In the German version of the model, there are paramedics (called "Rettungsassistenten"). Medical control is on-line, immediate, and direct. The training of the Rettungsassistent is comparable to that of many North American paramedics, but they may be limited in their scope of practice. Paramedics may practice advanced life support skills at all times when the physician with whom they work is physically present. In some cases they are restricted in action if there is no physician present, a legal position mostly claimed by the physicians' lobby. Under German law, unless an immediately life-threatening or potentially debilitating emergency is present, such individuals may be limited to basic life support skills only, or to restricted ALS skills, which are defined in the "standing orders" of the medical director of each respective county. In 2003, there was a reform movement to expand the "standing competency", especially in the realm of pain treatment, by offering additional training to the level of "Notfallsanitaeter".