and of itself doesn't unless you actually follow through with the physiology part of the course and actually start understanding how the systems interact with each other. Then if/when you take biomechanics, things really start to gel... and you start gaining a much deeper understanding about why we do certain things and also, when NOT to do certain things. 


zzyzx said:


> In paramedic school they teach you the basics, which means you learn one thing and that thing is something that you can directly use day to day. To get beyond just knowing the basics, you have to learn a lot more things that initially may not seem all that important. However, once you piece together all these bits of knowledge and you have a better understanding of medicine, you will know things that will make you better at what you do every day.


I'll expand upon this a little bit more, I think. I was an athletic trainer long before I became a Paramedic. I use the basic knowledge from that initial background (and it made _both_ nursing school and paramedic school easier) several times a day now and back when I actively worked in the field a few years ago. There are things that I do and know that I consider as "basics" and that stuff goes beyond the basics of either nursing or paramedicine. That stuff allows me to develop a line of questioning that helps me figure out what's going on with the patient very quickly. On more than one occasion, that has led the provider to change their priority of who to look at next and what to look for/order even before they see the patient.

Also, simply knowing what's normal across the body systems can also fine-tune your "sick, not-sick, oh-crap" assessment skills...


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## ExpatMedic0 (Sep 14, 2015)

Akulahawk said:


> I'll expand upon this a little bit more, I think. I was an athletic trainer long before I became a Paramedic.


I think Athletic Trainers are one of the best educated allied health professions. I don't know about your area, but from my experience  no one seems to know anything about them, they are a mysterious provider lurking in the shadows of healthcare. I had one for a partner when I was a medic for a women's roller derby and I learned a lot from the guy.


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## jwk (Sep 14, 2015)

Tigger said:


> I would hardly say that this indicative of the quality care of provided by NPs. There are bad providers of all levels.


A large part of the problem with NPs is there is no national standardized curriculum.  The quality of the educational experience is all over the map.  Sorry Remi, I'll have to disagree with ya - the idea of an NP ordering double the correct dose is far from a rare event if my experience is an indicator.


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## Carlos Danger (Sep 14, 2015)

jwk said:


> A large part of the problem with NPs is there is no national standardized curriculum.  The quality of the educational experience is all over the map.  Sorry Remi, I'll have to disagree with ya - the idea of an NP ordering double the correct dose is far from a rare event if my experience is an indicator.



Of course someone somewhere could order an incorrect dose of a med. This would not be the first time in history that it has happened, and NP's certainly aren't the only practitioners who make mistakes.

But TWICE the LD95? Not impossible I suppose, but EMTinCT clearly has an anti-NP agenda, so I still call BS on that story.


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## Summit (Sep 14, 2015)

I had a MD order a lethal dose of metoprolol. Hey does that mean MDs are bad?


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## Tigger (Sep 14, 2015)

ExpatMedic0 said:


> I think Athletic Trainers are one of the best educated allied health professions. I don't know about your area, but from my experience  no one seems to know anything about them, they are a mysterious provider lurking in the shadows of healthcare. I had one for a partner when I was a medic for a women's roller derby and I learned a lot from the guy.


No doubt. They also practice relatively independently, which is not a coincidence. Spending three years in mostly sports medicine role did a lot for me, and more than a just "these are all the muscles and how they work" type thing. Sports medicine is all about identifying how an injury will effect the rest of the body, which is a valuable thought process. Too often in EMS it seems we can only see the obvious illness or injury and do not bother to consider where else the injury may be manifesting itself.


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## MackTheKnife (Sep 14, 2015)

Tigger said:


> There a lot of ADNs looking for good jobs that probably also said "half the time, sign me up!"
> 
> And then the industry changed and they're stuck. I know BSN RNs that work in SNFs that are waiting for decent jobs to open up. Eventually that might well become the case for EMS.
> 
> ...


Tigger,
 Your comment is accurate to a degree (no pun intended!). There are ADNs that are hired right after passing the NCLEX-RN but it depends on the school's reputation as well as the location. Our grads from Keiser University Jacksonville, FL are 100% hired. NCLEX-RN pass  rate is over 90%.The program is a 16 month ADN. It is extremely fast-paced and that's one of the reasons I am going there. At 57 yo, time is short! Our Program Director has made our program tops in the area over the others which makes Keiser grads attractive without the BSN. And the BSN is a post-hire requirement; Enrolled in a BSN program within 1 year and degree attainment usually within 3-5 years.
IMHO, a Paramedic Practitioner would not be a good idea. As previously stated, there are PA's and NP's.


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## Tigger (Sep 14, 2015)

MackTheKnife said:


> Tigger,
> Your comment is accurate to a degree (no pun intended!). There are ADNs that are hired right after passing the NCLEX-RN but it depends on the school's reputation as well as the location. Our grads from Keiser University Jacksonville, FL are 100% hired. NCLEX-RN pass  rate is over 90%.The program is a 16 month ADN. It is extremely fast-paced and that's one of the reasons I am going there. At 57 yo, time is short! Our Program Director has made our program tops in the area over the others which makes Keiser grads attractive without the BSN. And the BSN is a post-hire requirement; Enrolled in a BSN program within 1 year and degree attainment usually within 3-5 years.
> IMHO, a Paramedic Practitioner would not be a good idea. As previously stated, there are PA's and NP's.


