Could EMS lead to being a PA

Missouri has a bill on the table to set the groundwork for a Paramedic Practitioner license.
 
It will never be sensible or efficient under the American healthcare system unless you have a severely limited scope and severely limited pay (think RN pay). Otherwise, why would you not just go to normal PA school?

Prescribers in buildings can see way more patients (and have better diagnostic tools) asking patients to use their time to travel to the appointment rather than the prescriber spending time driving between patients. The margin is not small.

Just about the only prescribers doing home visits are concierge docs or VA home health NPs.
 
Summit said:
It will never be sensible or efficient under the American healthcare system unless you have a severely limited scope and severely limited pay (think RN pay). Otherwise, why would you not just go to normal PA school?

Prescribers in buildings can see way more patients (and have better diagnostic tools) rather than spending their time driving between them. The margin is not small.

Just about the only prescribers doing home visits are concierge docs or VA home health NPs.
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I think maybe you've missed the point. The idea of a Paramedic Practitioner is not to have the "PP" in the field, but rather in a facility like a urgent care or ER. The Paramedic Practitioner is proposed to be equal in practice to a PA, just with a different education path to get there.
 
NPO said:
I think maybe you've missed the point. The idea of a Paramedic Practitioner is not to have the "PP" in the field, but rather in a facility like a urgent care or ER. The Paramedic Practitioner is proposed to be equal in practice to a PA, just with a different education path to get there.
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Why do you want to create an ER specific mid-level just for medics who don't want to go to PA school? What do you get that you don't get from a PA or NP? Is there a shortage or just going for cheaper?

That's a super EMS way of thinking. It's hilarious if it isn't sad: "we can do it cheaper with less." Why is EMS where it is? That mindset is a huge part.
 
Summit said:
Why do you want to create an ER specific mid-level just for medics who don't want to go to PA school?

That's a super EMS way of thinking. It's hilarious if it isn't sad: "we can do it cheaper with less." Why is EMS where it is? That mindset is a huge part.
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I'm not saying I do. But it does seem way more appropriate than the FNPs we are using to treat MIs and traumas now.

It also allows a convenient "escape path" for paramedics who want to get out of the field. Going from paramedic to Paramedic Practitioner would be more akin to a bridge program (with some extra foundational work obviously) rather than starting a PA program from the ground up.
 
NPO said:
I'm not saying I do. But it does seem way more appropriate than the FNPs we are using to treat MIs and traumas now.
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A paramedic who goes to PA-school-light is more appropriate than the ER/ICU nurse who goes to NP school or the paramedic who goes to PA school? Please explain...
 
Summit said:
A paramedic who goes to PA-school-light is more appropriate than the ER/ICU nurse who goes to NP school or the paramedic who goes to PA school? Please explain...
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There is your flaw in thinking. It's not proposed as "PA school light".

Is NP the nursing version of PA school light? Paramedic Practitioner is literally just NP for paramedics.

It's a mid level provider with a focus on emergency care, rather than say, family practice.

In my local ED we have several FNPs working as providers, and none of them had ER/ICU backgrounds prior to working in the ED (and it shows sometimes).
 
I’ll be blunt, I don’t see the point.

Nothing is stopping a medic from going to PA school. Creating a bridge is going to have limited purpose, PA school is pretty rigorous and requires a bachelors before starting a masters degree. The percentage of PAs who were former paramedics is small.

While NPs build on prior nursing education and experience, PA programs are designed to take someone with no clinical education and make them a competent provider. If EMS is made into a prerequisite for an ED PA you are removing a lot of very good PAs from their current model of practice.

The article itself is a bit misleading. In one diagram MAs are put under nursing, but in fact they are unlicensed assistive personnel who work under a medical providers license. Pay varies greatly by region, but I wouldn’t set a general expectation to make 120k as a NP or PA working regular time in most systems.
 
NPO said:
There is your flaw in thinking. It's not proposed as "PA school light".

It's a mid level provider with a focus on emergency care, rather than say, family practice.
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PA educate as generalists who specialize.

RNs are educated as generalists who then specialize.
NPs are still generalists with a semi-specialist focus in education.

Paramedics are trained specialists.

