Paramedic Practitioner: Is this where we should be heading?

[Katiebug]

It's been awhile since I've been here. I still recognize many of you and have been reading your recent conversations.

The last time I was here, around four years ago, I was a paramedic student working for a private service doing mostly dialysis transports. It was either here, or on EMS Village, I was feed a large piece of humble pie. I realized I wasn't so smart and decided to keep my mouth shut and listen until I got some real experience.

Since that time I have been working both municipal and rural 911. I have been peed on, pooped on, vomited on and bled on. I have plugged it, pumped it, breathed it, pushed assorted drugs on it, splinted it and scraped it off my boots. I have worked on everyone from the homeless epileptic to prostitutes to business owners to the mayor's parents. Both of them.

I listened intently to the old medics and picked up the good tricks. I'm aggressive and I believe in fixing people if it's in my scope of practice. I'm on par with you seasoned medics and I'm a competent medic in my own right.

Now I'm getting ready to leave EMS. Why? Look at the most recent thread about unions. In that thread it was noted that we are losing many of our best and brightest because paramedic is the pinnacle of our profession. There's no more room to advance.

I propose that we work toward changing that. As of now, I'll be getting my BSN and going to PA school. If there were a Masters level Paramedic Practitioner program, I'd likely do that instead. There's no reason it couldn't be on the same level as NP or PA.

There's been a lot of talk about education standards. Here's a way to raise the bar. In addition, paramedic instructors should hold a BS in paramedicine. In my area we are taught by other paramedics. Thats not always a bad thing, but I challenge you to find a nursing instructor with only two years of college.

We talk a lot about advancing our field, being understood and taken seriously, unions, salary.... The list goes on and on. What it will take is one of us getting the degree and putting a program together. The rest will follow.

Thoughts?

[ERDoc]

I would love to see paramedic become a college degree. One of the immediate issues will be pay. If you can become a PA or a paramedic in the same amount of time, why would you become a paramedic when you can easily make twice as much as a PA? The issue is much deeper than just someone starting the degree program. They already exist, but in most cases, you don't get any additional compensation. You need to increase reimbusement rates for ambulance services so they can afford to pay more. A governing body needs to be developed, which ACEP seems to be trying to do with it's EMS sub-specialty certification. Who knows, maybe it is the beginning of something good.

[croaker260]

Just look at what wake county is doing with their advanced practice paramedic. We are in the works for something very similar called a community paramedic here. Eventually these will HAVE to be a BS or higher degree. Current paramedic education doesnt cover it, and to be comprehensive and respected it will have to be taught at the university level.

[Katiebug]

Doc, I'm suggesting adding the BS and Masters programs to what we already have. There would be a natural progression just as RNs progress to NP.

Paramedics ride the unit, work in hospitals, etc... BS level studies teaching, management and business, along with advanced medical studies. Paramedic Practitioner would be similar to taking the PA course with a focus on emergency medicine and family practice.

Of course you could specialize, just like PA and NP. Emergency medicine, ortho, oncology, peds, nephrology... Whatever.

Just look at what wake county is doing with their advanced practice paramedic. We are in the works for something very similar called a community paramedic here. Eventually these will HAVE to be a BS or higher degree. Current paramedic education doesnt cover it, and to be comprehensive and respected it will have to be taught at the university level.

Got a link handy? I'd like to see.

[Katiebug]

http://www.wakegov.com/ems/staff/app.htm

Sounds like a cross between a sprint medic and a home health nurse. Not quite what I had in mind, but maybe a step in the right direction.

I just saw this a few minutes ago. The ante has been raised.

[ERDoc]

Doc, I'm suggesting adding the BS and Masters programs to what we already have. There would be a natural progression just as RNs progress to NP.

Paramedics ride the unit, work in hospitals, etc... BS level studies teaching, management and business, along with advanced medical studies. Paramedic Practitioner would be similar to taking the PA course with a focus on emergency medicine and family practice.

Of course you could specialize, just like PA and NP. Emergency medicine, ortho, oncology, peds, nephrology... Whatever.

But if you are going to specialize in those fields, how is it different from becoming a PA? A paramedics field of expertise is in prehospital care, what sense does it make to take them out of that field? Even if it did start to happen, the DNP lobby would shut it down in no time.

[Katiebug]

It's different in the same way that being an NP is different than being a PA. It's bringing a different background to the table. It's advancing a field that has so much more to offer.

Imagine Paramedic Practitioners opening their own clinics. I would go to one.

I think it's inevitable. You are right about the nurses union trying to shut it down though. All good ideas are ridiculed before they are instituted.

[ERDoc]

It's different in the same way that being an NP is different than being a PA. It's bringing a different background to the table. It's advancing a field that has so much more to offer.

Imagine Paramedic Practitioners opening their own clinics. I would go to one.

I think it's inevitable. You are right about the nurses union trying to shut it down though. All good ideas are ridiculed before they are instituted.

I won't start the NP vs PA debate, but I think you are looking at a background that has nothing to do with the field you are trying to enter. A paramedic, by definition, is a provider of prehospital emergency care. They are not providers of primary care, orthopedics, nephrology, etc. By moving into those fields, they are no longer paramedics, they have basically become PAs, NPs, and MD/DOs. I think paramedics should focus on making prehospital care better, more respected and better educated.

[Kiwiology]

In this part of the world Paramedic requires a Bachelors Degree (3 years) and Intensive Care Paramedic requires a Post Graduate Diploma ontop of the Degree.

You can sub specialise to becoming a Team, District or Regional Manager, Clinical Educator, Clinical Standards Officer, Rapid Response, Motorcycle Response, Ambulance Rescue (SERT) and one or two other things. Surely there are equivalent opportunities in the US I mean it's not like the Ambulance Service manages and educates itself without human effort???

Paramedic practitioners do exist here in Wellington and it's a fairly young program c. 2008 but seems to be working well

[BEorP]

It's different in the same way that being an NP is different than being a PA. It's bringing a different background to the table. It's advancing a field that has so much more to offer.

Imagine Paramedic Practitioners opening their own clinics. I would go to one.

I think it's inevitable. You are right about the nurses union trying to shut it down though. All good ideas are ridiculed before they are instituted.

I like your thinking, but I personally can't see things going this way for a number of reasons.

My personal opinion is that a lot could be gained by paramedics embracing the PA profession to bring it back to its roots. I feel that PAs could be strong advocates for paramedics if the majority of PAs were once paramedics and that it would provide a good avenue for advancement for experienced paramedics that would also benefit the PA profession. Unfortunately (in my opinion, at least), PA programs have largely shifted from valuing real healthcare experience to instead focusing on GPA and offering advanced degrees.