Primary Care Paramedics? I think it’s time

I am an offshore paramedic and we really are a primary care provider when we are out there. With a week of extensive training along with our paramedic training we are “better trained” than a majority of physicians in other countries as put by one of my instructors. Essentially we can do almost anything a family practice doctor can do minus x-rays. I completely agree with your post and think that this is a very obtainable outcome.

Bravo! We’re not that far off in many respects right here, in certain circumstances. For instance, I work with a very large entertainment company as a theme park medic. Our property alone sees 50,000+ visitors a day during our operating season. We were able to obtain an amended set of protocols that allow us to “treat and release” minor complaints. We currently offer extended paramedic training, such as Critical Care Paramedic… why not develop the same type of course for Primary Care? Introduce a whole new certification/licensure level; “Primary Care Paramedic.” We’re already 95% of the way there. All we need now are forward thinkers to develop the curriculum, and someone with the stones to allow us to pilot the project. Any input out there from MD’s?

I couldn’t agree with this discussion more. I have had this conversation with myself and my colleagues many times. I hope during my career there comes a day when the education requirements for all pre-hospital providers is substantially higher than it is today. In addition this I feel we need to create a step up from the paramedic level, i.e. an advanced practice paramedic. I would call them a “Paramedic Practitioner”. They should be on par with NP’s and PA’s in education.

I think about rural ER’s that are filling their provider positions with PA’s who have a very broad education with minimal emergency training. Why not create an advance practice paramedic to fill these roles? They already come with a strong background in the worst of the worst. Now they just need training on the continued care of critical patients as well as assessment and treatment of non-acute patients. These same people would be ideal critical care transport medics and primary care paramedics.

So where do we start? In my opinion, the one thing that holds back paramedics the most is the allowance, and actual promotion of, lower quality education. If we want the public to trust us with their primary care, we need to raise our standard level of education. The first step being to eliminate of the non-degree paramedic programs. The fact that somebody can be a paramedic on the street with a 14 week medic course, in the big picture, severely damages our image and standard of care. Yes, I realize that there are fantastic paramedics out there that graduated from these programs. These isolated paramedics however don’t change the fact that these programs are lowering the overall quality of care. We need every paramedic to have at least an associates degree with full courses in A&P, bio, chem and some generals in communication and composition. I simply will not trust a paramedic to diagnose my strep if he/she can’t compose a sentence. I feel that this needs to happen before we can even ask the public to trust us with their primary care.

I googled primary care paramedic and apparently in Canada this concept of a primary care paramedic is already up and running.

the primary care medic program is already up and running in america! it has been for decades! the problem is that paramedics and doctors on this side of the wire dont want to acknowledge anything or give credit to anything the military does. military medics go through a course called LPC limited primary care during medic school at fort sam houston. you gert further education as you progress in rank or position. it doesnt take a lot just the desire and the willingness to to come to the military and say “how are yall doing that” it doesnt take a doctor to treat everything. like you said in the article, imagine how many frequent fliers you would keep out of the e.r.

Change the mindset that we are there for true emergencies only. The reality is that due to an uneducated public in simple home remedies, knowledge of when something is truly severe, difficulty accessing “primary care” and a host of other reasons, we are the front line. Like it or not, we will get called for non emergencies and once we accept that it will be easier to see ourselves as being more than acute care specialists. The trouble is how do we get physicians and others to see how we can fill this gap and help educate us thereby changing and increasing our role in healthcare in general.
I also believe the NREMT could advocate for raising the education requirements to include mandated college courses and include electives similar to those taken by other medical professionals.(I do not know if they do so now.)
In the end the more we know the more we benefit the patient.

What if we approach this from a different angle, instead of trying to contort the current system in a way that could potentially break it….

If we were suddenly known as “Primary-Care” providers, the amount of non-emergency calls we go out on would sharply (DRASTICALLY) increase. The current system would be overloaded, more and more equipment would have to hit the street and telemetry-physicians would never have a moment off from Telemetry to tend to a patient in their own facility.

Nurses at all levels, ER staff, and clinic personnel (Urgent cares and all) would all be looking for work. Suddenly we would find ourselves with an enormous overabundance of Nurses and Techs and nowhere near enough physicians.

So, what do you suppose is a better solution? Me, I think that it would be easier if, those who wanted to practice Primary Care, would go out and get licensed to do so instead of flipping the whole system (not just emergency-care….the whole medical system as we know it) on it’s ear.

I see this as a “My two-years of school (in a limited niche of the medical field) should be just as good as your pre-med, gross anatomy and general practitioner training that may have taken 10+ years to complete.” You want to further your education? I would encourage it. It will help you as an EMT / Paramedic. As long as you practice within the scope of your position. It is, after all, the career in Emergency Pre-Hospital care you chose to pursue.

Paramedics (and EMT’s) were “invented” to do a very specific job, one which you outlined well in your article. I happen to think (and I’ve worked in both Urban and Rural areas) we have a pretty darn good system. It was designed to handle Emergencies and it does a damn-fine job of it.

If you want to practice Primary Care, get the type of certification that allows you to do it. From there, and under medical direction of course, you can create your own small business providing Primary Care to patients in the home “on-call.”

This is a free-enterprise system, right? Why does it always have to be up to the government to change things and supply us with the means to do what we can do ourselves? Just because they have it in Switzerland or Canada or Timbuktu, doesn’t mean it will work (and be good for us) here in the U.S.

Who, by the way , if not Workman’s comp insurance or the business itself, is expected to pay for your “Primary Care” services provided to your acquaintance with the torn-off fingernail? If I have this right, they were trying to avoid the EXPENSE, not the medical treatment he needed. To me, the subject in the article is not about “Primary Care Paramedics” it’s a medical and insurance expense problem….which starts us on a whole new conversation.

I stand very much against the author’s idea, for many reasons (not just political, either) I don’t have time to list them all here.

I am a Medic in NC, and am a huge proponent for a Paramedic Practitioner or an Advanced Practice Paramedics if you will. The need is obviously out there, and EMS personnel nationwide are a huge untapped resource. Many of us are forced into nursing after a few years of practice even though most hate the prospect of becoming a nurse, because there is no room for clinical advancement in EMS. The problem is that we need an institution like Duke, or George Washington U. to develop a 4 year B.S. program. And for the PA’s and NP’s that argue you can’t practice medicine with a Bachelor’s degree, let me point out that Stanford still produces PA’s with only an associates. degree and a few science prereq’s! But because medicine is a buisness and EMS is famous for barely making a dime, this has as much a chance of happening as does the US Public Health Service taking over EMS service nation wide, or having true national standards of practice.