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Degree requirements, Pink Floyd, and a seat at the adults’ table

Despite the growing pains and staffing shortages, degree requirements will improve EMS in the long-run

Scot Phelps, in his survey of Texas paramedic education programs, demonstrated that paramedic education already requires an equal or greater number of credit hours than an associate degree RN program.

I read with great interest the recent Joint Position Statement on Degree Requirements for Paramedics released on behalf of the National Association of EMS Educators, National EMS Management Association, and the International Association of Flight and Critical Care Paramedics.

The document clearly stakes out the position that a two-year associate degree should be the minimum standard for paramedic education in the United States. That’s a position I fully agree with, but more interesting to me is the associations who signed on to support the statement. One would expect NAEMSE to advocate for greater educational requirements; education is their thing. Likewise, IAFCCP would be expected to advocate for a change that, presumably, would one day result in greater professional credentialing and higher wages for its members.

But NEMSMA, a professional society made up of EMS managers and administrators, would seemingly have little to gain by advocating educational requirements that will only worsen the paramedic staffing shortages many of them are experiencing, and likely substantially increase their personnel costs. It would seem counter-productive to their members’ interests to support a degree requirement.

Unless, as I suspect, NEMSMA is taking the long view of what is best for the profession, even if that means some short-term growing pains. If so, I applaud them for their foresight.

Giving EMS a voice amidst nurses, medicine and allied health

NEMSMA’s support lies in stark contrast to some of those decrying the position, who think certificate education is just fine, thankyouverymuch.

I hear Pink Floyd playing in my head; “We don’t need no education, we don’t need no thought control, no pathophysiology in the classroom…”

When you’re in your rebellious and questioning adolescence, that song is a cool, anti-authoritarian anthem. But EMS is out of its professional adolescence now, and it’s time we realize that the teacher was right: how can we expect to have our pudding if we don’t eat our meat?

There is little question that the practice of out-of-hospital medical care has become increasingly complex, and in an era of integrative medicine, where collaborative relationships between healthcare disciplines are increasingly emphasized, EMS can no longer afford to stay in our own little silo of patient care from station to scene, to ED. Our perspective of healthcare delivery needs to be broader, and our education on the provision of it needs to be deeper.

And truthfully, many quality certificate EMS education programs are already doing that under the current National EMS Educational Standards. What they lack is an official stamp of legitimacy and the professional respect of our colleagues in medicine, allied health and nursing. A minimum degree requirement would meet both those needs.

It’s not right and it’s not fair, but as my partner, Nancy Magee likes to say, “perception is reality,” and the perception of EMS among the rest of the healthcare universe is “ambulance drivers.” And while the policymakers who hold the purse strings of EMS reimbursement – a substantial obstacle to increasing the length and cost of EMS education – likely don’t much care whether we have degrees or not, their decisions are not made in a vacuum. They seek input and counsel from healthcare industry leaders and advocacy organizations, virtually all of whose members have degree requirements. And those industry leaders advocate with a mind as to what is best for their constituents.

For EMS to have a voice that carries equal weight as nursing, medicine and allied health, we’re going to have to prove that we deserve a seat at the adult’s table. Right now, we’re still over there at the folding card table in the corner, sitting in our cramped chairs, sullenly muttering about how we’re grownups now, and deserve more than scraps and leftovers. And sadly, we’re still engaging in food fights on social media and complaining about how hard and unfair high school algebra is, thus proving our immaturity as a profession.

Implementing degree requirements for paramedics

It’s not going to be an easy transition. There will be obstacles. But we have to start somewhere, and we have to start sometime, and that time is now. Strangely enough, additional educational clock hours are not likely to be a big obstacle. Scot Phelps, in his survey of Texas paramedic education programs, demonstrated that paramedic education already requires an equal or greater number of credit hours than an associate degree RN program. We’re already there, hours-wise.

It’s probably going to worsen the paramedic shortage some regions are experiencing. EMS systems may have to contract and consolidate, which is not necessarily a bad thing. We’re bloated and inefficient now, and largely waste our personnel resources in our current system model.

There are those out there who will say, “How is a degree going to make me a better paramedic?”

Short answer; it’s not. There is nothing that an associate degree will do to improve the nuts and bolts provision of paramedic care. But there is more to being a paramedic than what you do in the back of the rig. If you don’t realize that already, then you’re a perfect example of why we need higher education: you don’t know what you don’t know.

Nor is a degree going to fatten your wallet, at least right now. But you can’t approach your profession with the mentality of; “Why should I do more if I’m not paid more?”

If a degree requirement were to happen nationwide tomorrow, it’s not going to result in higher wages for paramedics today. But 10, maybe 15 years from now? It’s quite possible.

The authors of the position statement acknowledge that the transition will likely be expensive, forcing many agencies to diversify their revenue streams beyond CMS reimbursement.

But that’s something that prescient EMS managers recognize needs to happen anyway, regardless of educational requirements. We’re going to have to do it to survive, regardless.

The authors also propose a workable implementation plan, acknowledging that this is the work of years, if not decades. Existing paramedics will be grandfathered. Rural and low-volume agencies may best be served by certificate AEMTs. Certificate paramedics will likely be replaced by degreed paramedics through attrition. With an average EMS career span of five years, within 10-15 years, we should see the majority of our paramedic workforce possessing degrees. Wages, hopefully, will follow, but right now a degree requirement isn’t going to take money out of my wallet or yours.

The question here isn’t, “Why should we require a degree to be a paramedic?”

The question is, “Why shouldn’t we?”

Read the full position statement below.

This article, originally published on December 19, 2018, has been updated columnist Kelly Grayson, is a paramedic ER tech in Louisiana. He has spent the past 14 years as a field paramedic, critical care transport paramedic, field supervisor and educator. Kelly is the author of the book Life, Death and Everything In Between, and the popular blog A Day in the Life of An Ambulance Driver.