There are plenty of great programs and ADNs out there. But surely it is clear that the nursing industry is moving towards BSN being the base level, or else they would not require it post hire. Also, I'm not sure 100% hired means, as we all know not all jobs are equal. I am sure that many (if not most) nursing school grads are hoping for a job at some sort of respected medical center, but many may end up initially settling for less prestigious employment. Yes they are hired, but maybe not where they had hoped.

As an aside, I am not convinced that there is no need for clinical graduate level studies for EMS providers. Other countries with successful prehospital care systems have graduate certificate programs in place for their "Intensive Care Paramedics" or whatever they call them. There aren't many of them, but it seems to be that there might be some benefit in teaching critical care transport medicine at a higher level than what is done here. It doesn't need to be a master's degree by any stretch, but such classes should probably be at that level. The same could go potentially go for community health type education as well, though my agency is currently doing alright with teaching them through the community college (though sadly they are currently non-credit). When it comes to leadership I think that is well served by existing Public Administration programs.


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## MackTheKnife (Sep 14, 2015)

100% hired by hospitals. No LTC, etc.


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## triemal04 (Sep 16, 2015)

Remi said:


> Of course someone somewhere could order an incorrect dose of a med. This would not be the first time in history that it has happened, and NP's certainly aren't the only practitioners who make mistakes.
> 
> But TWICE the LD95? Not impossible I suppose, but EMTinCT clearly has an anti-NP agenda, so I still call BS on that story.


Huh...guess you've never heard of someone mistaking *gram *for *milli*gram...or *milli*gram for *micro*gram...or any of the other ways you could accidently write the wrong dosage...

There's lots of agendas out there apparently.


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## Carlos Danger (Sep 16, 2015)

triemal04 said:


> Huh...guess you've never heard of someone mistaking *gram *for *milli*gram...or *milli*gram for *micro*gram...or any of the other ways you could accidently write the wrong dosage...
> 
> There's lots of agendas out there apparently.



Sure I've heard of that. But that's not what he was talking about. Maybe you should re-read the original post on this topic.

The only agenda here is the one where someone tries to prove that one group of practitioners is inherently incompetent, yet another group is virtually infallible, using a singular and likely inaccurate anecdote.


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## triemal04 (Sep 16, 2015)

Remi said:


> Sure I've heard of that. But that's not what he was talking about. Maybe you should re-read the original post on this topic.
> 
> The only agenda here is the one where someone tries to prove that one group of practitioners is inherently incompetent, yet another group is virtually infallible, using a singular and likely inaccurate anecdote.


What in god's name are you talking about?  Seriously, is it just that anytime someone questions someone or points out a flaw in someone in the same/similar profession as you that you automatically tune out and disagree?  *This* is what was posted originally:


EMTinCT said:


> Grandma went to a Nurses Practitioner who nearly killed her. I just wasn't impressed with the Np as she seemed uncertain and unskilled. *The Np wrote a prescription for twice the lethal dose of a muscle relaxant.* The pharmacist refused to fill it and called the Np to explain.


Do you really think that nobody, no doctor, no PA, no NP has ever mistakenly written "gram" when they meant to write "milligram" or "microgram" on a prescription?  Or added a zero or two to the dose?  Misplaced the decimal point?  Do you not understand that, depending on the drug, taking several grams instead of several milligrams or micrograms could potentially be a lethal dose?

People with agendas are generally not worth dealing with.  You friend, fall into that category.


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## DPM (Sep 17, 2015)

triemal04 said:


> Huh...guess you've never heard of someone mistaking *gram *for *milli*gram...or *milli*gram for *micro*gram...or any of the other ways you could accidently write the wrong dosage...
> 
> There's lots of agendas out there apparently.



Are you arguing then that's there's no point in seeking higher education because some people who have degrees sometimes make mistakes? Maybe no one should attempt to learn anything... I mean, we all make mistakes already! Higher education will only make things worse, right?


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## triemal04 (Sep 17, 2015)

DPM said:


> Are you arguing then that's there's no point in seeking higher education because some people who have degrees sometimes make mistakes? Maybe no one should attempt to learn anything... I mean, we all make mistakes already! Higher education will only make things worse, right?


Wait...what?  Now I'm really confused.  I'm just pointing out that to immediately discount the story that EMTinCT relayed, which unfortunately is not far-fetched (mistakes do happen, and it's not unheard of, or hard to accidently use the wrong unit of mass, or misplace a decimal point or whatever) as a certain poster has done...well...maybe it's not the smartest thing to do that.


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## DPM (Sep 17, 2015)

I quoted incorrectly previously, but the sentiment is still valid. There are people commenting on this thread who are arguing against higher education because other educated people are making mistakes... My mind is blown. (Which is probably why I can't quote...)


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## Carlos Danger (Sep 17, 2015)

triemal04 said:


> What in god's name are you talking about?  Seriously, is it just that anytime someone questions someone or points out a flaw in someone in the same/similar profession as you that you automatically tune out and disagree?  *This* is what was posted originally:
> 
> Do you really think that nobody, no doctor, no PA, no NP has ever mistakenly written "gram" when they meant to write "milligram" or "microgram" on a prescription?  Or added a zero or two to the dose?  Misplaced the decimal point?  Do you not understand that, depending on the drug, taking several grams instead of several milligrams or micrograms could potentially be a lethal dose?
> 
> People with agendas are generally not worth dealing with.  You friend, fall into that category.



