Paramedic Practitioners

You can't really use semantics as the prime backing behind your reasoning. Based purely upon training and education required, your logic is fallacious. They're both midlevels, they both have prescribing rights, and they're both trained to act within their scope of practice. The only difference is the letter of the law and the determination thereof.

To me, PA training is as tough or tougher than nurse prac training, due to being based on the allopathic and osteopathic methods. It's up for interpretation, but that's just me.

At the end of the day, both are midlevel providers who should be able to act within a collaborative relationship with a supervising physician. Just because the letter of the law states things one way, doesn't mean its necessarily the way it should be. If that were the case, we'd still be having tea time and flying the Union Jack.
 
with all due respect, Please read the links I have provided, I said things may differ from state to state, and in new york state, the information is clearly there. the education is different, the work is different, homeo or whatever is not what its about here in NYS, which was what I was talking about, but dont take it from me, go ahead and read it for yourself... the links are to the goverment websites.
 
Again, semantics.

I've read your links. The primary difference in scope of practice is minimal. The only difference is the wording.

In a practical sense, they do the same thing. Educationally, PAs are trained in a medical model, not a nursing model. Both are however, abbreviated forms of what MDs and DOs do.

Homeopathy has nothing to do with it.

Point is. They're both licensed midlevel healthcare providers who act under supervision of a physician. The difference is how much supervision is legally required, and I'm not disputing that.
 
OK, I have taken some text and put it here...

PA: A physician assistant is considered a dependent practitioner working under the supervision of a licensed physician responsible for the actions of the physician assistant.

So you can see, the PA's doctor is RESPONSIBLE for the PA's actions, the PA does as the MD orders him to do.

whereas:

NP: have a collabration. It really isnt like Supervisor / underling.

see here.

http://www.op.nysed.gov/prof/nurse/np-sample-collaborative-agreement.pdf
 
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So basically what you're saying is...

A) PAs are not professionals.

B) Due to the wording of laws created at different times, the amount of supervision required of each is a major factor in how they practice in clinical settings.


First of all, a PA is a licensed professional, trained to provide care to patients. Supervision is irrelevant. That's what they do, functionally.

Second, the amount of supervision has no bearing in how each practices. They both diagnose, both prescribe, and both do procedures within their scope of practice.


To reiterate. The wording of the law, while relevant in theory, is irrelevant in practice. Scope of practice and functional duty are what matter outside of law school and the courts.

Yes. You are right when it comes to how it is worded. That doesn't make up for the functional.similarities both in duty and scope of practice.

My point is, the PA is as much of a professional as a nurse practitioner IN PRACTICE. No more, no less. Nurse practitioners and PAs should operate under the same level of supervision, as midlevel providers.

I am aware this is not how it works, but how it should be. And hopefully, at some point it will change. Until then, as trained and licensed midlevel practitioners, PAs demand the same level of respect as NPs. Again, no more, no less.
 
sir.

PAs are professionals yes.

EMT Basics are professionals too :D

NP are also professionals, and so is my hooker down the street.

"Second, the amount of supervision has no bearing in how each practices. They both diagnose, both prescribe, and both do procedures within their scope of practice. "


I said the PA is not a practitioner the way a MD, DO, or NP or DDS is. the PA is the Physican's Assistant. He does what the MD authorizes him to do.

Yes the MD can authorize him to do everything a MD can do, or nothing more than to get a cup of coffee every day at 4.

Whereas the Nurse practionioner has certification as a practitioner. She works under no one else's authority. the MD collabrator just does as you have read in the PDF link, he is available when the NP is not there so the patient/customers of the NP has a place to go. And he is required to look at SOME the NPs patient records every 3 months to see if things are going smoothly.... If the Collbrator do not like what the NP is doing, he can end the collabratopn ( he should ) and the NP is out of business. but he cannot reduce what she does to getting coffee at 4.

IMHO !!
 
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Your argument lost it's charm when you brought up your hooker.



Back to the topic at hand...

How would you go about implementing a program for paramedic practitioners?

What kind of educational requirements and practical training?
 
Why mot PA traning with an EMS/prehospital residency?
 
Actually not a horrible idea. Just don't know how easy it would be getting a PA on the bus, salary and insurance wise.
 
Double post but Tapatalk won't let me edit.

Thinking about it, too. As far as prehospital PAs, it goes into residency requirements.

You'd have to train the PA as a paramedic along with advanced procedures. Why do 2-3 years PA school and a 2-3 year residency just to do it?


Edit (worked that time): What would you change about the way EMS education works in general?
 
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Just something to think about for those of you that are shooting down the mid level practitioner model. Parts of the UK and Australia already use this model.

Also for those of you who do not know I travel to Denmark twice a month. I have done some ALS ride along time there and also seen there system as a by stander quite a bit. Every priority ALS call gets a BLS ambulance an ALS chase car that contains an M.D. and a Paramedic duo.
 
bstone said:
Yup.



