And how do we get there?
Recently there has been debate about an education requirement for paramedics beyond just having a paramedic certification. Some, maybe many, people want to require at least a bachelors degree in “Emergency Medical Services” for someone to work as a paramedic.
There are different opinions as to exactly what courses should be required. More biology, more anatomy and physiology, more chemistry, all seem to be popular ideas.
Many people see nursing as the model to which EMS should aspire. After all, they ask, isn’t better education how nurses became recognized as a profession and how pay for nurses improved?
Yes, but that has nothing to do with how EMS is going to advance, if EMS is going to advance.
There are many differences between nursing and EMS. First, the work venue and opportunities. If you work in EMS, in most areas that means you work in an ambulance. Or maybe you’re a supervisor or lower level manager. Sure, there are some systems where there are Community Paramedics, but that’s not wide spread and isn’t likely to become widespread unless and until there is a funding mechanism. Right now, most of the Community Paramedic programs are funded by grants of one sort or another.
Once that funding runs out, if it’s not replaced by another source, we’re likely to see Community Paramedicine disappear once more.
Nursing, on the other hand has a lot of different work venues available. Even within a hospital there are different types of nursing. Some of those don’t even involve direct patient care. There are nurses who do research or work with doctors who do research. There are nurse managers, who do management and administration.
I have a cousin who has a PhD is nursing. She does research into Stroke care and a very small amount of direct patient contact. She works at a major teaching hospital and is well paid. I don’t see that sort of thing happening in EMS. Not that it can’t, just that it won’t.
By the way, there are two different types of Doctorates available for nursing. This post isn’t about that topic, interested readers can read the short article at the link.
In addition to working in hospitals, there are all sorts of nursing jobs outside of hospitals. Again, many of them don’t involve patient care.
In contrast, being a paramedic mostly involves working in an ambulance doing direct patient care. That’s not likely to change.
Also, in contrast to EMS, nursing in many areas is unionized. I won’t get into that debate here, but it should be noted that EMS systems that are uniionized generally have better pay, benefits, and working conditions.
Nursing also has far more control over who is a nurse than EMS has over who is a paramedic. Which is a problem for EMS. A lot of people who are paramedics identify primarily as something “and” a paramedic. It’s even more prevalent with EMTs. There are a lot of people who have gone through EMT courses and taken the test to get certified. Many of them have no intent or interest in working in EMS, but wanted or needed the certification for some reason.
Even people who are paramedics look at that certification as a means to an end and not as a career itself. Many of them are good paramedics, but they don’t see being a paramedic as their primary career.
I’m up to almost 600 words and still haven’t gotten to the biggest problem with a college degree requirement for paramedics.
Cost. More specifically cost and return on investment.
A Bachelors degree is not inexpensive no matter where you go. A person is going to have to lay out X amount of dollars to get that degree , if indeed one does exist.
Does anyone expect that ambulance services, especially privately owned for profit services, are going grant wage increases just because a person has a degree?
“Ahh,” you say, “When every paramedic has a degree, services are going to have to raise wages.”
Would you like to bet on that? Since paramedics have limited job opportunities, there is no incentive to give raises to them.
If I were to be asked by a young paramedic what type of college degree he should get, my advice would be to either get a Bachelors of Science in something like biology or chemistry OR a degree in business administration. Both are far more portable than a specific degree in EMS. Both give a paramedic a route on to professions outside of EMS. There is far more likelihood of a good return on investment with those degrees.
This is not to say that better education is needed in EMS, at both the BLS and ALS levels. That’s not going to happen at the BLS level for reasons I won’t go into. It should and might happen at the ALS level.
As long time readers will know, post retirement I make money in the Quality Improvement end of EMS. A big part of that job involves reading Patient Care Reports. My company rules don’t allow us to score the quality of writing other than as it relates directly to patient care. That is, we can’t correct spelling, grammar, syntax, or anything related to them.
If we were allowed to, I’d be far busier than I already am.
Which is to say that many of the reports are horrendous when it comes to how they are written. I wince at some of what I read in those reports, even if the clinical care is fine. I can only only imagine what the doctors and nurses who read those reports think about EMS providers. Not to mention what the lawyers think when they are reviewing reports for possible litigation.
If I were building a paramedic program, or rather if I were responsible for setting the requirements, remedial English and Mathematics would be added as well as better Chemistry, A&P, and Biology classes. That would be the first part of the program, before we even got to the medicine part. I’d probably add a basic business course as well, so the students could understand the economics of EMS.
That’s the biggest need in paramedic education right now. Produce paramedics that know what they are doing and why, can write a coherent sentence in a report, and understand why EMS operates as it does, then you can talk about making EMS a profession.
As it stands now, EMS on it’s best days is a trade, but spends most of it’s time as a skill set that can be used in a variety of other trades and even a couple of professions.