Elections have consequences

I came across this piece, and I agree.

Back in 2008, when then-candidate Obama promised Joe the Plumber and the rest of America that he intended to spread the wealth around, most democrat and liberal voters embraced the notion of wealth redistribution under the guise of equality. A universal health care plan, that would be free for all Americans, was the promise from the candidate of hope and change.

Tens of millions of Americans jumped on the bandwagon waving their
flags, fainting at his appearances, and fawning over his every word.

There’s more:

You, and the rest of the 50 million people who elected Barack Obama to not one, but two terms, deserve the pain that’s coming.

You asked for it. Now bask in it.

Go. Read the whole thing.


In response to Graybeard’s comment on my post about job prospects in the EMS field:

Yes, fraud is running rampant. In 2002, Medicare reimbursement for ambulances was less than $1 billion. In 2009, it had more than doubled, despite the fact that the amounts paid for each trip had not changed. I can tell you that the linked article’s claim that 80% of interfacility ambulance rides are fraudulent doesn’t surprise me one bit. I think that number is spot on.

The Feds are cracking down on this, but they are not even catching a fraction of the fraud. As the Affordable Care Act is implemented, it will only get worse.

Certification versus licensure

One of the most frequent memes in EMS is that paramedics are certified, while nurses are licensed. The people who say this are misinformed. To understand why, we need to look at what the terms mean.

Certification, as it relates to this case, is the process whereby a person is said to have met a standard by a certifying authority. Certification is the process of publicly attesting that a specified quality or standard has been achieved or exceeded. Usually this standard includes education, experience, and an exam of knowledge, skills, and abilities needed to perform the job. When an individual meets the standard, he or she receives certification from a certifying agency. The credibility and integrity of the certifying agency determines whether the agency’s certification means anything to the public. Certification is usually a voluntary process.

Licensing is an involuntary process, whereby a governmental authority grants permission for an entity to perform a given act. Licensing it always based on the action of a legislative body. Once a licensing law has been passed it becomes illegal for anyone to engage in that occupation unless he or she has a license. The health care professions are typically licensed at the state and/or local level, but not usually at the federal level. The license may or may not require that the person seeking the license meet a standard. Requirements for licensing vary from state to state. For example: Driver’s licenses only require that a standard be met on initial issue, a fishing license has no requirements for a standard, and a Concealed Weapons permit usually requires meeting a standard.

This makes paramedic a license, just as nursing is a license.

Research project

When I began writing this blog, I intended this to began as an EMS and gun related blog, and it has sort of turned into my soapbox. I have since retired and left the EMS field and continued on to a more advanced program, so I guess we can sort of go back this blog’s roots and talk for a minute about medicine.

For my Master’s degree research project, I have decided to use myself as a case subject for a study relating prediabetic individuals to weight loss. The connection between obesity and diabetes has been well documented, and my intention is to take that research to the next logical step and research the effects of dieting and weight loss on various factors in blood chemistry. My faculty adviser has approved the project, and I am now in the data collection phase of that study.

Nice Try

There are many people who abuse 911 for various reasons. Some because they are whiney people with minor complaints that want to be seen now instead of in the morning, some because they want a free meal or to get high, some because they are simply stupid, and many because they are mentally ill.

There is a woman who falls into the latter category and is known throughout several states for faking seizures in order to get attention. This woman is well known by nearly every medic in the state of Florida who has more than a couple of years on the job. Chances are, if you are a paramedic in the state of Florida, you have or will run on this woman.

I have met paramedics all over Florida, Georgia, and even as far north as Maryland who have run on this woman. She has been seen on shows like Paramedics and Trauma: life in the ER. More than a few medics have given this woman Valium without realizing who she was. She is very good at faking.

So came the day that we ran on her at 2:30 in the A.M one early morning. Tired of running stupid calls, those of us who were there chipped in and paid her bus fare to Orlando, which was 20 miles away, put her on the bus, and patted ourselves on the back for ridding ourselves of the problem. (Come to think of it, this may explain why she has traveled so extensively.)

Two weeks later, I ran on her again. During the call, she handed me an envelope and told me that the Orlando firefighters had asked her to give it to me the next time she saw me. I opened the envelope, and in it was a note. It read simply:

Nice Try.