This paramedic practicioner thing takes a specialist who then do further specialist education. I'm not convinced that is a great plan for the now pigeon holed practicioner or their patients.
 
NPO said:
I'm not saying I do. But it does seem way more appropriate than the FNPs we are using to treat MIs and traumas now.

It also allows a convenient "escape path" for paramedics who want to get out of the field. Going from paramedic to Paramedic Practitioner would be more akin to a bridge program (with some extra foundational work obviously) rather than starting a PA program from the ground up.
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NPO said:
There is your flaw in thinking. It's not proposed as "PA school light".

Is NP the nursing version of PA school light? Paramedic Practitioner is literally just NP for paramedics.

It's a mid level provider with a focus on emergency care, rather than say, family practice.
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Most NPs who work in EDs are seeing ESI 3-5 to free up docs to see 1 and 2s. Most ED NPs have a background as a nurse either in the ED or ICU. Because the NP market is now so competitive most applicants will either need to have a strong prior history or FNP with ENP or AGNP-AC/PNP-AC.

While NP programs typically have fewer clinical hours they require a bachelors of nursing. PA programs are designed to take a applicant with a strong academic but no or very limited clinical experience and make them into safe providers.
 
NPO said:
There is your flaw in thinking. It's not proposed as "PA school light".

Is NP the nursing version of PA school light? Paramedic Practitioner is literally just NP for paramedics.
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It is a cool concept but I do not really see the need to create a separate pathway when a medic with a bachelors degree and apply to a traditional PA program and specialize in EM. This discussion is putting the cart before the horse when the general standards of EMS education needs to greatly improve to even begin to justify it.

NPO said:
It's a mid level provider with a focus on emergency care, rather than say, family practice.
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That is what EM PAs, ACNPs, and ENPs are
 
I know in the US Military and especially the US Navy, they have an Independent duty Corpsman. Could this be what they are looking at bringing from the US Navy.

For example, Surface Force Independent Duty Corpsmen serve as the Medical Department Representatives aboard surface ships, with Fleet Marine Force Units, and isolated duty stations, independent of a medical officer. Perform diagnostic procedures, advanced first aid, basic life support, nursing procedures, minor surgery, basic clinical laboratory procedures, and other routine health care. Manage preventive medicine and industrial health surveillance programs, and associated shipboard administrative and logistical duties. Provide health education to junior medical and all nonmedical personnel. Perform patient care and medical management functions. Senior medical personnel assigned to shore and operational units provide medical assistance, training, and inspection services for the crew.
 
I think the other reality is you need to look at the dollars. There is going to be a balance between cost and reimbursement.

If we staff an ambulance with an EMT and a medical provider (PA, some form of independent paramedic practitioner, NP) we are substantially increasing the cost of service when they will probably be seeing roughly the same patients. If they are still transporting these patients then I think it is hard to argue increased billing when there are CCT and HEMS programs can often perform the same advanced interventions (chest tubes, invasive lines, et cetera) performed by medics and nurses.

If you are putting a medical provider in a fly car to go see patients at home then you are creating something we already have, look at companies like dispatch health. If that fly car is providing advanced intervention then why not just use a CCT or HEMS crew to get the same result?

If you compare hospital salary you have to consider the billable hours of work being done. I make more in nursing but I’m taking care of 1-3 patients in the ICU, PICU, or NICU at a given time. If I’m in the ED I average 3-4 patients, but I’ve certainly had 8 or 9 on several occasions with mass casualty situations. Floor nurses are providing care to 6 or so patients at once. In the times that we are using multiple nursing staff for a patient we are typically getting reimbursement for trauma alerts, acuity based billing, ECMO services, et cetera. For an average ICU patient we are billing about 3K for a daily bed fee for an acuity of a 2 patient assignment. Keep in mind that this does not include billing from medicine, pharmacy, therapies, billable supplies, et cetera. In some cases we have billed over 100k for a single ED visit (trauma alert, MTP, OR procedure at the bedside).

Comparatively in EMS I saw an average of about 3 patients a day but you were paying for me and my partner. Certainly many systems are busier, but if a crew sees 10 patients a day you are still looking at five a piece. I think our average reimbursement was 1200 or so, but that was all in and included drugs, disposables, and so on.

