Why are we often looked down upon as a profession?

[Carlos Danger]

that's kinda my point..... if the entry level bar is the NREMT-P, should we make the curriculum harder or longer, or raise the bar, making the program who aren't long enough or hard enough die because they aren't preparing their students enough for the exam.

I don't think so, personally. Assuming that the exam (either the NCLEX or the NREMT) actually does a good job of ensuring basic competency, then I think that's all we need in an entry level board exam and frankly anyone who can demonstrate that competency should be admitted, regardless of the type of educational preparation they have.

I actually like the fact that there are several options available for entry into nursing. I think a BSN is ideal for a career / profession minded person, but I also think that as long as folks are learning what they need to learn to be safe and competent, they should have options.

 

[DrParasite]

Gotcha! I think the field supe concept differs from place to place. My service has something similar. FDNY, though, for example, puts field supervisors in nifty pickup trucks and they drive around not doing too much patient care (anecdotally).

A supervisor belongs in a flycar, not on an ambulance. if a supervisor is on an ambulance, they are supervising that ambulance, not a shift. for a department that only has one ambulance in service, sure, but bigger systems should not have supervisors permanently assigned to an ambulance, because while you are transporting that non-emergency patient, you are unable to respond to the major MCI.

Wake's APP, perhaps?

ehhh, they deal more with fall prevention and overdoses, with the occasional high risk refusal (plus a ton of non-emergency stuff).

Assuming that the exam (either the NCLEX or the NREMT) actually does a good job of ensuring basic competency, then I think that's all we need in an entry level board exam and frankly anyone who can demonstrate that competency should be admitted, regardless of the type of educational preparation they have.

That was kind of where I was going with that (and it runs contrary to everyone who says paramedics need a 2 year or 4 year degree): if you have the knowledge to pass the basic exam, why should it matter how long you went to school, or what degree you have... if you have enough basic competency to pass the basic competency to pass the exam, shouldn't you get your P card?

 

[EpiEMS]

A supervisor belongs in a flycar, not on an ambulance. if a supervisor is on an ambulance, they are supervising that ambulance, not a shift. for a department that only has one ambulance in service, sure, but bigger systems should not have supervisors permanently assigned to an ambulance, because while you are transporting that non-emergency patient, you are unable to respond to the major MCI.

No disagreement here - supes belong in a fly car for sure.

That was kind of where I was going with that (and it runs contrary to everyone who says paramedics need a 2 year or 4 year degree): if you have the knowledge to pass the basic exam, why should it matter how long you went to school, or what degree you have... if you have enough basic competency to pass the basic competency to pass the exam, shouldn't you get your P card?

I think there is a distinction between baseline clinical/practical competency and the actual work of paramedicine/[insert profession here]. Why have a degree program at all if you can pass the exam? An exam is another barrier to entry, sure, but it is only one of many designed to weed people out. There is something that an exam cannot do that school can: exams don't test certain cognitive and personality traits very well (empathy..."stick-to-itiveness"...leadership...), and there are some of those that we ought to be monitoring.

Look, realistically, anybody (with enough study time) could take and pass pretty much any exam. Exams are great, but they aren't the be-all and end-all of assessments, especially in fields like EMS where basic human traits (empathy, etc.) matter.

 

[VentMonkey]

My personal opinion is ALL paramedics belong on fly cars, but I digress. You know one simple distinction between the EMS field, and nursing is summed up with one word, and a class they seem to focus on: ethics.

When was the last time we could all look at our respective EMS peers and say across the board we all abide by them? It's something that is seemingly, and appropriately emphasized with most medical professionals. Most importantly, it is taken seriously by them.

And no, I am not referring to a watered down oath, or mantra. I mean, again, portraying these ethics wholeheartedly to the point that there's no doubt what one's interpretation of "patient advocacy" implies. For some odd reason it is easier said than done within the EMS community.