Oh, triemal. Still having a hard time figuring out the point of all this?

First, let me make sure I understand your position: You have no problem with someone publicly saying essentially that "provider group A is incompetent because I saw one of them make a big mistake once, but provider group B is awesome because I dealt with one once who did a great job" (not what was actually written, of course, but was clearly the implication), and supporting that position with a single, questionable example. But you DO have a problem with someone else coming along and saying "No, you can't draw conclusions about an entire group based on a single example, especially when that example is dubious". And you think that response shows an agenda of some sort, but the original claim does not? Obviously, you and I have very different standards for what constitutes evidence of an agenda.

What seems just beyond your grasp is the fact that whether this NP actually made the error in question is completely irrelevant. Yes, I did express doubt that it happened *as described* - there are several reasons why I think that's unlikely, and we can discuss those separately if you want to. However, I also did concede that it _could have happened, _because of course med errors happen. Maybe you missed that? Again, that's not the real issue here at all.

The real issue is the logical fallacy of claiming that one group of providers is incompetent but the other is not, because of a single interaction. Doesn't matter what specific mistake was made, who made it, or whether it was as bad as described. It's a false generalization either way, and I would have called it out whether the person in the story making the mistake was the NP, PA, CRNA, MD, DO, gay, straight, black, white, whatever.


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## triemal04 (Sep 17, 2015)

Remi...dear...I'm serious.  You are clearly biased on this particular topic with your own agenda.  There is no point in talking with you about this, because what follows wouldn't be a discussion; it would be you mouthing the party line and refusing to consider facts and alternate views.  So why bother?


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## Brandon O (Sep 17, 2015)

The main problem is that (as demonstrated), many people's experience with midlevels remains limited, so when one of them does something dumb, they figure "all NPs are dumb," whereas when a physician does something dumb, they figure that guy was dumb.

[cf. the entire worldly history of human prejudice]


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## triemal04 (Sep 17, 2015)

Brandon O said:


> The main problem is that (as demonstrated), many people's experience with midlevels remains limited, so when one of them does something dumb, they figure "all NPs are dumb," whereas when a physician does something dumb, they figure that guy was dumb.
> 
> [cf. the entire worldly history of human prejudice]


Yep.  A very clear, and easy to see reason why what happened to EMTinCT could color his view of NP's in a very negative way.  Doesn't make it right at all, but when someone's first experience is negative (especially if that is their ONLY experience ever) and they may have previously heard or hear negative things about that group...that is how uninformed prejudices start.


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## Summit (Sep 17, 2015)

triemal04 said:


> Yep.  A very clear, and easy to see reason why what happened to EMTinCT could color his view of NP's in a very negative way.  Doesn't make it right at all, but when someone's first experience is negative (especially if that is their ONLY experience ever) and they may have previously heard or hear negative things about that group...that is how uninformed prejudices start.


I'm glad to see you now approve of Remi calling out such anecdotally based prejudice


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## triemal04 (Sep 17, 2015)

Summit said:


> I'm glad to see you now approve of Remi calling out such anecdotally based prejudice


It's not that, he's quite right in that regard; what I take issue with is the immediate and repeatedly stated opinion of "that's BS, it couldn't happen" when the mistake that EMTinCT mentioned is unfortunately an easy one to make, and very easily could have happened.  Just as EMTinCT shouldn't use that singular experience to form his views of NP's, Remi shouldn't discount what happened as "BS" because he happens to also be an advanced practice nurse.


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## Carlos Danger (Sep 17, 2015)

triemal04 said:


> It's not that, he's quite right in that regard; what I take issue with is the immediate and repeatedly stated opinion of *"that's BS, it couldn't happen"* when the mistake that EMTinCT mentioned is unfortunately an easy one to make, and very easily could have happened.  Just as EMTinCT shouldn't use that singular experience to form his views of NP's, Remi shouldn't discount what happened as "BS" because he happens to also be an advanced practice nurse.



You are misrepresenting what I said, and still ignoring the overall point to focus on a minor statement that actually has no bearing on the meaning of what I wrote.

Please quote where I wrote that "it couldn't happen".


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## Tigger (Sep 17, 2015)

You know, just because you (plural) can argue about literally everything, does not mean you have to. Let it go.


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## MackTheKnife (Sep 17, 2015)

Awesome! I'm not the only one who catches sh*t for my comments!


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## EMTinCT (Sep 17, 2015)

Wow, I totally didn't mean to stir up such a debate! Sorry! Grandma says that she knows there are people in every profession that are good and bad. We once called a plumber for the basement pipes and the guy who replaced the busted pipe used the wrong diameter (too small) and this made the problem worse. Grandma called a different plumber who fixed it right away. She says that the first guy was either having a bad day or is a bad plumber but that don't mean all plumbers are bad.

Then again I once looked at the NP education and I was shocked to see a lot of weird classes. Grandma told me they are called "fluff" classes.


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## Brandon O (Sep 17, 2015)

I think the nurses might agree with that part.


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## Carlos Danger (Sep 18, 2015)

You guys do realize that EMTinCT is a troll, right?


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## Summit (Sep 18, 2015)

Tigger said:


> You know, just because you (plural) can argue about literally everything, does not mean you have to. Let it go.


