Do We Really Need EMS Degrees?
I have been firmly in the no degree camp for most of my career. Even when I entered a program as an adult learner to get my bachelor’s degree, I felt like I was jumping through a hoop to fill out my resume. I never expected to become a better paramedic. In the three years I spent getting a degree, the first thing I learned: I was wrong. This diploma has made me a better paramedic. Period.
There is a growing discussion lately regarding the degree requirements in the EMS profession. Many paramedic programs across the country offer an associate’s degree; while some, such as Eastern Kentucky University and Pueblo Community College, offer bachelor’s degrees in conjunction with paramedic programs.
In many countries, including Australia and the UK, a bachelor’s degree is required for entry-level paramedics, and further training is required for more advanced paramedic practice. Why do we continue to cling to the belief that we don’t need more education for EMS professionals in the United States?
We’ve always done it that way. Perhaps the most damaging sentence ever uttered. Yes, we have always done it this way, but we continue to face the same challenges. Low wages, difficulty meeting reimbursement threshold, lack of employee and volunteer engagement plague all of our EMS systems. The fact that we still ask EMS professionals to volunteer is a discussion for another day, but certainly contributes to the current paradigm.
EMS professionals desperately want to be seen as clinicians, like doctors, nurses and other allied health professionals. You wouldn’t dream of taking your child to a pediatrician who did a year of school and took the rest from work. This may be why we are still considered a provider and not a provider by the Centers for Medicare Services. An ambulance is grouped in the same category as the company that supplies toilet paper to a hospital. We are a transport advantage, not a clinical advantage.
Increase your career options with more education
Due to injury on the job, family demands, or burnout, many emergency medical services professionals must eventually find work outside of emergency medical services.
How do you go from transportation provider to clinical service provider? Education. Now, before you all go out and start sharpening your pitchforks, listen to me. Am I to believe that a bachelor’s degree will improve your ability to start an IV, extricate someone from a vehicle, or attach a 12 to 0200 tube? No, no I don’t.
I also don’t think 8 years of school improves a doctor’s ability to intubate a patient who falls into the ER. However, what those 8 years of school do is teach a doctor how to stratify risks, identify opportunities, and make a decision under uncertainty, using the best information they have at the time.
The 4 years of study that a BSN completes make him a better communicator, a better listener and a better writer. Education is not just about clinical practice; education is learning to think.
In the midst of the pandemic, how do we decide what information is good, good and bad? We make these decisions by reviewing information, considering it, assimilating it, and coming to a conclusion. These are skills that are perfected in the process of earning a degree.
As EMS enters the realm of mobile integrated healthcare – which is coming fast, whether you like it or not – there is a need for mobile clinicians who can make decisions of moderate medical complexity. It’s a mouthful, but that’s the exact language used in the CPT codes that Medicare uses to pay clinicians for clinical services. Of course, we make decisions now, based on protocols, and the old caveat, “call the doc!” Continuing education will develop the minds of EMS practitioners to become clinicians, and to engage in and improve complex decision-making.
To look forward
As we advance EMS practice and continue to increase our clinical acumen, we must also take steps to increase our level of education. Higher reimbursement will equate to higher marginal revenue for agencies, allowing for higher compensation. The path to higher reimbursement is to be recognized as a health care provider, not a transportation benefit.
The way we gain recognition as providers, as clinicians, is by showing that we have the training that puts us in that category. This change won’t be quick, but it’s a change we need to make to move the profession forward.
I spent a lot of time in the camp without a diploma. I am now firmly planted in the diplomas for all camp. I don’t have all the answers as to what these degrees look like, but if I had to indicate a starting point? I would say, associates for paramedics, bachelors for paramedics, and masters for critical care or community paramedics. To develop the master’s level paramedic into a true advanced practice paramedic and move the profession into the realm of nurse practitioners and physician assistants. We cannot continue to do what we have always done and expect a different result.
What do you think: should EMS providers be required to graduate? Share your comments below.