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I definitely understand your perspective here. I'm a critical care paramedic, have several friends who are (perhaps unsurprisingly) generally emergency medicine physicians and related (surgeons, anesthesiology, nurses, etc.). I see the spectrum too. Extremely competent PAs who have long and detailed in depth discussions with physicians as "peers", on one side, and then I see horror shows from people who went from zero to ARNP in programs with "accelerated RN" where they are not functioning providers with far less schooling and clinical experience than even a PA (which is then galling to the PAs, as why are NPs independent practitioners, and PAs not?). I do think a lot of the issue is in the education and certification process. The AMA is only recently making the slightest inroads into well, not admitting they went too far in restricting physician flow, but maybe acknowledging that there is a problem there. Nature abhors a vacuum, and all. I had a friend, extremely intelligent, in a BSN program. Called me one day to ask about flow rates for various oxygen adjuncts (nothing fancy, just like "what do you typically run your nasal cannulas at? What about NRBs?") and I was blown away. "Oh yeah, somehow that got overlooked. I know how to set them up, add humidifiers, etc., etc. - they just assume, I suppose, that someone at some point will say some magic numbers to us". And I'll also say that you see the same pre-hospital too. In PNW, while there are valid criticisms that can be leveled against two of the pre-eminent paramedic programs (UW Harborview, and Tacoma Community), there are far, far, too many "strip mall schools" in other states that will take you from "zero to hero" in 4 or 5 months (of 6 days a week, 8 hours a day, of just class time), and dump you out on the world with just enough retained knowledge to pass your NREMT and the barest amount of ride time to meet DOT mandated minimums. It's scary, to be blunt. These people go out with no clinical experience and are now expected not just to work as a team on a 911 call, but to lead it. It's the medical equivalent of high school > college > MBA > management position without a day of work experience in your life beforehand. Except now there are literally (at least occasionally) lives at stake. |