C'mon dude... mods should have deleted that original inflammatory nonsequitor that everyone knew would turn into this multipage distraction from the original thread topic... well now look at the thread. Hey, now the troll is back with some more great "Grandma always said" crap.


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## cruiseforever (Sep 18, 2015)

Remi said:


> You guys do realize that EMTinCT is a troll, right?



Looks like he found the right bait to use.


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## triemal04 (Sep 18, 2015)

EMTinCT said:


> Wow, I totally didn't mean to stir up such a debate! Sorry! Grandma says that she knows there are people in every profession that are good and bad. We once called a plumber for the basement pipes and the guy who replaced the busted pipe used the wrong diameter (too small) and this made the problem worse. Grandma called a different plumber who fixed it right away. She says that the first guy was either having a bad day or is a bad plumber but that don't mean all plumbers are bad.
> 
> Then again I once looked at the NP education and I was shocked to see a lot of weird classes. Grandma told me they are called "fluff" classes.


My grandma says that your grandma likes to stir the pot.  Well played, well played.


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## EMTinCT (Sep 18, 2015)

Is that really necessary?


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## Summit (Sep 18, 2015)

EMTinCT said:


> Is that really necessary?


My Grandma says your posts aren't really necessary.


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## ExpatMedic0 (Sep 19, 2015)

My grandma would actually like to hear more about the thread topic ;-) Any other thoughts on paramedic practitioners, master's degrees, and the future of EMS? I did not start the thread, but its an interesting topic I like hearing thoughts and opinions on.


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## DPM (Sep 19, 2015)

To maybe steer things back in the correct direction: 

The UK, Canada, Australia and New Zealand are the countries with probably the most comparable EMS systems. They all have certificates / associates levels of training, with advancement to bachelors and maters level for advanced level, critical care and Paramedic practitioners. 

Are we doing it better, or are they? Is the education unnecessary? What do people think are the upsides and downsides of higher education standards for EMS? 

Personally, I am for higher education. Paramedic training in the U.S. could be slightly extended (by adding more A&P, chemistry etc) to make it an associates program. With higher education standards across the board we could realistically petition for better pay and allowances. Likewise, with higher standards we can then have serious discussions with our medical directors and managers, to finally expand and improve our protocols. 

My $0.02 anyway.


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## Tigger (Sep 19, 2015)

Summit said:


> C'mon dude... mods should have deleted that original inflammatory nonsequitor that everyone knew would turn into this multipage distraction from the original thread topic... well now look at the thread. Hey, now the troll is back with some more great "Grandma always said" crap.


We will not moderate the forum in that manner. That post hardly qualified as inflammatory and unfortunately there are many, many people who do in fact view the whole by their impression of a single part. While I hope we can all educate these people, I also expect that members here take the high road and don't let it devolve into what has happened above.


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## SandpitMedic (Sep 20, 2015)

ExpatMedic0 said:


> My grandma would actually like to hear more about the thread topic ;-) Any other thoughts on paramedic practitioners, master's degrees, and the future of EMS? I did not start the thread, but its an interesting topic I like hearing thoughts and opinions on.


Always the voice of reason. Good ol' Expat.


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## ExpatMedic0 (Sep 20, 2015)

DPM said:


> To maybe steer things back in the correct direction:
> 
> The UK, Canada, Australia and New Zealand are the countries with probably the most comparable EMS systems. They all have certificates / associates levels of training, with advancement to bachelors and maters level for advanced level, critical care and Paramedic practitioners.
> 
> ...


This is true, and its also worth noting the U.S. higher education system differs dramatically from many commonwealth countries and the EU. For one, the U.S. uses an associate's degree, and a 4 year bachelor degree. Many other countries which offer paramedic degrees(mentioned above) do not offer either of these, but instead offer a 3 year bachelor degree. Another interesting thing, I have met and worked with paramedics from other countries who claim to have a "masters degree" or "postgraduate certificate", but never completed university at a bachelor's degree level.. so although it maybe a master's degree or post grad certificate to them, it's likely an associate's degree at best in the U.S. since we tend to use the step ladder tiered education system for the most part. Secondly  the cost of higher education (especially at the University level) is much, much, higher in the U.S.  I think its also worth noting that our healthcare system  (including reimbursement system), is wildly different than many of the above mentioned countries. So these are all things to consider when comparing the U.S. to other countries. With that that said I still think we can learn a lot from many of those countries, specifically Australia who is really pioneering a lot of advanced EMS roles and education.


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## Brandon O (Sep 20, 2015)

Excellent points, @ExpatMedic0


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## triemal04 (Sep 21, 2015)

Oh to dream...what the hell.  The first steps would be easy...

First and foremost, before any progress or future improvements can be made, EMS must be fixed and standardized across the country.  Only when that is done is it both feasible and prudent to move forward.  Putting a long-range plan in place would also work, but again, the base problems need to be fixed before moving on.

EMS needs to be better represented at the federal level, and in a way that leads to heavy enforcement of rules/standards.  To be honest this would suck, but if the entire country is ever going to get on the same page it has to happen.  Essentially, a department of EMS needs to be created with a lot of clout.

There needs to be one enforceable standard for education throughout the country.  States can still certify people internally (no different than most medical professions) but the educational requirements need to be formalized, preferably with a 2 or 3 year degree.

There needs to be an enforceable standard for when EMT's and Paramedic's are used and who is actually a part of EMS; routine non-emergency transfers, dialysis runs, discharges and such do not require EMT's and Paramedics in attendance, should not be able to bill as if they are, and should not be allowed to legally call themselves ambulances or a part of the EMS system.

