# Op/ed calling for former mil providers in the civilian sector



## Devildoc (Oct 17, 2017)

This isn't really "news", and we've discussed it, but it's very, very important to gain traction and keeping trying to move this kind of thing forward.

Military medics, corpsmen could help fill shortage of primary care providers


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## TLDR20 (Oct 17, 2017)

Uh, I don't know man. The knowledge gap between a primary care physician and a line medic is about as large as can be. While an 18D or Recon corpsmanis closer to a PA that gap is still enormous. What do primary care doctors see? Diabetes, heart disease, CHF, aging issues, it isn't just sick call on healthy patients, it is life altering g care and prescriptions for intense medications.


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## Devildoc (Oct 17, 2017)

TLDR20 said:


> Uh, I don't know man. The knowledge gap between a primary care physician and a line medic is about as large as can be. While an 18D or Recon corpsmanis closer to a PA that gap is still enormous. What do primary care doctors see? Diabetes, heart disease, CHF, aging issues, it isn't just sick call on healthy patients, it is life altering g care and prescriptions for intense medications.



Agreed.  I think the biggest parallel is Navy IDC and PA; used to be an IDC could waive year 1 of PA school, but they don't do that any more.

I do think that there are plenty of potential mid-level-type jobs that enlisted medical providers can transition into with appropriate bridging courses, and I think those transitional/bridging programs are popping up here and there.


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## policemedic (Oct 17, 2017)

Ummm... No.

More later.


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## TLDR20 (Oct 17, 2017)

Devildoc said:


> Agreed.  I think the biggest parallel is Navy IDC and PA; used to be an IDC could waive year 1 of PA school, but they don't do that any more.
> 
> I do think that there are plenty of potential mid-level-type jobs that enlisted medical providers can transition into with appropriate bridging courses, and I think those transitional/bridging programs are popping up here and there.



The appropriate bridging courses are PA school, medical school and nursing school, lol. 

18D's and SOIdC's work because they have a dedicated formulary and are working off it, they do not treat complex metabolic diseases, and their patients are either foreign nationals with ZERO access or some of the healthiest people on the planet. 

Seriously I don't want someone who doesn't understand cellular biology and organic chemistry prescribing me medications. I think his point is valid, and maybe waving some of the requirements or taking experience in lieu of (some) classes could help. The bachelors requirement for entry to PA school was a barrier for me personally, had I just been able to take the science classes and go to PA school I'd be a PA right now. Same goes for nursing, why do I need a BSN and experience in an ICU to be a CRNA, or an acute care NP. IMHO that is one of the stupidest requirements there is. Make those nursing professions entry level and you will have a lot more military medics joining who don't want to wipe asses, and get spat on by homeless heroin addicts....

When I was an 18D I thought I was "basically a PA" as did many of us. Then you get exposed to really sick people and realize how far from the truth that is.


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## Devildoc (Oct 17, 2017)

TLDR20 said:


> The appropriate bridging courses are PA school, medical school and nursing school, lol.
> 
> 18D's and SOIdC's work because they have a dedicated formulary and are working off it, they do not treat complex metabolic diseases, and their patients are either foreign nationals with ZERO access or some of the healthiest people on the planet.
> 
> ...




I see it from a different lens, and maybe with the providers in a different role.  When I was first a paramedic, 1991, we had to call the doc for everything.  The tether was real, medical control was a necessary evil.  We had to call to ask permission to intubate.  Of course, it has evolved, the role has evolved, as has training and expectations.  I bring this up only to point out, creation of new roles and responsibilities will have some evolution and growth.

I don't think it's too much of a leap to bridge former military medical personnel into civilian roles.  They don't have to be 'same as,' they can be 'different from,' and not necessarily a shoulder-to-shoulder physician extender like a PA/NP.  But I DO think with the evolving role of technology, with telemedicine, etc., there can be creative use for former military medical practitioners.

For the record, I am not really advocating making medic-corpsmen-18D/SARCs PA-not-really-PA-kinda-doctors, and I am more trying to be a proponent of facilitating the transition of these people to civilian roles, and expecting that some of the roles may evolve from what we have now.  Although I see where the author is going, I envision more of a community physician extender, which paramedics are doing with success in some areas of the country.

I hear you--and agree--regarding the educational requirements (specific to advanced practice nursing).  As for PA, I know I am not the only one old enough to remember when you could be a PA with a BS degree in "PA studies"; the master's degreed-PA was a unicorn.


