PAs and Nurse Practicioners as medical control?

[JPINFV]

Honestly, the issue of medical direction should not be this complicated. If you are working in an area that allows physician extenders (PA,NP's) give you an order then, perhaps you should make sure there isn't legislation against it.

There is a very simple reason the title is "Medical Control Physician". We work under a physician's license, not a PA or NP's. Someday this may change, but for now don't go looking too far into it.

The question then is whose license are we working under. Is it the base hospital physicians or the system's medical director's license. If it is the medical director's license then why can't he delagate online medical control, in whole or in part, to a PA, NP, or MICN?

[Ridryder 911]

You are working under your medical control or EMS physician director license. However; just like any other health care worker, you may receive verbal and or written orders form a higher level provider.. i.e. P.A., NP, etc.. on a specific patient or procedure, if that person is licensed in that state.

Just because it is not an M.D, does not mean they are not authorized to give and make decisions for that patient and there care (within limitations). For example, an order to maintain a Diprivan drip or keep patient supine post angiogram.. etc. Is one going to disregard an order, because they do not have MD/DO after their name? Especially, when that state has granted them permission to practice within that scope of care. If all dispute, one could notify their medical director for clarification.

R/r 911

[Spock]

I think Doczilla has summed it up rather nicely.

Live long and prosper.

Spock

[zippyRN]

The question then is whose license are we working under. Is it the base hospital physicians or the system's medical director's license. If it is the medical director's license then why can't he delagate online medical control, in whole or in part, to a PA, NP, or MICN?

surely this represents one of the problems the fact that Paramedics aren't necessarily working under their own licence / registration ...

i think this discussion has not taken up the fundamental differences between the 2 havles of medical direction for EMS /Ambulance services

part 1 - strategic - strategic medical direction will remain a Medical only or medically led ( along with providers) function unless and until such time as Paramedic ing is a fully graduate profession and managers / leaders are post graduate prepared

part 2 - tactical /operational medical direction - while it's useful to have a physician available for this function a proportion of this - especially if there is any amount of "mother may I ?" left in the guidelines can be carried out by an advanced practice Nurse or Paramedic ( remembering that advanced practice Paramedics are a reality or a near future proposition on the right -pond ( Uk practice both ECPs and a paramedic background critical care practitioners) and dununder as well as Canada...

in Uk practice there is a degree of clinical advisor work in many Controls from Registered Paramedic Responder manager / ECPs working as clinical triage advisors, as ECP dispatchers and/or control supervisors , plus a number of Services air ambulance controllers are paramedics with air ops experience

[bassnmedic]

When I saw the info on this site and the difference in education and CE requirements, I was astounded.

http://www.fapaonline.org/pdf/COMPARISON_OF_PA_NP.pdf

Take care,

Todd

[Dustdevil]

When I saw the info on this site and the difference in education and CE requirements, I was astounded.

Don't be. The chart must be viewed within it's total context. PA is a stan-alone education. NP education is a continuum, built upon four previous years of nursing education, as well as a great deal of patient patient care experience. Consequently, the numbers on that chart do not give an accurate picture of the total educational requirements.

Simply put, it takes longer to train somebody from the ground up than it does to transition them to a new role within their field. That's why PA school obviously must involve more contact time than NP specialisation.

[somedic]

Either way, People iin the south want to be seen by a real doctor. I have seen the results of a PA/NP trying to explain what their job is to an ignorant patient (This is the south remember?)

Ive also noticed that a number of male nurses and PA/NP types not correct a paitnet that calls them doctor. I guess the salary makes the frustrations worth it .

Somedic

[Ridryder 911]

Either way, People iin the south want to be seen by a real doctor. I have seen the results of a PA/NP trying to explain what their job is to an ignorant patient (This is the south remember?)

Ive also noticed that a number of male nurses and PA/NP types not correct a paitnet that calls them doctor. I guess the salary makes the frustrations worth it .

Somedic

Vanderbilt University has an outstanding NP program, and the South actually utilizes NP's more than any area in the U.S. Albeit, many EMS providers may never see or experience this because there is more medicine than in emergency departments. Most of the medical care provided in the Appalachian areas are provided in clinics and public health departments are by NP's. The same is true in regard to pediatric clinics are usually staffed by Pediatric NP's.As well many NICU's are staffed by in house NP's.

In regards as not correcting the title after 30 patients continue to call you Dr.; after repeating "no I am not a physician" one get's tired and basically ignores it after a while. The same as patient calling an EMT a Paramedic.. I have seen very few stop and say ..."no, I am a basic emergency medical technician"....especially after doing so repeated times...even by the same patient.

Dust, you are right the chart is very misleading. As one that has entered both the P.A. and NP programs, I can at least speak from personal experience. P.A. programs only require one to have a B.S or B.A. and have met those requirements, their degree maybe in basket weaving and still be able to enter. Minimal to no healthcare experience is require in some, so the two years education is their sole exposure to medicine. As well the P.A. is diverse and can work from dermatology to urology to ER, the NP is restricted to their speciality and only focuses on that speciality (because of the general education, BSN and required experience as a RN). This could be compared slightly similar to a residency after general medical..only focusing in that area. This does not allow NP's to go from one area to another..

Again back to the original topic.. I have yet had a P.A. or NP that even feel that they are qualified, the liability is to high, and really have no interest to be responsible for the current educational level of EMS personnel.

R/r 911

[stcommodore]

I don't know if its true but my understanding is that current Act 45 doesn't reconize PA's in the prehospital setting for PA. But PHRN's are recpnized and may actually opperate under there own pratice and not require the "squad MD" to do what they do. Or in otherwards have "medical command." Like I said I don't know if thats true but it would also follow that a MD that was not the squad MD working as a paramedic would not require the squad MD for command or orders, etc. Hmm...

[Spock]

I don't know if its true but my understanding is that current Act 45 doesn't reconize PA's in the prehospital setting for PA. But PHRN's are recpnized and may actually opperate under there own pratice and not require the "squad MD" to do what they do. Or in otherwards have "medical command." Like I said I don't know if thats true but it would also follow that a MD that was not the squad MD working as a paramedic would not require the squad MD for command or orders, etc. Hmm...

I presume you are talking about Pennsylvania. PHRN's are allowed to preform any skill or administer any medication than is covered under their nursing license and is within their scope of practice as long as the service medical director has authorized it. That means as a CRNA I could give any drug or use any device I use in the operating room in the back of the ambulance as long as the medical director said OK. I rarely take advantage of this.

The changes to Act 45 (the law regulating EMS in PA) provides for a prehospital PA category. The new law also provides for the EMT-I. Personally I think the PHRN and PHPA are bull and both should take the paramedic class. I have both NREMT-P and PHRN certification.

Dust and Rid more than adequately answered the questions about the difference between PA and NP education. I got new information reflecting on my earlier comments about salary for the PA. PA's working for a private practice do indeed make more than 100k in this area. The PA's I work with are employed by the hospital (Catholic) so their salaries are much less.

Live long and prosper.

Spock