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  1. To my knowledge at least in the state of (Pennsylvania) no regulatory barriers exist, pre-hospital physicians are recognized and extended all the qualifications of your licensed specialty. The barriers that I see are predominantly financially driven i:e you’ll see it as soon as someone is willing to pay for it. Very few if any full time Prehospital physicians and no physician staffed helicopters to my knowledge. The majority of air medical programs are staffed medic/RN and run by hospital based health systems. They are not going to foot the bill to staff them with a physician. Another barrier would be the fragmented nature of EMS in general. In Pennsylvania provision of EMS is generally driven down to the lowest unit of governmental control ( no county, regional or state run system), with the state only controlling licensing and certifications. It’s all about the money in the US.

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