Paramedics: New Doctors' Helpers

COMPOUNDING the doctor shortage, says the Carnegie Commission, is the absurd fact that "expensively trained physicians are performing tasks that could well be carried out by less broadly trained personnel." Such tasks include taking the patient's history and blood pressure--chores that a doctor need not do. The U.S. has an ample supply of people, including 250,000 retired nurses, many of whom would gladly help doctors concentrate on more serious matters. Each year, the armed forces discharge 30,000 highly trained medical corpsmen, including seasoned veterans of battlefield medicine in Viet Nam. But in many areas, the only civilian medical job open to such skilled men is hospital orderly.

In a fresh and growing trend, more than 40 training programs for doctors' assistants are under way across the country. The graduates, already numbering in the hundreds, are tagged with clumsy names--paramedic, clinical associate, health practitioner. They all relieve doctors of time-consuming jobs like preliminary diagnostic tests. The physician then reviews the findings and decides treatment for a dozen patients in the same time he might otherwise spend personally diagnosing a single patient.

Started by Duke University in 1965, paramedic studies are wide-ranging --from community health to bacteriology and psychosomatic medicine, plus techniques such as regulating intravenous infusions and operating respirators. As a recent Duke graduate put it: "It's not all flashing scalpels and white coats, but you can pack a lot of medicine into two years." Duke is training 40 future physician assistants a year, most of them ex-medical corpsmen. A dozen Duke graduates have already helped to set up similar programs at other medical schools. For every graduate, there are five or six job offers--most paying $10,000 a year or more.

To ease the critical shortage of pediatricians, the University of Colorado trains public health nurses (who already hold a master's degree) in subjects like anatomy, pharmacology, child psychology, orthopedics and mental retardation. Colorado's first 65 pediatric nurse practitioners are now carrying medical attention to children of poor families who rarely consult a doctor.

Colorado's practitioners have worked out so well that the university has also started a child health associate program for candidates with only two years of college. They get two years' training in anatomy, genetics, nutrition and other basics, then spend a third year interning at health centers and in doctors' offices. Now Colorado is recruiting intensively among minority and disadvantaged high school students.

In a vastly different approach, the Office of Economic Opportunity has funded training for family health workers, who need only the equivalent of a fifth-grade education. Many are recruited from welfare rolls. At Watts Health Center in Los Angeles and at The Bronx's Montefiore Hospital, for instance, the workers learn to incorporate some of the functions of the public health nurse, the lawyer, social worker, physician and health educator. They make house calls and are trained to help people negotiate with welfare and other agencies to get the help they need.

Despite initial fears that paramedics might make errors of medical judgment, experience shows that this is not the case. One study of 180 patients examined first by a paramedic and then by a physician found the examiners disagreeing on only two cases. Supporters also point out that most paramedic work is double-checked by doctors. This fall California enacted legislation permitting physicians' assistants to work, provided they are under a doctor's supervision. Many other states are likely to follow suit.

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