The ability to gain reimbursement from Medicare (and Medicaid since it get's federal funding) should be removed if states are non-compliant with either educational standards, or who is allowed to bill and represent themselves as an EMT/Paramedic.

Insurance companies need to have the option to refuse any and all payments for the same reasons.

Once the basics were taken care of then other interesting topics like funding, public needs vs private profits could be dealt with.

Of course, doing any one of those things would be an utter nightmare that was so filled with political backstabbing, public hysteria (fed by various interest groups) misinformation, people looking out for themselves, people pushing agendas and the standard stupidity and ignorance (that is part of both politics, the federal gov't and EMS) that nothing would get done, or done well.

Basically politics and pie in the sky dreaming as usual.


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## Tigger (Sep 21, 2015)

triemal04 said:


> Oh to dream...what the hell.  The first steps would be easy...
> 
> First and foremost, before any progress or future improvements can be made, EMS must be fixed and standardized across the country.  Only when that is done is it both feasible and prudent to move forward.  Putting a long-range plan in place would also work, but again, the base problems need to be fixed before moving on.
> 
> ...


Of note, many of the things you list (which I agree with) might find solutions if we could just pass the EMS Field Bill. Moving EMS under the auspices of Health and Human Services would make a significant difference. 

The rest of healthcare is soon (or is) being forced to prove their worth. If what they are doing isn't working, CMS will not reimburse. EMS is not far behind, but we lack the federal leadership to become efficient and this worries me.


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## EpiEMS (Sep 22, 2015)

Tigger said:


> The rest of healthcare is soon (or is) being forced to prove their worth. If what they are doing isn't working, CMS will not reimburse. EMS is not far behind, but we lack the federal leadership to become efficient and this worries me.



Poses a good question (perhaps for another thread): What does EMS do that is worthwhile, and what does EMS do that isn't? 

And how does that link up with the need/desire/idea of midlevel providers in EMS/prehospital settings?


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## Medic 46 (Sep 23, 2015)

Here in Pennsylvania the the pay scale runs anywhere from $10 to $20 an hour for a paramedic. Whether you have an AAS or not you make the same pay. Even as a nationally registered paramedic in PA I can't practice the same skills as a medic from California or Washington state. I can't RSI, I can't give blood, if I have a beta blocker overdose pt dying in front of me I have to 1. Pray I have reception 2. Beg a doctor to let me give glucagon because there is no protocol for it. 
Point is I think before we start talking about education and accreditation we first need to actually standardize care in all states. Sure it's cool if with a degree a medic in Seatlle can RSI and I learn how to do it here. PA tells me that's a waste of knowledge and I will loose my license if I do.


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## DPM (Sep 23, 2015)

I hope that by standardising the educational requirements (more than the very basic standards laid out by title 22 etc) we can agree on a national standard.


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## triemal04 (Sep 23, 2015)

Medic 46 said:


> Point is I think before we start talking about education and accreditation we first need to actually standardize care in all states. Sure it's cool if with a degree a medic in Seatlle can RSI and I learn how to do it here. PA tells me that's a waste of knowledge and I will loose my license if I do.


As the vast majority of paramedics should not be intubating and definitely should not be using paralytics he is right to say that. 

CARE does not, and should not be standardized across states, counties, cities or departments.  Different areas will have different needs.  EDUCATION and the process of becoming a paramedic needs to be standardized nationally.


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## MackTheKnife (Sep 23, 2015)

Medic 46 said:


> Here in Pennsylvania the the pay scale runs anywhere from $10 to $20 an hour for a paramedic. Whether you have an AAS or not you make the same pay. Even as a nationally registered paramedic in PA I can't practice the same skills as a medic from California or Washington state. I can't RSI, I can't give blood, if I have a beta blocker overdose pt dying in front of me I have to 1. Pray I have reception 2. Beg a doctor to let me give glucagon because there is no protocol for it.
> Point is I think before we start talking about education and accreditation we first need to actually standardize care in all states. Sure it's cool if with a degree a medic in Seatlle can RSI and I learn how to do it here. PA tells me that's a waste of knowledge and I will loose my license if I do.


I don't know if it is possible for nationwide standardization. Everyone has their "ricebowl" they protect whether it be the state EMS agency or the controlling medical group (if that still exists) as relates to delegated practice.
I'm finding out in nursing school that each state has a different Scope of Practice and skill sets vary accordingly. I have never understood how LEO's get paid a lot more than EMS personnel, but they do.


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## DPM (Sep 24, 2015)

triemal04 said:


> As the vast majority of paramedics should not be intubating and definitely should not be using paralytics he is right to say that.
> 
> CARE does not, and should not be standardized across states, counties, cities or departments.  Different areas will have different needs.  EDUCATION and the process of becoming a paramedic needs to be standardized nationally.



Why do you say this? Why do some states / areas have different needs? They don't have differently trained Doctors and Nurses.


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## EpiEMS (Sep 24, 2015)

DPM said:


> Why do you say this? Why do some states / areas have different needs? They don't have differently trained Doctors and Nurses.