 

[EpiEMS]

For some odd reason it is easier said than done within the EMS community.

Lack of training, lack of emphasis, lack of QI...the reasons go on and on. Of course, more education and professional autonomy (i.e. self regulation once the education is in place) would go a long way towards addressing that - when we can discipline our own and not worry about what non-EMS providers expect, we can really push harder for more vocal patient advocacy (e.g. "No, Doctor, we did not apply a backboard to this patient because [insert one of the myriad reasons here], and you can do what you like, but it is not indicated."). For employees, unions would help us at this, and I'm usually no fan of unions.

 

[DrParasite]

You know one simple distinction between the EMS field, and nursing is summed up with one word, and a class they seem to focus on: ethics.

When was the last time we could all look at our respective EMS peers and say across the board we all abide by them? It's something that is seemingly, and appropriately emphasized with most medical professionals. Most importantly, it is taken seriously by them.

yeah, because those who are more educated never do anything unethical....
http://www.nj.com/news/index.ssf/2015/04/umdnj_whistleblower_cases_cost_rutgers_nearly_2m_i.html
http://www.nj.com/news/index.ssf/2009/09/umdnj_to_pay_83_million_to_set.html / http://www.nytimes.com/2006/11/24/nyregion/24hosp.html
https://www.ahcmedia.com/articles/102211-problems-at-umdnj-not-likely-a-surprise-to-leaders
http://www.dailymail.co.uk/news/art...-hospital-guilty-neglect-abuse-face-jail.html
http://www.foxnews.com/us/2017/02/0...er-va-scandal-ranked-among-nations-worst.html
http://www.medicaldaily.com/drug-scandal-colorado-hospital-3000-hiv-positive-388726
http://www.lamag.com/longform/kickb...nd-californias-largest-medical-fraud-scandal/
https://www.revealnews.org/article/...in-kickback-scheme-looks-to-spread-the-blame/
http://www.nbclosangeles.com/news/l...CEO-Charged-in-Insurance-Fraud-247193111.html
http://cironline.org/reports/california-doctors-used-fake-hardware-spine-surgeries-lawsuits-say-6523
http://www.mirror.co.uk/news/uk-news/victorina-chua-nhs-nursing-scandal-5726241
http://www.dailymail.co.uk/health/a...rses-earn-2-000-shift-drain-NHS-millions.html


so how are valuable were those ethics classes? I'm sure everyone involved in them passed their ethics class.......

 

[Summit]

^Some nice anecdotes you have there...

Now nobody said other professions were perfect.

What was the point you were attempting to make?

 

[VentMonkey]

so how are valuable were those ethics classes? I'm sure everyone involved in them passed their ethics class.......

About as valuable as they made them out to be. Clearly these exemplify nothing more than what's true with mankind in general. Regardless of a chosen career path no one is immune to foolishness.

I'm not saying it's some foolproof barrier to prevent malpractice, erroneous behaviors, or plain dubious providers. What I am saying is our focus as a "profession" does not reflect professionalism in general. Is nursing more right than EMS? Hardly. There is no more right than the other, but how can we not learn from other professions when their curriculum at least chooses to focus on an approach that seems both realistically applicable, and generally lacking in the EMS community.

There has to be a way other than over glorifying the "coolness" of a select few calls we see to convey the realities of this job regardless of our entry requirements. Again, living in the now, not dwelling on past mishaps, or constantly looking to the future.

 

[Carlos Danger]

That was kind of where I was going with that (and it runs contrary to everyone who says paramedics need a 2 year or 4 year degree): if you have the knowledge to pass the basic exam, why should it matter how long you went to school, or what degree you have... if you have enough basic competency to pass the basic competency to pass the exam, shouldn't you get your P card?

I agree.

