Urgent Care Paramedic

[NomadicMedic]

I stared my new job as an Urgent Care paramedic today. Paramedics fill the MA/LPN role. It's an extremely busy practice and learning the clinical flow is like drinking from a fire hose. Every time I felt like I sort of knew what I was doing, there was something else to learn. I hope to have the nuts and bolts down in a couple of weeks.

I can already tell this is a much more involved job than working as a medic on a truck. I'm using a lot of the same skills but the assessment is very different, charting is a different world and most important, it's an entirety different delivery model and longer, much more personal relationship with the patient.

At least on day one it's a lot more interactive and it's nice to see the treatment to a discharge/end point.

 

[Carlos Danger]

Good luck! You'll get the hang of it before long. Hope you enjoy it.

 

[NomadicMedic]

This may be the thing that drives me to nursing.

 

[VentMonkey]

it's an entirety different delivery model and longer, much more personal relationship with the patient.

Good luck, @DEmedic! FWIW, this is how I knew I wasn't cut out for nursing, or anything but being an prehospital EMS schlub.

 

[NomadicMedic]

I never thought I'd like this kind of role, but it seems to be really different than I envisioned. It is much more of a partnership with the PA than I ever thought.

I worked a 911 shift yesterday and was talking to some of the other guys about it. I took some grief from the young guys about taking the job. Once I explained that I was making more money than any of the 911 medics, wasn't getting my sleep interrupted, wasnt out in the rain, or the heat or in the middle of I95 at a wreck and I didn't have to carry anyone down a flight of stairs everyone kind of stopped and said, "are they hiring?"

 

[VentMonkey]

What's the medic scope like?

 

[NomadicMedic]

What's the medic scope like?

It's pretty wide. Just about anything can be delegated under supervision. But, I don't expect it to be anything that is really far outside of the paramedic scope. For example, many of the meds are outside of the paramedic formulary, but the administration is all delegated in a protocol.

 

[StCEMT]

I have a buddy that works out of a clinic that we get called to sometimes. Haven't really got to ask what it is like for him. He graduated with me though, so him being new and all, he still wants to be out on the road.

 

[EpiEMS]

I stared my new job as an Urgent Care paramedic today.

What's staffing like there? I'm curious, in particular, what the ratio of MD/DO : PA/NP : RN : etc. is, if you can provide the info!

I bet they'll be glad to have you when you get a code coming through the door!

 

[NomadicMedic]

What's staffing like there? I'm curious, in particular, what the ratio of MD/DO : PA/NP : RN : etc. is, if you can provide the info!

I bet they'll be glad to have you when you get a code coming through the door!

Today we had a receptionist, a pct, an MA (also a medic who just finished her RN), me, a rad tech and two PAs.

 

[EpiEMS]

Today we had a receptionist, a pct, an MA (also a medic who just finished her RN), me, a rad tech and two PAs.

No physician around usually? By the by, do they have any radiography other than X-ray?

 

[Generic]

California law doesn't allow a paramedic to work as an ALS provider outside of a pre-hospital environment. A few years ago, there was a bill that would allow a paramedic to work in a small rural hospital setting. I don't know if that was passed. The California Nurses Association fights hard against things like this.

I wish we could work in urgent cares as I have a friend who has been a paramedic for over 30 years and is closer to retirement than not. Getting him off the ambulance and into an urgent care for the same or more money would be ideal for him.

 

[Akulahawk]

California law doesn't allow a paramedic to work as an ALS provider outside of a pre-hospital environment. A few years ago, there was a bill that would allow a paramedic to work in a small rural hospital setting. I don't know if that was passed. The California Nurses Association fights hard against things like this.

I wish we could work in urgent cares as I have a friend who has been a paramedic for over 30 years and is closer to retirement than not. Getting him off the ambulance and into an urgent care for the same or more money would be ideal for him.

Actually, you are not exactly entirely correct. The last time I looked at the regulations for California paramedics it appeared that paramedics could work outside of the prehospital environment as an ALS provider in very limited circumstances. Most notably this is within the ER, using their entire scope of practice, facilities that are essentially remote/very rural. In that situation the paramedic is directly supervised by the physician. Most of the time, however, you are correct.