Not to speak for triemal04, but I think the value proposition of EMS differs greatly in different areas. Consider transport times and the propensity of a patient to go from potentially unstable to critical over a longer period. Don't forget, as well, that different areas have different resources - perhaps an area doesn't have much in the way of ALS services available, but an enterprising medical director thinks that his or her EMTs can quite easily, say, use CPAP, draw up epinephrine, or administer morphine by auto-injector.

Like states as laboratories of democracy, EMS needs to be somewhat customizable by region.


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## DPM (Sep 24, 2015)

EpiEMS said:


> Not to speak for triemal04, but I think the value proposition of EMS differs greatly in different areas. Consider transport times and the propensity of a patient to go from potentially unstable to critical over a longer period. Don't forget, as well, that different areas have different resources - perhaps an area doesn't have much in the way of ALS services available, but an enterprising medical director thinks that his or her EMTs can quite easily, say, use CPAP, draw up epinephrine, or administer morphine by auto-injector.
> 
> Like states as laboratories of democracy, EMS needs to be somewhat customizable by region.



All medics in all systems have the daily potential to see very sick patients. I don't think that having longer or shorter transport times should determine the level of provider that you get. I think defining what constitutes ALS at a national level, and setting appropriate educational requirements will help to improve EMS nationwide. We do a disservice to our patients when some systems are very much on the cutting edge, using evidence based practice and embracing the new science, while others are not. ETCO2 usage, pain relief, back boards to name a few of these contentious issues. When the research has been done and the consensus made, then we all need to be carrying out best practice.


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## Carlos Danger (Sep 25, 2015)

EpiEMS said:


> Poses a good question (perhaps for another thread): What does EMS do that is worthwhile, and what does EMS do that isn't?
> 
> And how does that link up with the need/desire/idea of midlevel providers in EMS/prehospital settings?



I think where they link up is in the disconnect between what EMS providers typically do/see in a normal shift, versus how they are currently trained and what the needs of most patients are.

One of the biggest failings of the EMS system is that it still requires virtually every patient to be transported to the ED.

Most American paramedics receive fairly in-depth training in a very narrow scope of practice. Typical training focuses solely on recognition and short-term management of acute, life-threatening emergencies, and completely eschews anything involving the assessment or management of chronic conditions or the provision of even very basic primary care. This results in a provider who is only able to provide useful care to very few people - only very sick or injured patients - everyone else needs to be taken to the ED to be assessed and cared for by someone else, even if all the patient needs is a few sutures or a course of antibiotics, and even if the patient would be better served with a referral to a clinic rather than a visit to the ED.

We would probably all agree that while we certainly do see very sick patients sometimes, most of us see far more patients who need help with a chronic condition or need treatment for a minor illness or injury that doesn't necessitate a visit to the ED. That's were a paramedic practitioner comes in: not only can they provide all the critical interventions that paramedics traditionally provide, but, just like a PA or NP in an urgent care setting, they can also avoid transport for many patients who would otherwise have no choice but to go to the ED.


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## Brandon O (Sep 25, 2015)

Remi said:


> Most American paramedics receive fairly in-depth training in a very narrow scope of practice. Typical training focuses solely on recognition and short-term management of acute, life-threatening emergencies, and completely eschews anything involving the assessment or management of chronic conditions or the provision of even very basic primary care. This results in a provider who is only able to provide useful care to very few people - only very sick or injured patients - everyone else needs to be taken to the ED to be assessed and cared for by someone else, even if all the patient needs is a few sutures or a course of antibiotics, and even if the patient would be better served with a referral to a clinic rather than a visit to the ED.
> 
> We would probably all agree that while we certainly do see very sick patients sometimes, most of us see far more patients who need help with a chronic condition or need treatment for a minor illness or injury that doesn't necessitate a visit to the ED. That's were a paramedic practitioner comes in: not only can they provide all the critical interventions that paramedics traditionally provide, but, just like a PA or NP in an urgent care setting, they can also avoid transport for many patients who would otherwise have no choice but to go to the ED.



The other shoe, however, is that not only are EMS providers not well-versed in non-emergent conditions, they're also not good at distinguishing what's emergent versus not. And that triage is not really an easy skill to acquire. (See: 90% of emergency medicine.)


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## triemal04 (Sep 25, 2015)

DPM said:


> Why do you say this? Why do some states / areas have different needs? They don't have differently trained Doctors and Nurses.


But they do different things depending on the location and setting.  It's easier to see with nurses than doctors though they have the issue too.  For example, a nurse working in a family practice doc's office will be able to, and expected to do very different things than a nurse in an ER.  A nurse in one ER may do different things than a nurse in another because that's what the hospital wants. 

But they were all trained to do the same things initially, to the same standard, and in a way that, more or less, is consistent nationally.  What they are made to do afterwards should not be dictated at the national level.


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## 0theories (Sep 25, 2015)

I'm fairly new to this field but receive(d) my education in Oregon where an AA is required for paramedic licensure. As an aside I already have a BS (used to be a riparian ecologist) so I just have to take the ems classes to qualify. What's hard for me to believe is that most paramedic programs don't require A&P (or chemistry or micro bio...)! I'm only starting the paramedic (2nd year) portion of the program, so maybe they teach you everything you need to know... But A&P takes almost as long as the entire paramedic class to complete. It would be like getting only half the education without it. 