When I started the Excelsior College nursing program in 2004, they had a slogan that went something like "the knowledge you possess is more important than where or how you acquired it". That idea is the basis for their non-traditional nursing programs, and also why I always thought it was stupid for RN's with certain backgrounds to have to complete an entire paramedic program to work in the field, and vice versa. It is also much of the basis for the libertarian argument that we shouldn't even have professional and occupational licensing by the government, but that's a whole other topic of course.

As much as I think anyone who can do the job should be allowed to do the job, there is clearly a market for higher levels of education, too. If hospitals prefer to hire BSN's, for instance, because of a perceived increased level of competency in areas aside from basic clinical nursing, that's not a bad thing at all. Market demand really should be a big influence on people's decisions about how much education to invest in; the fact that we got away from that quite a while ago is a big part of the reason for the student loan debt bubble and the devaluing of 4-year and higher degrees in many fields. But that's another topic, too.

 

[EpiEMS]

also why I always thought it was stupid for RN's with certain backgrounds to have to complete an entire paramedic program to work in the field,

I'm generally sympathetic to this - as long as the exams are passed. Would you agree that there is value inherent in, say, the field rotations for non-prehospital/flight/CCT RNs (i.e. given the differences between in-hospital and out of hospital conditions)? These are the sort of non-cognitive skills that a bridge program may help with (or not, as the case may be), in my mind.

 

[Carlos Danger]

Here's an important thing to consider for those who want to see educational minimums for paramedics to increase:

The industry EMS can do that by itself. It doesn't have to wait for the NHTSA to mandate 2-year degrees for paramedics. If more paramedics sought 4-year degrees, more schools would offer those programs. If there were more options for 2- and 4- year degrees in EMS, more paramedics would do them. Those paramedics would be more competitive and would put pressure on the rest of the members of industry to increase their levels of education, which in turn would create more demand for degree programs, which would make them more numerous and convenient.

That's basically what happened in nursing over the past 20 years. BSN programs became common and the percentage of RN's graduating with a BSN exploded long before hospitals started to mandate that level of education. And it still isn't required for licensure. People often say that EMS can learn from nursing; that's probably the best example there is of something that the nursing industry did that the EMS industry can and probably should do as well.

 

[Carlos Danger]

I'm generally sympathetic to this - as long as the exams are passed. Would you agree that there is value inherent in, say, the field rotations for non-prehospital/flight/CCT RNs (i.e. given the differences between in-hospital and out of hospital conditions)? These are the sort of non-cognitive skills that a bridge program may help with (or not, as the case may be), in my mind.

Well yeah, there has to be some way to show competency. Exams are far from perfect, but I don't think anyone has found a better way. As for field rotations to fill in the gaps in experience, sure, if they are needed. That should be between the clinician, the employer, and any relevant accrediting agency, though. I'm not a fan of arbitrary government regulations that say "nurses can't work in the field without a paramedic license, and they can't get a paramedic license without attending a full paramedic program" regardless of how much relevant knowledge and experience they may have gained somewhere else. Those regulations (almost all licensing laws, in fact) have origins in protectionism and cronyism and have nothing to do with public safety.

 

[EpiEMS]

@Remi, I'm with you 100% on these points. That said, (just to put it out in the open) there are many corollaries introduced, in theory, by this approach that many stakeholders (e.g. nursing unions) would not be amenable to (paramedics in the ER, say), so such an approach to addressing licensing laws has its (political) problems.

The industry EMS can do that by itself. It doesn't have to wait for the NHTSA to mandate 2-year degrees for paramedics. If more paramedics sought 4-year degrees, more schools would offer those programs.

Demand creates its own supply in a sense -- 100% agreed here, too!

 

[MonkeyArrow]

I'm not a fan of arbitrary government regulations that say "nurses can't work in the field without a paramedic license, and they can't get a paramedic license without attending a full paramedic program" regardless of how much relevant knowledge and experience they may have gained somewhere else. Those regulations (almost all licensing laws, in fact) have origins in protectionism and cronyism and have nothing to do with public safety.

