Every now and then, a debate lands in front of the EMS community that deserves to be read slowly, listened to carefully and reflected on honestly. The recent Socratic debate published by the International Journal of Paramedicine on whether an associate degree should be required for entry-level paramedics is one of those moments.
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I read the article in the IJOP and I listened to the debate on the YouTube channel, hosted by IJOP Editor-in-Chief Mic Gunderson, and came away encouraged, not because the issue was settled, but because it was treated with the seriousness and respect it deserves.
💡 | WATCH & DISCUSS
This was not a shouting match. It was not social media theater. It was a structured, thoughtful exploration of a question that sits at the heart of our professional identity: What should it take to become a paramedic?
Before we get into the content, it’s worth pausing on the method. This was a Socratic debate, which is not a cage match about defeating the other side, but one of presenting reasoned arguments, exposing assumptions and inviting the audience to think more deeply. Each side is given space to articulate its case fully, without interruption or rebuttal designed to score points. The goal here was understanding, not conquest and that tone elevated the entire discussion.
The argument for an associate degree
Advocating for an associate degree were Sean Caffrey, Gregg Margolis, Mike Thomas and John Todaro. They framed their case around professional maturation and alignment with modern healthcare, arguing that paramedicine has evolved beyond its historical roots.
Today’s paramedics are expected to assess undifferentiated patients, make autonomous clinical decisions, integrate with complex healthcare systems and function as the front door to care. That level of responsibility, they contended, requires a deeper and more structured educational foundation.
Their argument emphasized that an associate degree is not about elitism or exclusion, but about equipping clinicians with essential competencies that support practice in environments where protocols alone are insufficient, e.g.:
- Critical thinking
- Ethics
- Communication
- Research literacy
- Clinical reasoning
As clinical complexity increases, so does the need for education that fosters judgment rather than rote compliance too.
They also pointed to professional trajectory. A degree-based entry pathway, they suggested, creates smoother transitions into leadership, education, community paramedicine, research and system design, helping avoid educational dead ends and supporting long-term career development.
Notably, this team did not dismiss current workforce pressures. Instead, they challenged the profession to consider whether it is prepared to invest in the level of education that aligns with the expectations, responsibilities and future direction it increasingly places on paramedics.
The argument against mandating a degree
The opposing team of Lewis Imperatrice and Ed Bauter did not argue against education. They argued against exclusion. Their concern was practical, grounded and urgent: mandating an associate degree risks narrowing the entry pipeline at a time when EMS is already stretched thin.
Cost, access to colleges, time, geography and life circumstances are real barriers to obtaining a degree, particularly in rural systems and underserved communities.
They reminded us that EMS has historically thrived on multiple pathways into the profession, and that excellent paramedics are built through quality instruction, mentorship and experience, not solely academic credentials.
Most powerfully, they asked an uncomfortable question: if we raise entry requirements without fixing pay, working conditions and career sustainability, are we simply asking people to give more to a system that gives little back? That is not resistance to progress, it’s just realism.
The international lens
The debate also sits within a broader global context. In countries such as the UK, Australia and Norway, paramedic education bachelor’s degrees, rather than associate degrees, have become increasingly common. These models reflect different healthcare structures, funding mechanisms and professional histories.
Whether those systems offer lessons, warnings or simply contrasts is a matter for thoughtful consideration and precisely the kind of reflection this debate invites.
No verdict by design
What makes this IJOP debate so valuable is that it does not tell the reader what to think. There is no declared winner, no attempt to “score points,” no effort to dismantle the opposing view. Instead, it presents reasoned arguments side by side and trusts the profession to engage with them, and that may be its greatest contribution.
So rather than offering a verdict here, I would encourage you to do what this debate asks of us all: read it, listen to it, reflect on it and decide for yourself; and then contribute to the debate via the NEMSMA list serve. The jury, quite deliberately, is you.
In the words of panelist Greg Margolis — “thank you for listening and for keeping an open mind.”
Additional resources
Do you believe requiring an associate degree for entry-level paramedics would strengthen or strain the EMS profession?
EMS1 readers respond
“I’d have no issue of having a AS degree as a paramedic, if there was a school/university that offered it as a degree program. There’s several community colleges/universities in my area that have a paramedic certification program. I don’t know why nursing is a degree and EMS is a certification other than when EMS was first introduced in the U.S. it was to teach a layperson the minimum skills necessary to get a patient to the hospital.”
“I do not believe that an AA degree should be required for entry-level paramedics. Degrees are a challenge, particularly in rural areas, to fund, attend and do not have the needed ROI. Leaders, however, should strive for an AA or BA. And in turn should mentor and lead the entry level medics. Take care and keep up the good work!”
“I would like to see the EMS industry reach a point where paramedic programs are associate degree programs, concurrent with better funding and federal government recognition. The pay increases would follow a more professional career presentation. Many nursing programs were certificate-only as recently as the 1960s, but degrees in nursing have launched the profession, and pay has followed. While EMS is not exactly the same as nursing, it can mirror that industry in growth and professional recognition.”
“For all the points listed — no — plus, having went for the ASC AFTER a very good hospital program — I learned nothing in the college courses, had to endure endless woke BS, and class schedules that have no sense of reality for working EMS. Incurred debt, and it did not gain me anything. I later went for my BSc in completely unrelated field, and now pursuing my masters — but my company pays, gives me time off to attend. For 40 years, I’ve been hearing how important we are to the system — yet we still are paid much less than cops or fire. Hell, even Sanitation in NYC is paid better. Glad to be out, paid what I’m worth, with a real life after work.”