So... I'm all for making a degree required (eventually a BS I think like they're starting to do for nursing here). Maybe the pay for higher educated paramedics would go up, and then they'd start hiring EMT-Bs again


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## EpiEMS (Sep 25, 2015)

DPM said:


> All medics in all systems have the daily potential to see very sick patients. I don't think that having longer or shorter transport times should determine the level of provider that you get. I think defining what constitutes ALS at a national level, and setting appropriate educational requirements will help to improve EMS nationwide. We do a disservice to our patients when some systems are very much on the cutting edge, using evidence based practice and embracing the new science, while others are not. ETCO2 usage, pain relief, back boards to name a few of these contentious issues. When the research has been done and the consensus made, then we all need to be carrying out best practice.



No disagreement on the front that all medics (all providers, even) in every system have the potential to see very sick patients. And I certainly don't disagree that there should be more national definition (at least, as a baseline) for what constitutes ALS and what evidence-based practices should be implemented. What I'm questioning is the need for lots of ALS availability when transport time to a top-tier hospital is <10 minutes - especially for the times where ALS is conventionally seen as a value-add (multiple-trauma, cardiac arrest) despite evidence to the contrary (i.e. OPALS studies).


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## ExpatMedic0 (Sep 26, 2015)

Remi said:


> I think where they link up is in the disconnect between what EMS providers typically do/see in a normal shift, versus how they are currently trained and what the needs of most patients are.
> 
> One of the biggest failings of the EMS system is that it still requires virtually every patient to be transported to the ED.


 agreed %100



Remi said:


> Most American paramedics receive fairly in-depth training in a very narrow scope of practice. Typical training focuses solely on recognition and short-term management of acute, life-threatening emergencies, and completely eschews anything involving the assessment or management of chronic conditions or the provision of even very basic primary care. This results in a provider who is only able to provide useful care to very few people - only very sick or injured patients - everyone else needs to be taken to the ED to be assessed and cared for by someone else, even if all the patient needs is a few sutures or a course of antibiotics, and even if the patient would be better served with a referral to a clinic rather than a visit to the ED.



Agreed, but this in my mind is what's so special about the concept of a paramedic. I don't mean to sound corny, but there is something fascinating about the concept and its romantic to me. Paramedics do receive fairly in depth training concerning a narrow specialty. Out of hospital acute emergencies. In many countries they are the only healthcare providers other than doctors who are doing certain advanced procedures and somewhat autonomously orchestrating acute emergencies and various other forms of calamity and chaos. Aside from just performing advanced technical skills during a resuscitation it goes beyond just that. Even for example, just the concept of reading an ECG, understanding it, and diverting to the cath lab is an incredible accomplishment for any healthcare system and society. The concept of a paramedic is great, and I think it was a good invention and we are doing great work but....
You are right, the training is so incredibly limited to "here and now"( and that's necessary sometimes) but the majority of our calls are managing the patient's chronic non-communicable diseases, thats whats killing people nowadays, sometimes the need to go the ED, sometimes not. The question is... where do we draw the line and where should our job begin and end, if in a theoretical world where paramedic practitioners roam the streets with masters degrees? How do we stay unique masters of acute life threatening emergencies in the prehospital environment while also preventing some hospital admissions and being educated enough to recognize when someone does not need to go to the ED, versus when someone does; yet remain up to par on acute life threats in pseudo austere environments and non clinical settings(i.e. the prehospital environment)?


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## MackTheKnife (Sep 26, 2015)

Some here are advocating for Federal involvement. Be careful, you might get what you wish for.


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## MackTheKnife (Sep 26, 2015)

The BSN push started years ago and has its supporters and detractors. It's bigger now with hospitals trying to achieve magnet status. I would opt for an Associates degree as being adequate. A&P and Micro definitely!


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## graycord (Sep 28, 2015)

Tigger said:


> Competitive services are starting to want degrees. Some (two sadly) states require it.



Which ones?


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## Tigger (Sep 28, 2015)

graycord said:


> Which ones?


Oregon is one for sure. The other is a midwest state that escapes me, Kansas maybe?


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## ExpatMedic0 (Sep 29, 2015)

ya I worked in Oregon, I can confirm that. Not sure who the other is but I know some other states (like Texas and another one) require it for a paramedic licence versus a paramedic certification. My last employer required a degree, but that is an international contracting company.


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## Christophire (Aug 6, 2020)

Tigger said:


> While I think this is eventually a worthy goal, I think we should first concentrate on increasing the baseline education for paramedics. It is nothing short of amazing that EMS providers are afforded any sort of respect within the medical community given that many (most?) paramedics do not even a possess a two year degree in their field of study. How can we say we need masters level practitioners providing autonomous care when we struggle with the degree of autonomy that we already hold?
> 
> It is important to not get a head of ourselves. While I would like nothing more than to eventually be able to be in some sort of graduate EMS program (masters or not), I would rather see the majority of paramedics (who serve the very vast majority of our patients) have an education that allows them to become a true part of the healthcare team



Were I do understand where this is coming from, however it is not just the medic class alone if you do not go the was it be route. There are prerequisites and also having to obtain your basic key first and most move up the ladder to army then aemt-p as so on. All together your certification takes around 4 years where you also need to re certify.  I have gone the nd route and I am currently pollinators practitioner status as well adding other conc concentrations such as athletic trainer and advanced cardiology and pulmonologist curriculum.  I also teach rn, pa in acls pals etc..


where I am proud of my degrees, in order to be successful the medic course is intense in its concentration.