So do you think the converse should be allowed too (paramedic to nurse)? Can you clarify your point as to how much, if any, education should be required in your mind to be eligible for hire/certification? Should an aspiring doctor forego medical school, but if able to pass Step 1, Step 2 CS/CK, Step 3, be board eligible?

 

[Carlos Danger]

@Remi, I'm with you 100% on these points. That said, (just to put it out in the open) there are many corollaries introduced, in theory, by this approach that many stakeholders (e.g. nursing unions) would not be amenable to (paramedics in the ER, say), so such an approach to addressing licensing laws has its (political) problems.

Oh of course it has political problems - that's why the laws exist in the first place. Licensing laws aren't going anywhere.

 

[EpiEMS]

So do you think the converse should be allowed too (paramedic to nurse)? Can you clarify your point as to how much, if any, education should be required in your mind to be eligible for hire/certification? Should an aspiring doctor forego medical school, but if able to pass Step 1, Step 2 CS/CK, Step 3, be board eligible?

This is way off topic, but the marketplace would govern. Would you go to a "physician" who has no medical education but passed the exams? Would you hire a "paramedic" who passed NRP but didn't ever take a class or step foot on an ambulance?

 

[Carlos Danger]

This is way off topic, but the marketplace would govern. Would you go to a "physician" who has no medical education but passed the exams? Would you hire a "paramedic" who passed NRP but didn't ever take a class or step foot on an ambulance?

Exactly. There are still non-governmental certifying bodies (the NREMT, or the NCSBN, for instance) who objectively verify education and competence. If medical licensing laws went away entirely, it's difficult to imagine that much would really change. Insurance payors, accrediting bodies, and employers would still require verification of training and competence, which would be provided by non-governmental certifying boards and/or credentialling services. But without the clumsy, protectionist laws in the way, competition between credentialing agencies would demand flexibility and allow for innovation and new approaches to education.

Physicians in Europe are educated quite differently and in a significantly shorter period of time than here in the US. Are they unqualified just because they aren't educated the American way and aren't licensed in the US? There are lots of qualified doctors from overseas who can't practice in the US for no reason other than the fact that there educational institutions were not accredited by the ACGME, which intentionally keeps the supply of doctors educated in the US low as compared to demand. Of course they tell us it's for our own good; that we need the government to keep us safe because we aren't capable of making rational decisions on our own. But in reality, it is pure protectionism.

 

[MackTheKnife]

@Remi, I'm with you 100% on these points. That said, (just to put it out in the open) there are many corollaries introduced, in theory, by this approach that many stakeholders (e.g. nursing unions) would not be amenable to (paramedics in the ER, say), so such an approach to addressing licensing laws has its (political) problems.



Demand creates its own supply in a sense -- 100% agreed here, too!

Actually, supply creates its own demand. Sayes' Law of economics.

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[EpiEMS]

Actually, supply creates its own demand. Sayes' Law of economics.

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Say's law is a major point of, shall we say, theoretical contention in macro theory, and the idea of Say's law is wayyyy broader than this (i.e. aggregate demand always must equal aggregate supply in the [insert time frame here based on your ideological stripes...obviously it is true in the long term] run)..I could go on and on, but this isn't the place. The point remains...if more people wanted degrees in EMS, more programs would emerge (or the total number of seats would grow), at least in the short to medium term


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[MackTheKnife]

Say's law is a major point of, shall we say, theoretical contention in macro theory, and the idea of Say's law is wayyyy broader than this (i.e. aggregate demand always must equal aggregate supply in the [insert time frame here based on your ideological stripes...obviously it is true in the long term] run)..I could go on and on, but this isn't the place. The point remains...if more people wanted degrees in EMS, more programs would emerge (or the total number of seats would grow), at least in the short to medium term


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Epi, you are da man! Great recitation of Eco 101! Seriously, bro! Just wanted to realign the two terms in proper alignment.

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