Don’t get blinded by the ambulance lights – get a degree

We need to look beyond the immediacy of emergency care to make the EMS vocation a profession


The bigotry of low expectations” and “EMS: The low information voters of health care,” two EMS1 articles by Kelly Grayson were blunt. They reminded me of a project I had with a university-based emergency medicine leader.

We were discussing the value of a bachelor’s degree in EMS. The physician considered EMT and paramedic as vocational activities that touched patients. They were excellent work opportunities for 18-22-year-olds to get patient care experience as they progress up the medical professional ladder.

His scenario looked like this:

  • Freshmen – Sophomores: EMTs working on university ambulance.
  • Sophomores – Juniors: Trained as technicians and work in emergency department.
  • Juniors – Seniors: Paramedics working on medic units and in hospital.

The physician wanted to offer an alternative "pre-med" undergraduate bachelor degree. He felt that the students with the best academic record would have a superior chance for medical school admission. If they could not get admitted to medical school, they were well qualified to become a physician’s assistant or pursue a graduate degree in medical research.

Our research showed that some students in legacy EMS bachelor degree programs would drop out once they obtained their National Registry credential and obtained full-time employment. The physician was baffled by this behavior.

Who are EMS caregivers?

The 2011 National EMS Assessment was commissioned by the Federal Interagency Committee for Emergency Medical Services and funded through the National Highway Traffic Safety Administration  [1]. It built upon the information developed in the National Association of State EMS Officials assessment known as the NASEMSO 2011 EMS Industry Snapshot [2].

There are an estimated total of 826,111 credentialed EMS professionals at the EMT-Basic, Intermediate, and Paramedic levels in the United States. 64 percent are EMT-Basic, 24 percent are EMT-Paramedic, and 6 percent are EMT-Intermediate.

Seventy percent of the EMS workforce is between 20 and 49 years old.

EMS professional education is most commonly a certificate and not a degree. Movement should be toward a degree, but cost and access to programs are currently limited [1,2].

Caregiver pay is poor

We are not well compensated for our efforts. Working conditions for many paramedics are grim, near minimum wage. The U.S. Department of Labor identified 2010 median pay for 226,500 "paramedics and EMTs" at $30,360 per year ($14.60 per hour) [3].

As a contrast, the 310,600 firefighters’ 2010 median pay is $45,250 per year ($21.76 per hour). Police and detectives make more than firefighters. Registered nurses make even more than police and detectives, at $64,690 per year ($31.10/hour).

A board-certified emergency medicine physician earns an average of $270,000 per year, or $130/hour [4].

Professionalism outpaced by ER physicians and nurses

In “EMS 2.5: Building beyond the buzz” we looked at the success emergency medicine physicians accomplished in 40 years, going from a low pay and low prestige side job to a board-certified EMS subspecialty [5,6].

In that same time period, the nursing profession has gone from certification schools to a significant role as medical professionals [7].

What has EMS done in those 40 years? There have been some bachelor degree programs established, many more associate degree programs, but the vast majority continues to be certificate programs.

Do EMS caregivers lack academic discipline?

Grayson said, “75 percent of EMS workers are willfully ignorant and never care to learn, 15 percent are unintentionally ignorant, and perhaps 10 percent are truly knowledgeable prehospital care professionals.” [8].

I spent a dozen years as a faculty member of an online bachelor degree completion program in health science. The early years were a challenge, with technical issues and constant changes in course format and design. A colleague pointed out that the A students would crawl over broken glass to complete work, while a D student would be stymied at the first technical or procedural challenge.

When caregivers are interested in an issue or topic, they provide A-level work. When it is not interesting, difficult or provides no immediate reward, they provide D-level work. There are many working caregivers who are two courses away from completing an associate degree. They just need to finish algebra and English composition.

These were working adults, with families and often two jobs. It's very tough to complete a degree under those conditions.

Note to the young caregiver

If your parents have saved and sacrificed so you can get a bachelor degree, I recommend that you take full advantage of this life-enhancing opportunity.

I understand your desire to start saving lives as soon as possible. I was living in a fire station while flunking out of engineering school. It took 13 years to get my bachelor's degree.

Going to university as an 18-year-old is the best investment of your time and interest:

  1. It is a unique experience that will not be duplicated when you are on the job and working to complete the degree. The journey is valuable.
  2. You have the least amount of distractions. No significant other, mortgage, part-time job or studying for a promotional exam.
  3. Which degree you get is based on your interest, work habits and intellectual ability. The experience of completing the process may be more valuable than the content of the coursework.

Getting started in EMS

If you want to work as an EMS professional, research where you want to live and which emergency service agency you want to work for. I suggest you start this as a sophomore.

Visit these departments during your summer break. Visit a bunch of work locations and talk to the crews. Get an application package. Prepare for the CPAT (Candidate Physical Aptitude Test) if needed.

Determine what the requirements are and, if that is your dream location, commit to meeting those requirements.

The proposed EMS bachelor degree was science- heavy and, to meet the needs of the EMS Educational Standards and specific university requirements, would take five years to complete. After looking at legacy EMS degree programs and market research, the project was killed.

Given a choice between a legacy pre-med degree and an EMS one, the parents preferred tradition.

References

1. Federal Interagency Committee on Emergency Medical Services. (2012) 2011 National EMS Assessment. Washington DC: U.S. Department of Transportation, National Highway Traffic Safety Administration. Accessed 9/8/2013 from http://ems.gov/pdf/2011/National_EMS_Assessment_Final_Draft_12202011.pdf   

2. Mears, G. (2011) 2011 EMS Industry Snapshot. Falls Church, VA: National Association of State EMS Officials.   Accessed 9/8/2013 from http://www.nasemso.org/documents/NASEMSO2011SnapshotPresentationFINAL10-2011.pdf

3. Bureau of Labor Statistics (2012) Occupational Outlook Handbook, 2012-13 Edition, EMTs and Paramedics. Washington, DC: U. S. Department of Labor.   Accessed September 8, 2013 at: http://www.bls.gov/ooh/healthcare/emts-and-paramedics.htm

4. Medscape (2013) Emergency Medicine Physician Compensation Report: 2013. New York, NY: WebMD LLC.   Accessed 9/9/2013 from http://www.medscape.com/features/slideshow/compensation/2013/emergencymedicine   

5. Ward, M. (2013) “EMS 2.5: Beyond the buzz: Time to stop whining, time to start building.” ems1.com. Accessed 9/8/2013 from: http://www.ems1.com/ems-advocacy/articles/1395903-EMS-2-5-Beyond-the-buzz/   

6. Zink, Brian J, MD (2006) Anyone, Anything, Anytime: A History of Emergency Medicine. Mosby Elsevier.

7. Egenes, K. J. (2009) “History of Nursing” In Roux & Halstead Issues and Trends in Nursing: Essential Knowledge for Today and Tomorrow.   Sudbury, MA: Jones and Bartlett Learning.

8. Grayson K. (2013) “EMS: The low information voters of healthcare: Making decisions purely on emotion and superficial knowledge.” ems1.com. accessed 9/9/2013 from: http://www.ems1.com/ems-advocacy/articles/1515770-EMS-The-low-information-voters-of-healthcare/

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