## Name, Sister! Today, this is one of the most common professions in Latvia. In our country, there are 11,701 registered practicing nurses, with 9,184 (78%) employed in the profession. So why is there a shortage of nurses in Latvia? Because the profession, firstly, involves physical strain – it is associated with being on one’s feet constantly, moving heavy objects, and having to do all this at any time of the day or night, regardless of one’s own biological cycles. Secondly, nursing work promises constant contact with the physiological and psychological manifestations of sick people, increased conflict in the work situation, and, at a minimum, a constant need to solve non-standard issues in the absence of a doctor. ## Universal Soldier of Medicine The national professional standard, among other things, prescribes the specialty of "Physician Assistant." This is also known as a paramedic. There are 4,366 registered in this field, but only 2,660 (61%) are working. What are their responsibilities? - Provide emergency medical assistance to patients (injured) according to algorithms; - Conduct professional diagnosis and treatment of common diseases according to their competence; - Independently prescribe medications according to the regulations of the Republic of Latvia; - Be involved in the work of the Disaster Medicine System, as well as during military operations; - Certify the death of a patient. As can be seen, a physician assistant is required to be, if not a magician, then at least the only possible means of salvation – as it can be difficult to see a family doctor in the provinces, and only physician assistants work in 125 local practices (50 medical points in Latgale, 44 in Vidzeme, 25 in Kurzeme, 6 in Zemgale). ## Tested on Myself Sarmite Villere, Deputy Director of the Rīga Medical College of the University of Latvia, pointed out that there are 60 physician assistants working in one emergency department of RAKUS, or "Gaiļezers." That they work competently can be confirmed by your author: I broke my wrist right before New Year’s, and despite the pre-holiday time, all the bones were set and packaged in such a way that by the evening I was sitting at the festive table, hiding the splint in my sleeve, and later even surgery was not needed. What statistics also show is that we are dealing with a profession of young people: 39% of paramedics are under the age of 34. In the world, this is a highly respected and well-paid profession, known as Physician Assistant in the USA, Canada, the UK, Ireland... ## Paramedic Needed The best is the enemy of the good! Recently, there has been a discussion in the country about a new professional standard – paramedic. They will be trained in Latvia for a full 4 years, receiving a professional bachelor’s diploma. The Ministry of Health intends to make changes to regulatory frameworks as well. A paramedic, ideally, is a highly qualified specialist with medical education who works in emergency services, rescue, and military units. Their main task is to provide urgent pre-hospital medical care and save lives of the injured at the scene and during transportation to the hospital. A paramedic differs from a doctor in that they do not make definitive diagnoses or prescribe long-term inpatient treatment. They differ from a physician assistant in having a broader range of powers: a paramedic can perform complex resuscitation procedures and administer potent medications right on the spot. They differ from a nurse in having deeper medical knowledge, allowing them to perform functions similar to junior medical staff. For her part, Sarmite Villere, president of the Emergency Medical Assistance Association, emphasizes that the emergence of the paramedic profession in the labor market is not discussed in the context of the financial situation and human resources. Undoubtedly, such a specialty is necessary – but primarily for the army. ## Opinions Diverged Liga Kozlovska, chair of the Saeima subcommittee on public health, expressed concern about replacing the physician assistant position with a paramedic. According to the professional family doctor and deputy from the "Green Farmers," this creates unnecessary bureaucratic chaos. Her party mate, deputy and anesthesiologist-resuscitator Gunars Daudze, also believes that a physician assistant is a more qualified position than a paramedic, and leaving the population of Latvia in the care of the latter would be an unforgivable mistake. On the other hand, Liene Cipule, head of the Emergency Medical Service, wishes for the arrival of paramedics who can stabilize patients in the pre-hospital period. All this, of course, demonstrates the government’s course towards preparing for war. At the same time, it is clear that to attract personnel, the new specialty will be, at least initially, better paid. Consequently, a number of young, professional medical workers will prefer to stay in the country under these conditions. And Latvia will not have to hire Ukrainians or Filipinos in hospitals. ## And About Salaries So why work in Latvia for a miserable salary compared to what is paid abroad? Salaries for medical assistants in Ireland, for example, are 2-3 times higher than in Latvia, both in absolute figures and considering purchasing power. Here, income levels depend on specialization and the nature of assistance. Young people earn an average of 610 to 1,703 euros per month (net). The average level is around 900-1,200 euros. However, assistants for people with disabilities receive about 420–550 euros net for a full month of work... In Ireland, the hourly rate ranges from 15 to 21.50 euros per hour (600-860 euros per week). In large networks like HSE (Health Service Executive), experienced specialists can earn up to 56,000 euros a year (4,666 euros a month). However, in Ireland, gross salaries are subject to higher taxes (progressive scale), and housing rent (especially in Dublin) is significantly more expensive than in Riga. Dace Roga, deputy head of the human resources development department at the Ministry of Health, believes that Latvia needs to retain the profession of physician assistant. But those currently mastering it are urgently encouraged to obtain a new qualification…