Paramedic Practitioners

[Veneficus]

Anecdotes do not evidence make.

Neither does studying what you are doing and calling it a measure of effectiveness.

Most people can demonstrate they effectively do what they do very well.

You can even generate good numbers when you compare when people above your level do the same thing.

But you cannot compare how well you do compared to people who operate above your level.

I have no doubt that a PA can follow a treatment guidline as well as any doctor that does. Because ay moron off the street can.

Knowing when you are looking at the exception and modifying treatment accordingly or novel treatment in resistant patients is a much different matter.

Let me know when you find a study that shows PAs do that just as well as a doctor, so we can shut down every medical school in the world with it.

Edit: I am sure we could demonstrate car mechanics fix cars as well if not better than mechanical engineers.

 

[EpiEMS]

Neither does studying what you are doing and calling it a measure of effectiveness.

Most people can demonstrate they effectively do what they do very well.

You can even generate good numbers when you compare when people above your level do the same thing.[/QUOTE]

There's not many unbiased studies, surely, and lots of them have been done by people with clear-cut incentives one way or another (i.e. DNPs studying efficacy of NPs vs MDs).

But you cannot compare how well you do compared to people who operate above your level.

I'm hard pressed to think about how to study that. Though there's research on the topics of patient education, namely, where RNs do a much better job than MDs.

Edit: I am sure we could demonstrate car mechanics fix cars as well if not better than mechanical engineers.

As a whole, yes, you're right. PAs are not a replacement for physicians, but they do serve a useful purpose – and I wouldn't advocate removing MDs from the loop, obviously, but I am trying to encourage the recognition of a place for midlevels, especially because of how cost-effective they are.

 

[Arovetli]

because of how cost-effective they are.

You get what you pay for.

 

[EpiEMS]

You get what you pay for.

Yes and no. Medical care is a weird market - there's all kinds of perverse incentives and there's lots of asymmetric information. Plus, PAs aren't supplements for physicians, just a compliment for them.

 

[Arovetli]

Yes and no. Medical care is a weird market - there's all kinds of perverse incentives and there's lots of asymmetric information. Plus, PAs aren't supplements for physicians, just a compliment for them.

The argument for inclusion of midlevels in healthcare generally revolves around midlevels billing at lower rates and quicker and cheaper to educate thus lending an economic advantage and consumer misinformation over the utility of the product. Oh I agree, there is alot of perverse things occurring in medicine, especially when it comes to misleading patients as to the abilities of the midlevel provider.

The "economic advantage" is created by an inferior product and dubious marketing practices. Quantity and propaganda over quality.

Please clarify your last sentence so it can be properly addressed.

 

[Veneficus]

Yes and no. Medical care is a weird market - there's all kinds of perverse incentives and there's lots of asymmetric information. Plus, PAs aren't supplements for physicians, just a compliment for them.

Actually, I blame doctors for this one.

If they did their job instead of worrying about how much money and how much vacation they got, then there wouldn't be a need of any midlevel outside of a remote or austere environment.

The next time I hear one of my EM friends complain about how hard they have it working (2) 12 hour clinical shifts and then an 8 hour office shift, I will remember to shed a tear.

Not because I don't have an appreciation for their efforts, but because a 32 hour work week for the money they get is rather light in my opinion, especially when the hospital has to then hire additional midlevels for coverage.

As I stated above, if an inpatient is being seen by a midlevel, either the physician or midlevel should forgo any compensation for repeating the same service.

The place for a midlevel is where there is no doctor and they are better than nothing. Not working next to a doctor or "lightening" the load. If there are more patients then doctors, the solution is another doctor, not forcing lesser care on unsuspecting patients.

 

[MichMedic1]

