PAs and NPs are needed. Do you really need ten years of education to order an X-ray, proscribed a medication to treat an uncomplicated patient, or suture? These are paramedic-level skills, or could be. Why not have a PA doing this?
The problem is not treating, it is knowing what you are looking at to start treating properly.
Organ systems are connected, your heart problem causes renal and liver problems, and they all have to be explored in order to come up with the best treatment options.
Then there is the issue of not knowing what you don't know. A problem very obvious in EMS.
Infact I just a saw a patient a few days ago who was being managed by a medic for his injuries for 16 days on flexeril and motrin. Back pain was still there, and when I ran his kidney function labs, they were all out of whack.
Why did I run his renal function tests? Because I know ibuprofin affects renal function in high dose. I also understand volume of distribution and pharm kinetics. So I equate long term usage with high dosage.
Paraspinal backpain is rather easy to manage. Sometimes you must change or escalate treatment. Medicine is not one size fits all.
Along the same line, I saw a patient who fell down the stairs, who was managed by a PA for 7 days on the same treatment regiment. WHen I saw him, I reduced his dislocated shoulder, found his clavical fracture, and the intercapsular injury to his wrist.
It was not that the PA made a terrible mistake, he was doing the best with what he had and knew.
I have and know a little bit more.
But it doesn't change that he would have been better off coming to me first. Laying 7 days in your bed with pain, a fx, dislocation, and likely second fx which is not diagnosable until bone healing is seen on x-ray weeks later, taking 800mg motrin, the PA as the provider of first resort is simply not good enough. (especially when he thought it was just a muscle-skeletal injury)
Like I said, the PA did his exam, started following his normal management routine, and didn't even know about the specifics of the wrist injury. He cannot be faulted.
(Those are the most recent stories, but I have many more.)
Simple is not always as simple as it looks.
Another true story, pt diagnosed with topical dermatitis, managed appropriately for such condition without improvement for years.
Final diagnosis when symptoms failed to resolve? Follicular Muscinosis, a precursor legion to T-cell lymphoma.
Do you think that changes treatment and severity?
I can train any paramedic to treat simple problems, it doesn't require a "mid level" provider. That makes them an unecessary expense. But I cannot "train" somebody to critically think about conditions and complications they have never heard about. Similarly a person cannot be trained to think about unusual presentations or unknown origins unless they have extensive understanding on the workings of the whole body.
That is a body of knowledge unique to medical education.
When a PA or NP Dx renal stenosis as a cause of HTN (a rather common problem) you know the treatment?
Refer to physician.
Then treatment begins.
In such cases, and there are many more, the mid level provider is just a waste of time and money before the patient sees a doctor.
