I am not the least bit opposed to the idea of a community health paramedic, but frankly, I just don't see how it would work.
First, I think we need to define our terms. What are we really even talking when we discuss "community health paramedics"? Are we talking about a paramedic who has an extra hundred or so hours of in-service training and is intended to make house calls for dressing changes and trach care in between 911 responses, or are we talking about a graduate-education prepared clinician who provides actual primary care in the home? I see references to both models throughout this discussion, and they are very different things.
The first model is probably quite feasible. I would imagine that a 100-hour or so standardized curriculum could be developed
(they already have been, apparently, in a few places), and possibly even a new level of national certification eventually created, and that it probably wouldn't be too hard for EMS agencies to contract with CMS payers and other insurers to provide some basic care at a lower cost as compared to home care RN's.
The latter model, however - the "primary care paramedic" - which is I think is what most of us have in mind, would be a dramatically greater challenge. To the extent that I actually don't see it happening anytime soon, if ever. For several reasons:
- Education: The only other non-physician primary care providers in the US are PA's and FNP's. Both require a masters-level education, while a majority of paramedic programs are still two-semester vo-tech certificate programs which use textbooks written at a 10th grade reading level and require no college-level science or social science courses. I've been a paramedic for 15 years and in that time, even though the topic of education has always been an issue, almost nothing has improved. The whole "EMS is in it's infancy" thing is a BS excuse. We know we are undereducated, and we've known it for a while now; the problem is not the age of the profession, it is that as a profession we just don't have the will to change.
- Legal / regulatory: There is no licensure in any state (that I'm aware of) for a paramedic to practice primary care. Changing that will be a MASSIVE battle in some or most states. The nurses will fight tooth-and-nail, and the physicians will too, in some cases. And both the nurses and the doctors have a lot more money and a lot more lobbying power than EMS. It isn't fair, but it is reality.
- Competition / market demands: No matter how great of an idea it is, you can't do it for a living if you can't convince someone to pay you for it. And I don't see much market demand for in-home primary care. There's some, and I would expect it to increase over the next couple of decades, and some populations are already underserved, but most of the needs are already filled by home care nurses, and if there were really a huge demand for in-home primary care, I think you'd see more services like this one: Metro Medical. So the business model exists, but it seems like there'd be a lot more of this if the demand was really there.
- Reimbursement: I see this as the least of the challenges, probably, but still a challenge nonetheless.
- Lack of interest: Universities are not going to develop and set up expensive new graduate educational programs for a small handful of students. There would need to be a significant demand for such programs, and I don't see there being nearly enough paramedics with both the interest and requisite undergrad education to justify the cost to the universities.
Rather than starting from scratch, the most realistic option might be something like convincing a PA program to design a somewhat-abbreviated "paramedic track" program for paramedics with appropriate undergrad education. This program would take into account and grant credit for paramedics' existing knowledge and skill sets, and would focus on in-home primary care and perhaps even medical direction of paramedics. That would be a tough thing to set up, and would require the strong support of stakeholders in the healthcare community.