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## MackTheKnife (Aug 6, 2020)

Christophire said:


> Were I do understand where this is coming from, however it is not just the medic class alone if you do not go the was it be route. There are prerequisites and also having to obtain your basic key first and most move up the ladder to army then aemt-p as so on. All together your certification takes around 4 years where you also need to re certify.  I have gone the nd route and I am currently pollinators practitioner status as well adding other conc concentrations such as athletic trainer and advanced cardiology and pulmonologist curriculum.  I also teach rn, pa in acls pals etc..
> 
> 
> where I am proud of my degrees, in order to be successful the medic course is intense in its concentration.


IS this humor or satire?  What you wrote makes no sense. ND route? Pollinators practitioner?  LOL!  You teach RN, PA, etc.?


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## Bishop2047 (Aug 6, 2020)

Pollinators practitioner?


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## mgr22 (Aug 6, 2020)

I'm guessing voice recognition software was involved.


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## FiremanMike (Aug 6, 2020)

mgr22 said:


> I'm guessing voice recognition software was involved.



And alcohol..


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## johnrsemt (Aug 7, 2020)

So Oregon will only hire brand new paramedics with a 2 year degree, over paramedics with 10 or 20 years of experience without a degree?  With the exact same medical training?
When I went to paramedic school, it was in a program that we could do it with or without a degree; $10,00 difference.  Medical part was exactly the same, it was another year to get the Associates degree.  Clinical hours were the same.  People that spent the extra money, came out of school and made the same amount of money.  People that their fire departments or EMS services paid there way, didn't pay for the degrees, so they had to pay the extra $10K out of pocket.  
Some that I talk to now (2004 is when we graduated) said that they wished they hadn't spent the extra money.  Only one of the 12 said she has ever made more money with the degree than without, and that was $0.50 more an hour.


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## Pond Life (Aug 11, 2020)

On the whole most paramedics pay for their own degrees here in the UK. The Para degree costs about £14K ($18K) but if you're sensible you often find grants for all degrees and courses after that. If you stay int eh ambulance service your pay will remain low. But go outside of the service and it can be very rewarding financially.
I certainly am making loads more money as a result of having my degrees and the experience that goes with it than a normal paramedic here in the UK and Im not alone. I think the expectation now is that paramedics do their basic degree, go on the road for a few years and specialise with an MSc and then move on, up or sideways.
Paramedic earns £27K ($35K), Specialist paramedics about £31K ($40K) and Advanced Paramedics £44K ($57K). Most of the advanced paramedics I'm working earn between £65K ($84K) and £85K ($110K).


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## Jambow (Sep 3, 2020)

NC effective jan 1 21, currently the paramedic students can take a hybrid a&p class - (non college credit)
5. The required Anatomy and Physiology course shall meet or exceed the requirements listed in the Continuing Education Master Course List of the NC Community College System. Courses that are currently accepted include: 
• BIO- 163: Basic Anatomy and Physiology 
• BIO- 165 & 166: Anatomy and Physiology I & II (Must complete both sections) 
• BIO- 168 & 169: Anatomy and Physiology I & II (Must complete both sections) 

NC has Certificate, Associates and Bachelor programs - I think after 2021 a lot of them will transition to Associates programs
Many of the large metro areas already has an Associates as their minimum qualifications

I 100% agree that we need a standard of education in our field of work


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## DrParasite (Sep 3, 2020)

Jambow said:


> NC effective jan 1 21, currently the paramedic students can take a hybrid a&p class - (non college credit)


That course is also known as A&P for paramedics... and has been around for years; it's a joke.  It's often offered online, and the reason it's a non-college credit course is because they, the community colleges, know that no one would ever give you any credit for it.  The fact that it hasn't been required previously is disturbing (although many NC cert programs did incorporate it into their paramedic class before this mandate.).

You can't even compare what hybrid A&P teaches you to a true, 8 credit program (A& P I and II, with a hands-on lab for both classes).


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## FiremanMike (Sep 3, 2020)

Before taking an A&P course, I would highly suggest that you evaluate the portability of that course..  There are many courses out there, but they don't always give you credit for future endeavors.

TBH, the traditional 1 semester of gross anatomy and then 1 semester of physiology gives you the most options downstream and are generally accepted everywhere.  My own nursing program wouldn't accept the combined A&P 1 and 2 classes (which are both offered at my college and designed specifically for medical professionals), they require the traditional setup.


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## Akulahawk (Sep 4, 2020)

FiremanMike said:


> My own nursing program wouldn't accept the combined A&P 1 and 2 classes


If the material covered was academically identical to what is covered in a more traditional Anatomy and (then) Physiology course of study, they should, or at least offer a "case by case" consideration of your courses. Unfortunately this is one of those instances where an institution doesn't want to look any deeper than what they've already approved and done because they know what's generally taught in one kind of course vs what's taught in an A&P integrated program. Their "systems" probably just aren't designed to cope with anything other than a Gross Anatomy course and a Physiology course.

The Community College District that I did my RN program through used integrated A&P, 2 semesters, to cover the entire material. However  their evaluation systems could easily handle an Anatomy course and Physiology course, they just figured you did a full year of study after doing it either way. I'm a little bit more of a fan of integrated A&P courses as you learn the physiology as you learn the anatomy, essentially you learn what it does and how it works. I suspect that it is a bit easier to teach how various systems interact when teaching just physiology.


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