Well I have read this entire discussion and it has been enlightening for many reasons. First of all, I must qualify my comments by saying that I am an EMT (Basic) with exactly one year of experience & a former medical coder with 7 years of experience, so my opinions might change in the future. For now, I believe that NPs are not qualified to treat much more than common, chronic & acute conditions. I believe that PAs are a little better than NPs in terms of "medical" treatment. I do not believe we can compare them to each other because they are trained very differently from each other. The real problem is the shortage of qualified physicians due to the constraints of our medical schools. Class sizes do not allow an influx of new students, which prevents us from having larger numbers of doctors in training. I don't think we can blame any other group for that issue. I became an EMT because I want to work in medicine but I don't personally want to be a doctor. Nursing classes have 3+ years of waitlists, PA school is accepting students that claim they want to work in areas of need- but then go the parts of the country that already have plenty of providers (liars), and medical school is ridiculously difficult to get into because of the limited number of students they are able to accept. So here I am wanting more education, but with limited options. Don't get me wrong-- I LOVE EMS! It is fulfilling (even with the low pay), interesting, and my coworkers are awesome! But-- there needs to be more possibility in the future for our "profession" as a whole. Nurses have demanded their roles & then used that leverage to create a terminal practice degree while "we" have submitted ourselves to the underling position. More education would definitely be a plus, but I know a lot of healthcare providers who have a B.S. or Masters and they know LESS about medicine than I do as an EMT. More education is intended to teach students more information, but what we get are people who did well in their gen-ed classes and borderline in their healthcare classes. More years in college does not always equal more knowledge--- just more people who think they're important & who got into medicine for the power or the money or both. As far as Paramedic Practitioners go-- I say yes! But not for the reasons you might think. I believe that we are going to have to keep putting band aids on healthcare until we see some changes, and maybe allowing paramedics to fill the gap will, in itself, bolster the opinion of others about the professionalism of EMS. There are already some options in place in Alaska that are working well. There is a MICP (Mobile Intensive Care Paramedic) and a CHP (Community health Practitioner). These are different in role and title and are specific to Alaska. MICPs are credentialed through EMS, while CHPs are licensed by the medical board to act in absence of a physician but supervised (long distance by a Dr.). I do not think this would work well in all states, but it is something to research and consider in other areas of the U.S. As far as billing issues go-- I can tell you that they are not double billing, but rather billing 2 halves. The hospital bills for use of equipment, supplies, and beds, while the providers bill for services. This means the radiologist bills for interpreting your x-ray & the hospital/clinic bills for the actual xrays & related equipment. If a PA sees a hospital patient M-Th & a Doc sees the pt. on Fri., then pt. is billed for 85% for the first four days & 100% for one day. You cannot bill both visits on the same day for the same patient (if you do-the men in little black suits WILL show up!). In closing, I respect all of the aforementioned opinions & look forward to future discussions. I am not sure what the answer is but I know with all of this wisdom that we will figure it out.

 

[medicsb]

Many medical schools have increased enrollment and there will likely be around 20 new schools within the next 5 years. Med school will become easier to get into as school will have to dig deeper into the applicant pool to fill spots. And as it is, it isn't THAT hard to get into, it just takes a lot of hard work and dedication.

 

[Veneficus]

I have noticed the bottleneck isn't in enrollment, it is in residency.

It will be a complex problem to sort out because of the pay disparity between different specialties.

While it may on the outside seem like increasing students will lead to hard to fill specialties having people in them (like family med) the real issue is nobody goes into those specialties because of the likelyhood of going bankrupt or working 100x more than say a dermatologist.

Which will of course lead to student loan default and in a few years, graduates who do not get into financially stable (nevermind financially enticing) spots will either leave the country or work in a field outside of clinical medicine.

Everything will be right back where it started.

Some systems pay physicians for years out of school, with specialty specific performance bonuses. Such places do not have the earning potential of the US, but the lack of pay disparity does seem to help balance the needs of providers as well as consumers.

But as a very wise prson I know says:

"five is four" and the US system will inevitably collapse, in all likelyhood during my career.

It is like standing across the river watching Rome burn while the citizens throw gas on the flames.

 

[MichMedic1]

I think that it will help to have more medical schools and spots available for med students. There is a medical school opening near me in 2014, so I think you might be right. I am not sure if it will make a big impact, but here's to hoping!

 

[MichMedic1]

I had not even considered the bottleneck in residency until I read your post. Interesting. I also love the Rome burning analogy-- sad but true.

 

[Arovetli]

I have noticed the bottleneck isn't in enrollment, it is in residency.

The bottleneck is absolutely at the Match. There's D.O. (ABSOLUTELY NOT an MD vs. DO statement) schools proliferating like bacteria with no GME to support them. Current schools are increasing seat size again no GME support. There are currently unfilled FM/peds/IM slots at Nowheresville Community Hospital but even these will fill up in the near future.

Honestly, it is not that hard, an above average intelligence maybe, a propensity for science and superior work ethic, to get into or complete medical school. You just have to be dedicated to it and put in the time...a freaking lot of time.

It is incredibly hard, however, to match certain specialties due to the competition.

Taking a 250K+ debt load, it is hard to entice new doctors into primary care fields when they can pursue other fields with double, triple, quadruple or more the compensation.

And the midlevel assault on primary care is a huge headache new physicians want to avoid which further discourages selecting a primary care career.

P.S., I like your signature....lol

 

[Veneficus]

P.S., I like your signature....lol

I told you I was stealing it fair and square