Your thinking is incorrect. PAs act at the same level as NPs. Their licenses are from different state boards but their function is identical. NPs are also required to have a Supervising Physician, tho this MD/DO might be thousands of miles away and only available via carrier pigeon.
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Their function is FAR from identical. NP is a very generalist concept. There are no national standards, and in fact, there are online programs for them meaning NO clinical education past what they might have received in their ASN program. DNP programs in particular are loaded with far more nursing theory and political indoctrination than they are clinically oriented subjects.

PA's can be generalists as well, but many specialize, with some doing residency-type programs after they get their degree. Both their didactic and clinical education is far superior to NP's, and the vast majority of it is clinically relevant. While it's true they have sponsoring physicians, their scope of practice and clinical accumen far exceeds that of 99% of nurse practitioners. PA's have had educational standards and national certification in place for decades. Not so for NP's.
 
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Here's a thought.

Train a paramedic to the bachelors level (BAAS). Call them something like an interventional paramedic.

They could perform minor invasive and clinical tasks under standing orders from a physician medical director. They'd act as the primary lead in transport duties, since they'd be trained to the same level as RN, but with specialization in emergency and transport care.

They wouldn't have prescribing rights per se. This would keep the ambulance as transport to care rather than a mobile clinic and wouldn't infringe on other specialties. They could however administer selective medications under either the standing orders or consultation with the medical director.

Just brainstorming, but thoughts are welcome.

I'd advocate this because
A) there's not always going to be a midlevel who wants to ride the truck.
B) it allows medics to advance their careers and education.
C) the ambulance performs as an ambulance, not as a mobile outpatient clinic.
 
Require a 2 year associates degree at a MINIMUM to become a paramedic.

Offer a 4 year bachelor's degree in pre-hospital emergency medical science. This should include the following courses, in addition to core curriculum:

8 hours of biology including lab
8 hours general chemistry including a lab
8 hours of organic chemistry including lab
8 hours of physics with lab
Anatomy and Physiology I & II with lab

Paramedics who have completed the 4 year bachelor's program, will then take the GRE with biology, cell and molecular biology, and math subject tests added. Students who meet the minimum science and overall GPA threshold (3.25 and 3.5 respectively) and have satisfactory scores on the GRE, may then apply for a competitive specialized Physician Assistant program that is offered at an existing medical school with affiliated PA program.

Entrance requirements should also include a minimum experience criteria, somewhere around 3 years at the advanced level.

The terminal degree would be called something along the lines of:

Master of Physician Assistant Studies with an emphasis on Pre-Hospital Emergency Medicine.

Basically it is the standard MPAS training, with previous experience as a paramedic required and additional emphasis (maybe one additional semester) solely focused on prehospital integration with definitive care.

Also, I'll add, the true value of having a mid level in the field does not necessarily lie with the ability to perform advanced interventions. In fact, show me a paramedic who can load up and get the critical patient to the hospital quickly and alive (hopefully better than they found them), and I am generally happy.

The REAL value lies in the ability to treat and work up non critical patients and avoid them going to the hospital all together. Taking the strain off of the ED and EMS system by doing general work ups for non emergent conditions in the field is highly valuable in my opinion.

EMS and the ED have become a safety net for primary care. The faster we can wrap our heads around that fact, and find an efficient way of dealing with the issue, and hopefully plugging patients with limited resources into a primary care system where they are followed, the faster we can begin to fix this current convolution of primary care and emergency treatment we call the ER.
 
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There are already PA residencies that focus on prehospital care/EMS. And they can cross train for EMT-P.

I do think there should be a medic-PA fast track though. And what you've got looks killer for that.

Thing is though, it turns into mostly academic training from BS on. That's my reasoning behind a BAAS. You can do didactics as well as clinical time, in theory (someone correct me if I'm wrong. I'm not up to date on academia these days).

The BAAS could effectively operate aa field chief then, and would be trained with a combination of book smarts and hands on skills. Maybe an associates + experience or cert requirement (CCP comes to mind)?

And on the subject, I'm very much in favor of all medics being trained to associate level. Improves quality of care (There are plenty of good medics out there that don't have the AAS, not saying that) as well as academic respectability for EMS like what nursing got with the BSN. What's not to like?
 
I'm not advocating a paramedic to PA fast track at all. In fact, the opposite.

The post graduate training should be around 28 months at a minimum after receiving your bachelor's degree.

Also, PA school is not exclusively academic. They have a large number of clinical hours and rotations that must be completed. The clinicals are broad, and intended to give a general survey of the wide array of specialties in the medical community.

Simply having a bachelor's degree, some experience, and a few months of additional training isn't going to cut it.

If medics want prescribing authority, the ability to do advanced procedures and complex work ups on patients, etc. then the education should be comprehensive and include extensive upper level science electives and comprehensive post graduate training, based on a medical school education model, not some sort of hybrid academic/vocational situation (which we currently have....)

