Why Physicians Make the Big Bucks...

[UMSTUDENT]

http://www.time.com/time/generations/artic...38630-1,00.html

Read that article in TIME and see if it doesn't make you want to vomit. You'd swear that home examinations, blood draws, glucose sticks, and portable 12-leads were brand-new inventions.

The reasons physicians make the big bucks is because they're smarter. They recognized a trend in medicine and adapted to it, while simultaneously having the brains to market it as a "new" type of technologically advanced health care. Be it the ignorance of TIME magazine, or simply deceitful or ignorant physicians, they fail to mention that the paramedics in the 911 system they briefly mention have providing these services for years. It doesn't take a rocket scientist, or a physician for that matter, to walk over to grandma's pill box and make sure she's been taking the prescribed dose. We've been doing preventive medicine for years. Moving rugs, positioning beds in new locations, watching patient medication dosing (frequent flyers)...

Does anyone else find it interesting that the Medicare billing practices regarding at home visits were changed in 1998? Does anyone else find it interesting that the advanced practice scope of practice for paramedics was primarily put down by physician consultants? MONEY MONEY, M-O-N-E-Y!

Medical Doctors---The Advanced Practice Paramedics of the future! See the English aren't stupid. Socialized medicine quickly realized that we can train "Enhanced Practioner Paramedics" to do the same job with significantly less BS and cost to the healthcare system. True capitalism is great.

[Just Plain Ruff]

I found that article to be a refreshing article. If my grandfathers doctor would have made housecalls maybe he would have lived a little longer, long enough to meet my son.

I don't see where you can correlate that we're doin the same thing as the doctors. They have their niche and we have ours. WE can tell people what we see but as for guaranteeing that what we point out get's done there is no way to guarantee that. Yet a physician can.

I think the housecall is a not so lost art. I know of several physicians in the small town I used to work in that would make housecalls.

[UMSTUDENT]

I found that article to be a refreshing article. If my grandfathers doctor would have made housecalls maybe he would have lived a little longer, long enough to meet my son.

I don't see where you can correlate that we're doin the same thing as the doctors. They have their niche and we have ours. WE can tell people what we see but as for guaranteeing that what we point out get's done there is no way to guarantee that. Yet a physician can.

I think the housecall is a not so lost art. I know of several physicians in the small town I used to work in that would make housecalls.

I'm not saying they don't have their purpose. A well trained, properly educated physician extender is capable of making these decisions. PAs and NPs (while more of an independant practitioner) are perfect examples. I just think it is something that had our profession been smart about, we could have jumped on a golden opprotunity. Your sentiment is one of the biggest problems I constantly find in EMS. We've become so restrained to the idea of being "under" physicians that we don't have the ambition to seek professional autonimity. Again, the skills these physicians are performing in the home are things we commonly do: nebulizer treatments, blood pressures, ECG monitoring, etc. A properly educated paramedic, with an advanced scope of practice and diagnostic skills, could do this same job.

[Ridryder 911]

Okay, yeah they are getting paid well, but we had the ball and dropped it. It is our own fault.... period. We did not have the stamina (or other definition of anatomy) to be able to fill the void.

I remember in the early 90's of ACEP, FACS, ACS attempting and promoting EMS to "fill the void" to expand their horizon, but hell no!..We have to have lights and sirens, blood and guts, to be in business.. Thinking that EMS should be strictly for emergencies only. Not, that I totally disagree, and that would be nice, but for EMS to survive budget crunches, and for medics to make a decent salary, we will have to respond to more than MVA's, chest pains, and GSW's.

Ironically, I have seen very few GSW's that have Blue Cross and Blue Shield in their back pocket... yet, again Medics feel that they should be paid equivalently (rightfully) but the old saying what comes in = what can go out. Yes, EMS is a business, and that business is to save lives. But it is still a business..

Medicare and insurance companies are getting tired of expensive EMS taxi cab rides.. period.

Okay, now the Doc will go see that patient and do some simplistic tests, as noted in the article and possibly prevent this patient from being admitted, saving the minimal of $3,000-15,000 initial admission. Now, do this several times a day at a couple of thousand places and you have saved the Insurance + Medicare $millions.... so do we see how insurance companies are happy? Can you say HMO?.. and a healthy bonus check for that Doc that did not order excess tests, and admission ... ching.. ching!!!!

The same is true, as hospitals are full.. thus decreasing the load as well.

Now, we had the chance.... and we blew it!!! We cowardly lowered ourselves to small interest groups of the volunteers and rural areas!!! Yes, they killed the National EMS Scope of Practice Act as it was initially written to allow Paramedic Practitioners and widen the Scope of Practice. Crying and whining it would put them out of business!! In reality, it would had provided better and more advanced care, where it is really needed the most. Yet, again most was only seeing things for themselves. When performing and advancing to this level would had increased care, and income for EMS, as well as professional standing and pay for Advanced Level Paramedics. (Imagine Paramedics only having to work 1 job.. .shock & dismay!)

So now, we see the Doc's are doing it ... and yes, making some $$$ .. it's not their fault. Who's fault is it really...?

R/r 911

R/r 911

[UMSTUDENT]

So true.

One of my current professors said the following in our "Introduction to Paramedicine" class. The major focus of the class is on professional development.

He always says, "Paramedics are masters of disaster, starting with our own profession."

[xcentrk]

So what is the issue here, that Doc's are getting more $$$ and doing the same thing as you? Not quite, take a look at the whole picture.

A little background. I am an EMT (8yrs) and also a PA (2yrs) in a pediatric setting. We'll do 1-2 house calls after office hours for certain patients who need it. Combined we see about 70 patients/day. We do hospital rounds each morning, and split calls when office hours are over.

