I was asked today my thoughts on how to actually fix the problems affecting US EMS, particularly the education issue, by one of the minority who actually wants to fix it. Because the topic is rather complex, I thought it would be better addressed as a post.
I think the most important thing is to think strategically. Somebody (probably numerous people) is quoted as saying “amateurs talk tactics, professionals talk logistics.”
So let’s look at the issues.
US EMS providers don’t actually need a degree most places. They claim it is an expense that has no reward. They cite the fact most EMS agencies don’t want educated workers more than uneducated ones.
Well, I think the solution to that is to make having a degree worth paying for in another way. You could have a professional organization where a degree is required for membership. I belong to 2 physician only professional groups.
Preferential hiring would be another way. I have an anecdote to that, which I won’t type out in its entirety now, but the long and short is a friend with a completely unrelated degree applied for a state level director of public safety position which had hundreds of applicants, most of them fire chiefs, and to narrow the list down, the powers that be (who had degrees) decided they would not interview anyone without at least a bachelor’s. It narrowed the list to 2 candidates. My friend got the job. No fire chief was interviewed.
It seems rather easy to convince educated State leaders to make a degree a requirement for State level Emergency jobs. But I believe in the long term win too. Many community colleges teach EMS courses. They usually have a department Dean or the head Dean who has a PhD, I would think it nearly impossible to fail to convince these people they should preferentially hired educated educators. The same thing could be done at the provider level. Let’s face it, if you can pay an educated person the same as an uneducated one, unless the person was a sociopath, why would you choose otherwise? The average non-fire medic lasts 4-5 years at a given employer; each employer has to train every outsider to their system, so it is not like you get a big advantage from “experienced” people. I also cannot think of any reputable EMS agency that doesn’t have a set FTO criteria over a certain period. Almost every educator I meet opines they would rather have an inexperienced open mind rather than an experienced closed one. Isn’t FTO time education? Why would the rules be different? In addition to preferential hiring, you could make a degree required for promotion. If the Police and Fire service could do that, what stops EMS?
Let’s look at another preferential hiring technique, other organizations that are highly desirable in healthcare like educated workers. Nursing Magnet hospitals, Air med providers, highly desirable EMS jobs, nothing stops them from offering bonus points or preferential treatment to degreed persons. Some of them have so many applicants nothing stops them from making that the base requirement for an interview. When some 17 year old fresh out of school, or some ex-military member with a GI bill to spend realizes they can get a degree and immediately beat out everyone else in line for the most desirable jobs in the market, it is going to cause a lot of people to ambitiously pursue that. What reputable agency doesn’t want people with that kind of ambition and insight working for them?
Use market forces. Currently I live in Europe, in a country where the state pays for almost all education including post graduate. There are PhDs in India and Here who would love to work as a US paramedic. For the same wages US medics currently make! Why not let the market decide?
The German educational hierarchy. Here we use the German system too, and while I don’t like all of it, here is the relevant part. If you are hired at the university or university hospital as a MD, in your employment contract it states you must obtain your PhD in 10 years or your job is forfeit. The level after PhD. (called Habilitation) in another 10 years, or you are out too. Those EMS providers asking “what’s in it financially for me?” Your job! Move up or move out! Sure you could look for a new entry level position say every 5 years, but it certainly cuts you out of promotional ability.
You could hire people on the same way. By accepting this job you understand if you do not get an associate’s in 5 years, you are out. If you do not get a bachelor’s in 10, you are out. This will not affect the earlier generations, because either they are so close to getting out it doesn’t matter, or their nearly 10 years in and probably are looking for another employer anyway.
Tie it to promotion and in a way unique to US EMS because it has almost none, lateral transfer. You want to be the FTO, on the bike team, special events team? “Degreed people to the front” or “TWODNNA” (those without a degree need not apply) These are the supervisors and highly public face of EMS. You want, rather need, your smartest people in front of people and cameras. Some will say “you don’t need a degree to be smart.” That is certainly true, and many very stupid people are given degrees of all kinds. Because a degree is a system and some people simply master the system. But what it also is, is (double “is” drive the grammar check nuts) universally recognized proof that you learned the minimum you needed and paid some dues to your profession.
An FTO teaching others with a degree who doesn’t have one? Certainly not. There is no credibility there. That is like an EMT as the instructor of a medic class. In fact, since an FTO is mostly about system familiarization, it would be much more desirable to hire from outside a system and invest in training that person to the system than it would be to continue the good old boy seniority system. The ability to be recognized as expert is part of being a profession. If I want to change jobs or even countries as a doctor, I have to in some places take a test, fill out some forms, pay a fee, but I do not have to start medical school again. They accept I am a doctor; they just need to verify I can function in their system. Why should any EMS leader be any different?
Now none of this will happen overnight. Basically the people interested in EMS being a profession will have to advance into the positions of authority to implement this. They will also need a degree themselves. But no more trying to argue to convince swine of the value of pearls. It is time for the pearls to stop suffering swine.
Is that arrogant and elitist? You bet it is. But I like the word “elitist.” It is so very “special forces” like. The best of the best. Maybe some don’t want to be the best? That’s cool. If that is you, repeat after me: “Two all-beef patties, special sauce, lettuce, cheese, pickles, onions, on a sesame seed bun.” Because if you do the minimum work to live, you don’t get the same job opportunities and responsibilities as those more dedicated to their profession.
What do Olympic athletes give for even a shot to be a champion? Time, money, effort, health risks, the list goes on. After all, look at the old EMS adage, “I won’t pass anyone who I wouldn’t feel comfortable working on my family.” I bet none of the people who say that would be comfortable with some minimally qualified, unmotivated self-centered, slacker just in it for the money. Especially if they knew their family could get a champion.
I know some will claim they are “happy at the EMT level.” Ok that’s fine, no need to change EMT, just medic. But here is a dirty little secret of US EMS: Management lives for people like you, because you earn less than a MCDonalds or Starbucks employee and work far harder and more hours. Of course it might be hard to get one of those jobs in today’s economy, in every country I have been in except the UAE, the people working at Starbucks were also college students; educated people working for the price of the uneducated. Market forces…
US EMS would also benefit from at the very least from a national self-serving labor union. Truck drivers have one. You drive a truck don’t you? What do truck drivers make compared to you? Garbage collectors have a union, they save thousands of lives every day. What do they make compared to you? Just saying…