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## TLDR20 (Oct 17, 2017)

I think we are talking about different things. I think what he is saying would apply to, say, and urgent care clinic in "wherever". Primary care or family medicine though, that is not the place. I still think I could do the job of a PA or Doc in the average urgent care clinic, fractures, the flu, URI and UTI's maybe an STD or other sick call shit. Got it... that maybe something they could bridge. 


Primary care, diagnosing and treating diabetes, Age related issues, treating cholesterol, HTN and a myriad of others, on a single patient are things primary care doctors do. That stuff is not easy and has very little "bridge".


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## Red Flag 1 (Oct 17, 2017)

[USE


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## Devildoc (Oct 17, 2017)

@Red Flag 1 , This is the crux of the argument, to me.  For me they are an untapped potential for a variety of jobs.  I do think some of those jobs have not been invented yet (specific to physician extender roles).  The conversation needs to be, how do we tap that potential and get them into the workforce?


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## Red Flag 1 (Oct 17, 2017)

My $.02.


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## Devildoc (Oct 17, 2017)

Red Flag 1 said:


> Yeah, there is a large untapped amount of ability up against a great need. The route that feels most natural for seasoned combat medics is in the role of a first responder. Combat medics do exactly that in the field so ParaMedic/EMT seems the natural fit. The crying need right now is for RNs. It would be great if we could integrate what our medics know into the BSN requirements. I think the guy who would have the best handle on that would be @TLDR20. I guess the other question is if there is a usable tier of health care between the PA/RNP and CNA? Right now, I just don't see that outside of the first responder field.
> 
> I agree with the idea of the sick call stuff on the surface, the trouble with that is the hidden stuff that people don't tell you. It takes time and training to develop the clinical eye and ear to keep patients and caregivers out of trouble. I had a "seasoned" MD miss diagnose me with right-sided pneumonia when in reality I had multiple blood clots sprayed into both lung field bases. He blew off the left sided pain I had as referred pain. If I went with his diagnosis, I would not be here at my keyboard.
> 
> ...



@TLDR20  and I actually graduated from the same nursing school; well after I left they started a military-friendly program that allowed fast-tracking for veterans with medical experience.  I think we are starting to see more schools do that.

Paramedicine has had some good experience with physician extender programs in the community. As we well know, ED's are overburdened with non-emergent stuff, and these paramedics can do simple wound closure in the home with sutures, and triage patients to an appropriate facility, and make simple diagnosis. Of course, they have the eyes and the ears of the attending with them through Modern technology. I could see that type of role expanding, but I agree, I think the roles could be very limited with non-traditional out of hospital medicine.


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## TLDR20 (Oct 17, 2017)

Devildoc said:


> @Red Flag 1 , This is the crux of the argument, to me.  For me they are an untapped potential for a variety of jobs.  I do think some of those jobs have not been invented yet (specific to physician extender roles).  The conversation needs to be, how do we tap that potential and get them into the workforce?



You need buy in from not only physicians but the large hospital organizations. IMO it is hard to qualify what someone did in the service. All corpsman/medics are not created equal. All don't have the same level of training, and therefore awarding of "credit" needs to almost be case by case. That is what UNCG did, and it took them 2 years to figure it out, and it was hard to deal with accreditation.


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## BloodStripe (Oct 23, 2017)

What prohibits specialized "A" schools from getting accredited by a regional accrediting body? Is it time? Standardization? For instance, JSOU is accredited by ACCET. As there is a push for more and more service to college transfer, and yes I understand not every college would accept another regionally accredited credit, it seems like it there are a fair amount of DOD schools that directly translate to civilian counterparts, ie mechanics, air conditioning repair, basic medicine.


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## Devildoc (Oct 23, 2017)

NavyBuyer said:


> What prohibits specialized "A" schools from getting accredited by a regional accrediting body? Is it time? Standardization? For instance, JSOU is accredited by ACCET. As there is a push for more and more service to college transfer, and yes I understand not every college would accept another regionally accredited credit, it seems like it there are a fair amount of DOD schools that directly translate to civilian counterparts, ie mechanics, air conditioning repair, basic medicine.



That is a great question, and that is had been a bone of contention in military medicine, particularly the Navy, for the last two decades.  When a corpsman goes through there C School they can get certified as a lab tech, a radiology tech, Etc. So that is directly applicable to the civilian sector. But when you get out of corps it's cool, you get a taste of EMT, a taste of basic nursing, Taste of lab, Etc. And of course field Med and some of the field oriented NECs could theoretically contribute to paramedic, but you don't have any experience with geriatrics or cardiac or the medicine side of the house, as mostly trauma.  The Navy has been working on it for a long time.


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