He gets paid well b/c he has book knowledge AND extensive 'hands-on' experience. How many PT's do you see a day? See a couple hundred a week, and you learn more then you ever will in books. That, along with being on call all night, and having to do hospital rounds every morning ..... yeah, you deserve some more money. It's not just work my hours and go home to relax like when I worked on the ambulance. It's more, work office hours, do a house call or so, get woken up all night by calls, get up early for rounds, and then back to the office.

Now, I am not saying that EMT/Medics are paid well.... That used to be my full time job for many years, I know all too well the lack of pay. When time came to further my education, instead of doing a 10 month Paramedic program, I did a 2yr PA program. I now get paid more, not only because of the extra schooling, but because I see a lot more patients in a day. I still hang out on the volley ambulance when I don't have call (that's why I keep my EMT current) to get my fill of that end of things, which I would miss otherwise.

[UMSTUDENT]

So what is the issue here, that Doc's are getting more $$$ and doing the same thing as you? Not quite, take a look at the whole picture.

A little background. I am an EMT (8yrs) and also a PA (2yrs) in a pediatric setting. We'll do 1-2 house calls after office hours for certain patients who need it. Combined we see about 70 patients/day. We do hospital rounds each morning, and split calls when office hours are over.

He gets paid well b/c he has book knowledge AND extensive 'hands-on' experience. How many PT's do you see a day? See a couple hundred a week, and you learn more then you ever will in books. That, along with being on call all night, and having to do hospital rounds every morning ..... yeah, you deserve some more money. It's not just work my hours and go home to relax like when I worked on the ambulance. It's more, work office hours, do a house call or so, get woken up all night by calls, get up early for rounds, and then back to the office.

Now, I am not saying that EMT/Medics are paid well.... That used to be my full time job for many years, I know all too well the lack of pay. When time came to further my education, instead of doing a 10 month Paramedic program, I did a 2yr PA program. I now get paid more, not only because of the extra schooling, but because I see a lot more patients in a day. I still hang out on the volley ambulance when I don't have call (that's why I keep my EMT current) to get my fill of that end of things, which I would miss otherwise.

Your entire argument is circumstantial. First, many paramedics see a fairly substantial number of patients in a one-week period. It is totally dependent on the call volume of the individual's jurisdictions. Doing rounds at a hospital doesn't constitute total patient care. If you're seeing 70 patients a day there is going to be huge break-down in your level of care. Assuming you worked 24 hours straight with no break, you had the ability to teleport, didn't chart orders, and did not eat you'd only be spending an average of 20.4 minutes with each patient.

Secondly, for you to assume that all paramedics completed a 10 month program is a little ignorant. Some PAs complete 25-30 month certificate programs, although it is my understanding that this is changing.

Lastly, for you to assume that you have more education than every paramedic is a huge fallacy. I'll just leave it to that. At least paramedics are better at exaggerating.

[xcentrk]

If you're seeing 70 patients a day there is going to be huge break-down in your level of care. Assuming you worked 24 hours straight with no break, you had the ability to teleport, didn't chart, and did not eat you'd only be spending an average of 20.4 minutes with each patient.

Combined we see about 70 patients/day.

Combined. ... I see about 30, he sees about 40. Give or take. No "exaggerating" needed.

With an average 10 hr day that leaves about 20 mins a PT. Where I work, PT's have a 10 min time slot (20 for physicals). Sometimes you run over, sometimes under.

I SHOULD have stated that these are the numbers for LI, NY (where there are only 2 paramedic programs to choose from, one being much better then the other IMO). That was a fault on my part. Other parts of the country may, and probably do, differ. Anyhow, this started by stating that a Paramedic could basically do the home visits that an MD (not PA) would do.. and I am pretty sure anywhere in the country, MD's have hands down, more training hours then a Medic.

[UMSTUDENT]

Combined. ... I see about 30, he sees about 40. Give or take. No "exaggerating" needed.

With an average 10 hr day that leaves about 20 mins a PT. Where I work, PT's have a 10 min time slot (20 for physicals). Sometimes you run over, sometimes under.

I SHOULD have stated that these are the numbers for LI, NY (where there are only 2 paramedic programs to choose from, one being much better then the other IMO). That was a fault on my part. Other parts of the country may, and probably do, differ. Anyhow, this started by stating that a Paramedic could basically do the home visits that an MD (not PA) would do.. and I am sure ANYWHERE in the country, MD's have more hours then a Medic.

I appreciate your education, I really do. I also appreciate the education physicians receive. I just think those hours could be better spent on more pressing matters than skills that could be easily be done by a physician extender like yourself. A paramedic, perhaps with equivalent education, who could encompass all aspects of the "prehospital" environment. I'm not advocating that your average paramedic be out there stomping around...

Thanks for the reply.

[xcentrk]

...... A paramedic, perhaps with equivalent education, who could encompass all aspects of the "prehospital" environment. I'm not advocating that your average paramedic be out there stomping around...

That clears things up a lot.

Yes, a totally excellent idea. A paramedic with some additional specialized training could definitely do something like that. Just like most other practitioners choose a specialized field to practice in (as in Peds for myself). Paramedics learn a little about EVERYTHING, MD's/NP's/PA's have to do that and learn a lot about one field. Totally attainable by a Paramedic program, just not with the medic programs currently out there.

I think Ridryder 911 was pointing towards that with the whole thing about the "National EMS Scope of Practice Act as it was initially written to allow Paramedic Practitioners and widen the Scope of Practice", but I can't say I have any knowledge about that.

If there was a "Paramedic Practitioner" program out there that let me work like I do now, AND be able to let me have my time on the ambulance, I would have been first in line to sign up.