Although the term itself is somewhat subjective, a quick Internet search on any major search engine brings several good definitions of what it means to be a professional. One of my favorites comes from an unknown author who simply opined, “A professional is someone who can perform their job admirably under conditions that would cause the amateur to turn back.”
I like this definition because it applies well to what we do in EMS. We face adverse and challenging situations on a daily basis and are expected to perform our job flawlessly no matter the circumstances. It also applies well to EMS because it transcends the petty squabbles we have among our various camps. Whether the EMS professional is paid, volunteer, full-time, part-time, fire-based, hospital-based or private, it doesn’t matter under this definition as long as they exemplify the values our profession upholds.
There’s a problem with that definition though. Although contemporary times have brought many meanings to the word “professional” or “professionalism,” the word truly describes the actions of a person who’s a member of a “profession.” That is a word much more contentious to define. I and many other like-minded EMS professionals view EMS as a profession, but academia and the general public may not agree with our assertion. Scholars and wordsmiths alike have been wrestling with the term through the centuries. As society has become more complex, so has the definition of what makes an occupation or trade into a real “profession.”
Searching the Internet for a definition of that word leads to volumes of conflicting opinions, books, statements, rulings and other records generated as occupations have tried to gain their own status as a “profession” through the years.
When searching for the true definition of a profession or professionalism, it’s important to consider many points of view. Abraham Flexner, the noted early 20th century crusader for high professional standards in the medical profession, is often quoted as a defining authority on the term. Volumes exist about his work as various groups have tried to measure themselves against his six criteria for professional status, and various others argue for or against their claims. Flexner’s six criteria state that a profession has the following (1):
• Intellectual operations coupled with large individual responsibilities;
• Raw materials drawn from science and learning;
• Practical application;
• An educationally communicable technique;
• Tendency toward self-organization; and
• Increasingly altruistic motivation
Further definitions of a profession in the literature describe one as having a barrier to entry consisting of mastering an extensive body of knowledge made up of research and theory, serving a defined purpose with benefits to society gained from application of that knowledge, self regulation and discipline of the profession through peer-review and a tendency to serve for the benefit of society rather than simply for the practitioner.
I put the above information into an EMS article because I’d like you to use it to evaluate the following information about our profession that has come up in the media. Recently, many of my friends sent me articles written in my home state of Illinois concerning a series of meetings around the state held by the Lt. Governor. She wanted to talk with EMS providers directly about issues facing EMS in their region. She has formed an EMS commission through the state’s office of Rural Affairs and wants to address the issues being brought forth by the field providers in the meetings.
All of this seems like an admirable goal, right? Many states are doing similar things recently and I think it’s a fairly positive trend.
This article, “Training Cuts into Emergency Medical Service Volunteer Numbers” concerns a meeting the Lt. Gov held in Galesburg, Ill., in which she invited the region’s EMS providers to come and fill her in on the issues they’re facing in the state. Although I believe airing our concerns to the regulatory bodies is a quite reasonable thing to do, reading the article mostly soured me on any hopes that real progress may be coming from any of these meetings. I’ve simply heard the same things too often before.
Something interesting I noted from the article is that Illinois is increasing the length of initial EMT training from 110 hours to 170 hours, and the EMTs in the audience don’t like this. A local EMS provider said, “Many times we like to think that more is better, but in this case, it means more is less ... meaning less EMTs.” That same provider also said, “A volunteer cannot afford to devote 170 hours of classroom time to earn a license, especially when the volunteer is juggling full-time work.” This EMS provider received a round of applause from the crowd for her “passionate speech.”
The crowd also applauded a local ambulance director who “argued for looser training hours and renewal hours” stating that volunteers must devote “30 hours to education a year in order to renew their licenses.” This person also said, “Thirty hours a year may not seem like a lot, but I want you to think of it in terms that each person has to not only go on calls at any time of the day or night, but also find the extra time to maintain the extra hours to stay certified.” The crowd may be right that the demands on volunteers’ time may be great and that finding time to spend thirty hours per year honing their knowledge and skills on topics that may save their patient’s lives is difficult, but a proper way to gain perspective on that may come to us from this recent survey by Neilson that shows the average American spends around 100 hours per year using Facebook.
Think about this: That article went out to the public and became the impression that a good number of people had about our profession for the day. What message do you think they carried away after reading it? Do you think they viewed us as a group of professionals? Are you proud of our profession after what you read there? I don’t, and I’m not.
Although I agree that the length of training time is an issue facing EMS and especially volunteers, I disagree that publicly stating our initial training period as too long is something that we—or any other profession should be doing. EMS has a downward pressure on our educational standards that’s killing our hopes of gaining professional status and approaching our collective issues in a professional manner. We don’t look like a profession. We look like adolescents bickering with our parents over taking out the garbage. Would dentists complain that their initial training period is too long and then state their wish to decrease their continuing education requirements in the same breath? Would physical therapists? Would nurses?
Real professions dictate their educational standards. They balance the sanctity of their professional purpose with the constraints on their members and come up with their own solutions. Frankly, I think that the ideas expressed in this article show a lot of why EMS is as fragmented as it is today. We’re not looking at our issues as a profession or even as an occupation looking to gain professional status. We’re looking like technicians.
My opinion is that a lot of our contentious issues in EMS can be boiled down to us not looking at ourselves as a profession working for a common benefit to society. We’ve divided ourselves into camps that are only loosely affiliated with the whole. The day we all can view EMS as an upcoming profession looking to advance ourselves as a whole is the day we fix these issues and make advances that will benefit our patients and ourselves. EMS serves a vital purpose for society as a true profession. It’s up to us to take the journey.
1. http://wwwsoc.nii.ac.jp/jaas/periodicals/JJAS/PDF/2004/No.15-139.pdf - A paper on Flexner’s positions