That, my readers, is a true story.

Government complexity

The government makes EVERYTHING more complicated. When it comes to performing maintenance, the US Navy has a complicated system in place (or did when I was in)called the Material Maintenance Management (3M) system, which controls all PMS (Planned Maintenance System). PMS is time consuming and overly complicated. The procedure for each maintenance action is written on an MRC (Maintenance Requirement Card.

 What makes the system so complicated and cumbersome is the fact that government bureaucrats have managed to turn the system into a set of procedures that make doing your taxes seem easy. Failure to follow the procedure exactly can and does end with sailors being courts-martialed. Maintenance is scheduled for each work center, and the work center supervisor schedules each person for his maintenance. Let’s take a look at a required daily maintenance activity (D-1R). We are scheduled to perform that activity toady, so we look for the MRC, on the Maintenance Index Page (MIP) and confirm that it is correct MIP by checking it against the LOEP (List Of Effective Pages) after checking the effective date to ensure that the LOEP is the current one. After locating the current MRC, we confirm that it is correct by checking its effective date against the one on the MIP.

So take a look at the card here. Granted, this one is a joke, but looks remarkably like the real ones. There is a section that has the information about the equipment on the card and the frequency of maintenance. Then an area that specifies who may perform the maintenance, and the man hours it will take to complete. There are sections that specify safety regulations that must be followed, along with a list of every tool that is required. If the card calls for a 6 inch screwdriver, you better not get caught using a 4 inch or an 8 inch screwdriver. The procedure is then listed, and it must be followed exactly as per the card. Failure to do so can land you in prison.

These are the numbskulls that are getting ready to run our health care system. How do you think that will work out?

The future of medicine

Just last week, I posted about how Obamacare was forcing health providers to find cheaper ways of treating patients. Well, here is one way. Minnesota is using paramedics, who are being called “mid level practitioners” to perform medical procedures previously reserved for medical professionals with higher levels of education and training, with doctors being available for television consultation and supervision.

This is happening despite the objections of Nursing associations, who have long opposed having paramedics being considered as their equals. Even though a paramedic has undergone the same amount of training (45 credit hours for nursing, versus 50 for Paramedic, both form the core for associate’s degrees), many in the nursing community have fought to keep them in the back of the bus. (However, this post is not intended to fight the nurse versus paramedic battle.)

The thing that this drives home is that our health care system is poorly organized and antiquated. There is no way that a doctor can know everything that a patient will need, and they have begun to specialize in fields, leaving general doctors hard to find. The amount of school that a person must attend takes a decade and leaves the new doctor with over a half of a million dollars in student loan debts. Doctors expect to earn large sums of money, so that they can be reimbursed for the decade of work that it took to become a doctor and so that they can repay the student loans.

Physician assistants and Nurse practitioners programs have addressed some of that, and there are many people trying to get into and complete these programs, but there are fewer of them than there are medical schools, and competition is fierce. There are just over 150 physician assistant schools in the United States, and they are producing less than 7400 licensed physician assistants a year. Not nearly enough when you consider that US medical schools produce 18,000 doctors each year, and that doesn’t count foreign medical schools, like the ones in the Caribbean or in India. Physician assistant schools are a 24-30 month long Master’s degree program, but the schools do not care what your bachelor’s degree was in, just that you have one.

So the gaps are being filled in with paramedics, who have a two year associate’s degree and likely make less than $15 an hour. I am a paramedic, and I can tell you that there are some good ones out there, and there are some bad ones, but paramedics do not know enough about general medicine, especially when they are right out of school, to do this job effectively. That doesn’t mean that they can’t be taught, because after all, physician assistants are trained in two years, but I don’t think this is the answer.

Now that doesn’t mean that our heath system doesn’t need an overhaul. I have long felt that it was ridiculous that I need a bachelor’s degree (it doesn’t matter in what- one doctor I know has a bachelor’s in golf) to attend medical school, or physician assistant school. Eliminating that requirement would cut the time and money needed to become a doctor or a physician assistant considerably.

As the shortage of medical professionals continues, pressure will mount for lower level providers (who make less money) to take on an increasing role in your health care, because Obamacare will pressure the medical profession into providing cheaper, but not necessarily better, health care.