 

[EpiEMS]

Most notably this is within the ER, using their entire scope of practice, facilities that are essentially remote/very rural.

Why couldn't they just perform ALS procedures under the direction of the physician, and just call them something other than "paramedic" or make it clear that they are not operating under their paramedic license?

 

[Qulevrius]

Why couldn't they just perform ALS procedures under the direction of the physician, and just call them something other than "paramedic" or make it clear that they are not operating under their paramedic license?

They certainly could. But the notion is being very actively lobbied by the state nursing board, and since CA is oversaturated with both domestic and imported nurses - not to mention underpaid medics - the only thing the board cares about is to stay in business (read: keep the wages above a certain figure). Especially in the urban sector, they could care significantly less for the boonies.

 

[Summit]

I think they care less about urgent care environments that often don't have RNs

Heck, the urgent cares around here don't care what you are. EMT? LPN? CMA? NRP? Whatever! They'll teach you how to draw blood and give shots.

 

[SpecialK]

Interesting. I've never heard of this.

It sounds like you are working at what I'd call a private accident and medical clinic. I'm not sure I see the point of this to be honest. Anything ambulance personnel could do is done by the Nurses (such as inserting IVs) and there wouldn't be that much need for it anyway. Most of our A&M clinics aren't hugely busy because people have to pay for them and they are not cheap.

There is some talk of ambulance personnel in smaller areas getting involved in some basic primary health promotion and perhaps co-locating with the local GP. WIth the latter has come a suggestion of personnel "doing something" with the GP or Practice Nurse but nobody can come up with exactly what; there's very little need for more than taking somebodies blood pressure or temperature honestly. Something like fundoscopy or otoscopy which the GP (and many Practice Nurses) do routinely could be taught to ambulance personnel but the workload would be so low I don't think it's really useful. Most GP's haven't needed to put in an IV in twenty years since they were a House Officer.

I am all for expanding roles and whatnot and I could be missing something, and it sounds interesting, but not sure it's worthwhile to be honest. It might work somewhere like a small remote community where the only health service is a Nurse or Nurse Practitioner but not in a regular A&M clinic.

As an aside, you'd never find me in a place like this. It is egregious people are expected to pay up front for going to one of these clinics. They are approximately $80-100 a visit depending on when you go. Never, never could I morally entertain working in such a place.

 

[EpiEMS]

It sounds like you are working at what I'd call a private accident and medical clinic. I'm not sure I see the point of this to be honest. Anything ambulance personnel could do is done by the Nurses (such as inserting IVs) and there wouldn't be that much need for it anyway. Most of our A&M clinics aren't hugely busy because people have to pay for them and they are not cheap.

Beauty of the US system -- our urgent cares (equivalent of your A&M clinics) are often much cheaper than the ED (A&E room at a hospital) for patients, and also often more convenient/faster. From the perspective of the clinic, nurses are often more expensive to hire...

 

[SpecialK]

Beauty of the US system -- our urgent cares (equivalent of your A&M clinics) are often much cheaper than the ED (A&E room at a hospital) for patients, and also often more convenient/faster. From the perspective of the clinic, nurses are often more expensive to hire...

For us it's the other way around. A&M clinics charge an arm and a leg, and ED is free. There is some argument about "A&M is faster" and yes, that's true and I guess if you want to pay for it you can but I fundamentally disagree with the concept of people having to pay out of their pocket for healthcare.

A Paramedic costs about the same as a Registered Nurse, an Intensive Care Paramedic would be approximately more expensive but not by much.

 

[EpiEMS]

For us it's the other way around. A&M clinics charge an arm and a leg, and ED is free. There is some argument about "A&M is faster" and yes, that's true and I guess if you want to pay for it you can but I fundamentally disagree with the concept of people having to pay out of their pocket for healthcare.

A Paramedic costs about the same as a Registered Nurse, an Intensive Care Paramedic would be approximately more expensive but not by much.

Makes sense in the context of the system. The thing for our urgent cares is, I don't believe they have the same obligations as an emergency department (subject to a couple of conditions - e.g. if they're part of a hospital that accepts Medicaid like most do and has an ED, etc.) to treat anybody and everybody. As far as RNs, I guess the market for medics in the UK is probably more analogous to our RN market - insofar as that the supply is a bit tighter?