Do the financials of paying an ambulance provider $60 plus an hour in regular time really make sense? That PA-ish person would probably have well under 5-10 billable contacts in a shift (and I think that is being very generous), but a PA in clinic might see 15 or so patients in 8 hours of clinic or 20+ in a 10 hour ED shift.
 
Kavsuvb said:
I know in the US Military and especially the US Navy, they have an Independent duty Corpsman. Could this be what they are looking at bringing from the US Navy.
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IDCs, 18Ds, PJs, and so on typically fill a role in remote areas with small units (think SOF operations or rescue) or as a bridge to medical care where there is typically no acute disease (on a sub or small ship). These situations are exceedingly rare in civilian medicine, the vast majority of EMS calls are within a short proximity of a medical center.

Also most military medics and corpsmen are caring for healthy young adult who have a single disease presentation (appy, GSW, dehydration, et cetera). They don’t see, with very rare exception, patients with multiple comorbidities and chronic diseases. When they do provide care to civilians outside of forward deployments they have a much more limited role (for example if a IDC is caring for a family member during a clinic visit) typically to a level we would see for civilian AEMTs or maybe a paramedic.
 
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Got news for you: paramedics aren’t that much of a skilled professional. You have medics graduating with zero EMT experience, slug medics, monkey skilled medics, etc.

Until you improve the standards to attend paramedic school, and get rid of the assembly line pay to play programs, you aren’t going to have quality.
 
Peak said:
Comparatively in EMS I saw an average of about 3 patients a day but you were paying for me and my partner. Certainly many systems are busier, but if a crew sees 10 patients a day you are still looking at five apiece. I think our average reimbursement was 1200 or so, but that was all in and included drugs, disposables, and so on.
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Damn, I wish I only saw 3 a day... When I was on the truck, we averaged 8 or 9 in 12 hours... some units could average 14 in 12 hours, especially on a hot summer day... the only time I saw 3 a day was when I worked my part time gig in the burbs. or got lucky with a slow night shift.

That all being said, if you want to be a PA, go to PA school. EMTs and paramedics are good in emergencies and can do a lot of skills in certain situations, but there is a lot of situations where the only thing they can do is transport to the ER and provide some pain management.
Summit said:
That's a super EMS way of thinking. It's hilarious if it isn't sad: "we can do it cheaper with less." Why is EMS where it is? That mindset is a huge part.
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Sadly, much of the modern EMS management thinking revolves around this concept, and I agree, it's one of the huge problems with the prehospital healthcare thinking.
 
This is an interesting theory, but IMHO there doesn't need to be another APP pathway. There is already bitter competition between NPs and PAs and adding another to the mix seems like a bad idea.

I echo the above, this can only be considered if we increase the entry barriers and educational requirements for paramedics. Even then there would be additional pre-reqs on top of paramedic school prior to entering "Paramedic Practitioner" school, at which point why not just go through one of the established routes?
 
Perhaps a better question is why do medics seem to gravitate toward RN instead of PA? I believe it is program availability- either the ability to work full-time and attend courses part-time, or the ability to work alongside a full-time program. PA school simply doesn't have that option.

With life going more remote in the Covid world, maybe now is the time to investigate remote delivery of as much of these programs as possible. Most non-clinical courses are capable of being delivered remotely. Even some schools have been forced to get creative with clinicals during the pandemic; perhaps there can be fewer hours in the field (while proving competence) and more remote intense critical-thinking exercises. Not only does it ease the travel burden on students, but also allows programs to utilize the extra field time to educate more students.

Maybe now is the time to create more hybrid or part time PA programs.
 
I do respect and have several P.A.-C friends, I do understand their education as more towards the medical model. Twenty-five years ago, you betta! A lot of former medics pursued as well as PA schools searched for those. I now see many electing either medical school or PA school. Most without any prior medical experience and even the clinical education changing to linked to a specialist making rounds all day.

I again, respect and enjoy working with them. I am pursuing the my DNP for the NP (Dual Role) at this time. It just met my criteria for speciality (Critical Care/ER and with the family as a general background). Each profession has its advantages and disadvantages. Some states do allow NP to practice within their own license, specialty.
 
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