The original lines that delineated an EMT from a Paramedic and a Paramedic from a doctor are becoming increasingly blurred. Skills that were once reserved for physicians are now routinely performed by paramedics, and skills once reserved for paramedics, such as defibrillation, are now routinely performed by Basic Emergency Medical Technicians (EMTs). However, there is wide variation among states, and even among counties within states, of what type of care providers at different levels are allowed to provide. In addition to these variations, some states and counties allow for "add-ons", such as defibrillation or IV therapy, which enable workers at a lower level to learn and use additional skills that would not normally be within the scope of practice of their qualification level (for example, an EMT is not generally permitted to start an IV, but after successfully completing an IV add-on course, he or she would then be able to do so.) Add-on skills are generally more common in rural areas where definitive care is further away geographically and immediate interventions by EMTs are beneficial for patient care.