Anything short of that and I fear the program will not come close to meeting the educational minimums required of practitioners intending to perform the aforementioned tasks.
 
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The issue with giving medics prescribing rights in practice would be backlash from the existing prescribers. Even with limited rights, it gets into how much is enough and how much is too much.

At the end of the day, medics still operate primarily in the field, either as responders or transport. There's only so much that can be done in the field, and the additional academic training that you propose I can see the point of, but how many medics in practice would want to do masters level work?

As far as complex procedures, there's only so much that a medic can do without a hospital or advanced transport. Doing workups and diagnostics in a field setting without physician oversight brings up all kinds of issues, both with the medical establishment and insurance issues.

I really do see where you're coming from though. I just believe that medics operate in a similar capacity to RNs, just in a different setting with different levels of expertise.

I see medics operating on a midlevel provider level opening up all kinds of opposition. It would be too much too quick. Starting at a bachelors level (I would actually advocate a 5 year bachelors honestly, similar to other professional degrees, like architecture), it would set a standard of operating procedure and a clear scope of practice that EMS doesn't currently have and produce medics trained to lead clinically in the field.

Edit: The five year bachelor would include the two years of medic training plus upper level training in field and clinical specific sciences. Medics wanting to do that could skip the first two years and take on the sciences and clinicals. To make a poor analogy, medics are field and clinical operators, not lab junkies. I'd venture few of us have the attention span for the sheer volume of science and math needed to operate in transport and response settings.
 
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thank you

WTEngel said:
Require a 2 year associates degree at a MINIMUM to become a paramedic.

Offer a 4 year bachelor's degree in pre-hospital emergency medical science. This should include the following courses, in addition to core curriculum:

8 hours of biology including lab
8 hours general chemistry including a lab
8 hours of organic chemistry including lab
8 hours of physics with lab
Anatomy and Physiology I & II with lab

Paramedics who have completed the 4 year bachelor's program, will then take the GRE with biology, cell and molecular biology, and math subject tests added. Students who meet the minimum science and overall GPA threshold (3.25 and 3.5 respectively) and have satisfactory scores on the GRE, may then apply for a competitive specialized Physician Assistant program that is offered at an existing medical school with affiliated PA program.

Entrance requirements should also include a minimum experience criteria, somewhere around 3 years at the advanced level.

The terminal degree would be called something along the lines of:

Master of Physician Assistant Studies with an emphasis on Pre-Hospital Emergency Medicine.

Basically it is the standard MPAS training, with previous experience as a paramedic required and additional emphasis (maybe one additional semester) solely focused on prehospital integration with definitive care.

Also, I'll add, the true value of having a mid level in the field does not necessarily lie with the ability to perform advanced interventions. In fact, show me a paramedic who can load up and get the critical patient to the hospital quickly and alive (hopefully better than they found them), and I am generally happy.

The REAL value lies in the ability to treat and work up non critical patients and avoid them going to the hospital all together. Taking the strain off of the ED and EMS system by doing general work ups for non emergent conditions in the field is highly valuable in my opinion.

EMS and the ED have become a safety net for primary care. The faster we can wrap our heads around that fact, and find an efficient way of dealing with the issue, and hopefully plugging patients with limited resources into a primary care system where they are followed, the faster we can begin to fix this current convolution of primary care and emergency treatment we call the ER.
Click to expand...

This looks like the only intelligent post in this whole thread.

But I have to say, with all of those requirements it is probably easier to just become a doctor.

Maybe we just need more of them rather than all of this pseudo-practicioner midlevel stuff?
 
Veneficus said:
This looks like the only intelligent post in this whole thread.

But I have to say, with all of those requirements it is probably easier to just become a doctor.

Maybe we just need more of them rather than all of this pseudo-practicioner midlevel stuff?
Click to expand...

I agree, but mid level providers are cheaper right? At least that's what we've been told in school. In terms of NP vs MD/DO

bstone said:
I don't know if this sort of paramedic would find a strong enough demand in order to make it a reality. I would strongly support an EMS "residency" for NPs and PAs.
Click to expand...

I think this would be awesome!
bstone said:
I think the point of a paramedic practitioner would be to initiate very advanced interventions in the field. What would those be? I imagine things like starting central lines, general anesthesia, cracking a chest, chest tubes, thrombolytics, antibiotics, etc etc. In the cases where someone is too sick to get out of bed but doesn't need an ER workup they would be able to examine, diagnose, and prescribe treatment independently of an ER physician (or NP/PA).
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Omg my skin crawled just thinking about doing a CVC in some of the filthy houses I've stepped foot in. I do however think that for the 99% of bs calls or at least seem like bs at first having a PP/PA whatever doing assessments like say the people who call 911 for a tooth abscess x 2 weeks , 2months whatever... The PP could assess them and say either ya you need serious medical intervention or go to a dentist in the morning or here's an rx for norco for pain/ abx for the infection, & be done with it.
 
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