I have been firmly in the no-need-for-a-degree camp throughout most of my career. Even when I entered a program as an adult learner to get my bachelor’s degree, I was of the opinion that I was jumping through a hoop to pad my resume. I had no expectation of becoming a better paramedic. In the three years I spent earning a degree, the number one thing I learned: I was wrong. That degree made me a better paramedic. Period.
There is a growing discussion of late regarding degree requirements in the EMS profession. Many paramedic programs around the country are offering an associates degree; while some, such as Eastern Kentucky University and Pueblo Community College, are offering bachelor’s degrees in conjunction with paramedic programs.
In many countries, including Australia and the United Kingdom, a bachelor’s degree is required for paramedics at the entry level, and further education 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 have always done it this way. Perhaps the most damaging phrase ever uttered. Yes, we have always done it this way, yet we continue to face the same challenges. Low pay, difficulty achieving break-even reimbursement, lack of employee and volunteer engagement all plague our EMS systems. The fact that we are still asking EMS professionals to volunteer is a discussion for another day, but certainly contributes to the current paradigm.
EMS professionals want desperately to be viewed as clinicians, akin to physicians, nurses and other allied healthcare professionals. You wouldn’t dream of taking your child to a pediatrician who went to a year of school and picked the rest up on the job. This is perhaps the reason that we are still viewed as a supplier and not a provider by the Centers for Medicare Services. An ambulance is lumped into the same category as the company that supplies the toilet paper to a hospital. We are a transportation benefit, not a clinical benefit.
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Changing the paradigm
How do we go from being a supplier of transportation to a provider of clinical services? Education. Now before you all go out and start to sharpen you pitchforks, hear me out. Do I believe that a bachelor’s degree will improve your ability to start an IV, extricate someone from a vehicle or attach a 12 lead at 0200? No, no I do not.
I also do not think that 8 years of school improve a physician’s ability to intubate a crashing patient in the ER. However, what those 8 years of school do accomplish, is teach a physician how to stratify risk, identify opportunities and make a decision under uncertainty, utilizing the best information they have at the time.
The 4 years of school that a BSN completes makes them a better communicator, a better listener and a better writer. The education isn’t all about the clinical practice; the education is about learning to think.
In the midst of the pandemic, how do we decide which information is great, good and bad? We make these determinations by examining the information, considering it, digesting it and coming to a conclusion. These are skills which are honed in the process of getting a degree.
As EMS moves into 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. That is a mouthful, but that is the exact language used in the CPT codes which Medicare uses to pay clinicians for clinical services. Sure, we make decisions now, based on protocols, and the old reserve, “call the doc!” Further education will develop the minds of EMS practitioners to become clinicians, and engage in and improve complex decision making.
Looking to the future
As we advance the practice of EMS and continue to increase our clinical acumen, we must take steps to increase our level of education as well. Higher reimbursement will equate to higher marginal revenue for agencies, which will allow for higher pay. The path to higher reimbursement lies in being recognized as healthcare providers and not a transportation benefit.
The way we gain recognition as providers, as clinicians, is to show that we have the education which places us in that category. This change won’t be rapid, but it’s a change we have to make in order to move the profession forward.
I spent a long time in the no-need-for-a-degree camp. I am now firmly planted in the degrees-for-all camp. I don’t have all the answers as to what these degrees look like, but if I were to state a starting point? I would say, associates for EMTs, bachelors’ for paramedics, and masters’ for critical care or community paramedics. Make the master’s level paramedic a true advanced practice paramedic and move the profession towards the arena of nurse practitioners and physician’s assistants. We can’t keep doing what we have always done and expect a different outcome.
What do you think: Should EMS providers be required to get a degree? Share your comments below.
