By James H. McConnell, NRP, BS

As EMS agencies across the nation struggle with a shortage of qualified professionals, the race is on to find creative ways to recruit and retain employees in this mission-critical occupation.

In addition to the pay inequities for EMS when compared to other healthcare occupations, the lack of a clear career path and the limited opportunities for professional growth are likely major barriers to increasing the pool of paramedic prospects.

One way to alleviate these challenges is to develop and implement career pathing for EMS employees. This helps to provide options for paramedics based on their personal interests and skillset. Additionally, a clearly-defined path helps to balance support for professional advancement with clear expectations of what is necessary to earn varying levels of recognition, responsibilities and compensation.

Options for paramedic skills acquisition

Gastonia, North Carolina’s Gaston County EMS (GEMS) has been working for several years to increase opportunities for the agency’s 129 full-time EMS providers. During the 2020 budget process, GEMS leadership submitted and was approved to move forward with a career pathing plan for our paramedics.

As a primarily ALS service, the initial plan is to focus on the development of GEMS paramedic personnel within the agency, though there are also plans for EMT personnel in process.

The GEMS Paramedic Career Path provides multiple options for employees based on their interests and accomplishments. Employees benefit from new skill acquisition, compensation for additional responsibilities, and clearly defined options and expectations for professional growth.  

Steps to succession planning

GEMS leadership has laid out the career path in a game board format so that personnel can easily mark off their accomplishments and determine what steps they should take to reach their desired career goal within the organization. Click here to view the GEMS Paramedic Career Path.

Opportunities are grouped initially by education and years of service. For those who attain additional degrees or those who support others as a Mentor or Preceptor, they earn additional steps in the path. Formalized leadership responsibilities such as Paramedic Crew Chief or Field Training Officer are additional, compensated steps in the pathway as well. The final grouping focuses on individualized categories to earn the rank designation of Master Paramedic.

Available Master Paramedic pathways include Critical Care, Community Paramedic, Tactical Paramedic and Rescue Technician. Progression through the various steps is supported additionally by GEMS in the forms of education leave, on-site classes, paid professional development each month, and bi-annual paramedic refresher training. 

In addition to expanding opportunities for personal career development, we anticipate the career path will help with ever-critical succession planning within the organization.  

This plan has been well-received by the GEMS paramedics. Chief Mark Lamphiear hopes that this will be a solid foundation for growth for GEMS paramedics and serve as a way to recognize and compensate employees for such growth.

“At the core of our profession, we are servants to the public. That level of service comes with tremendous sacrifice by our employees and a critical, specialized skillset. I’m proud of the work that our EMS clinicians do every day and this is just one way that we hope to support them in their career development and say thank you for their service to Gaston County,” Lamphiear noted.

About the author

James H. McConnell, NRP, BS, is deputy chief, Gaston County EMS, Gastonia, North Carolina.

They exist in almost every EMS system across the country. Your medics are dispatched to that all-too-familiar address, typically for a low-acuity medical call. While responding to the call (and taking the precious ambulance resource out of the mix for a potentially higher acuity response), one of the crew members says, “Ya know, someone should do something for this patient to keep us from having to respond all the time.”

EMS-based mobile integrated healthcare (MIH) programs have been around for almost a decade, and some have published outcomes from their programs. While high-profile studies have questioned the value of “traditional” EMS from a patient outcome perspective, data being published on the outcomes of MIH programs are revealing not only dramatic reduction in acute care utilization, but also improvements in patient outcomes and experience of care. These data may create the new value proposition for EMS in the U.S.

MedStar’s MIH outcome data

MedStar Mobile Healthcare in Fort Worth has been operating an MIH program since 2009. The program includes the management of high utilizer group (HUG) patients, and a robust 911 Nurse Triage Program.

Patients who use 911 15 or more times in 90 days, or those who are referred into the program by ED or payer case managers due to high ED utilization, are enrolled in the HUG program. MedStar's Mobile Healthcare Providers conduct regular home visits, connect the patients to available resources and teach the patients how to better manage their own healthcare. Typical enrollment is 30-90 days.

HUG outcomes:

• Since July 2009, 779 patients with two years of utilization data available (1 year pre- and 1 year post-enrollment) have reduced ambulance transports to the emergency department by 5,909 (49%) and 70% for patients designated as "system abusers"
• The program has also reduced ED visits in this patient population by 3,496 and prevented 1,596 hospital admissions
• This reduction has saved $23 million in healthcare expenditures for ambulance, ED and admissions ($29,481 per enrolled patient)

Low-acuity 911 callers are referred to a specially trained RN in MedStar’s PSAP. These nurses are specially trained in triaging patients in a non-visual (dispatch) environment and use a robust decision support software system by Priority Solutions called LowCode to help find appropriate resources for the patient’s medical issue.

911 Nurse Triage Program outcomes:

• Since June 2012, 12,226 low-acuity 911 callers have been referred to this program, and 37.6% of these patients have had a response other than an ambulance to the emergency department
• This reduction has saved $6 million in healthcare expenditures for ambulance transport and emergency department expenditures ($1,298 per enrolled patient)

Increased patient satisfaction through MIH

In healthcare’s transforming economic model, patient experience and improvement in health status is exceptionally important. Patients enrolled in MedStar’s HUG program report a 36% improvement in their health status, a 96% patient satisfaction rating and 98% of the enrolled patients would recommend the service to others.

For the 911 Nurse Triage Program, you might think that people who call 911 for an ambulance, and instead get a Lyft to a clinic, might be dissatisfied. However, the patient experience scores for the Nurse Triage Program maintain an overall patient experience rating of 93.6%, with 87% of the patients stating the alternative disposition saved them time and money and that the call should not have been handled any differently.

Perhaps widespread adoption of programs like these will be able to enhance the value proposition for EMS, in terms of economics, patient experience of care and health status!

Want to learn more? Visit www.medstar911.org/mobile-healthcare-programs to see more details about MedStar’s MIH programs.