The educational standards for paramedics have risen steadily over the past few decades and some are calling for it to become even higher. If current trends continue, it won’t be long before one must have at least a bachelor’s degree before they can become a paramedic.
I’ll pose a question that many will find abhorrent: Are these ever increasing educational standards harming our profession more than they’re helping?
Before you label me a heretic and castigate me with all prehospital practices not based firmly in evidence-based medicine, allow me to share how I found myself asking this question.
The Current Situation
I’m a crew chief and field training officer at a large urban EMS service. We’re a third party government agency and we provide cutting edge prehospital care in a large Northeastern city. We’re the exclusive providers of standby coverage to the NFL, NHL, and MLB in our city. Every call we answer comes through the 9-1-1 system, and we don’t perform routine inter-facility transfers.
Within the organization there’s room for growth, and there are a variety of career paths beyond working on an ambulance, such as technical rescue, public safety diving and a motorcycle medic unit. We also have tactically-trained paramedics embedded with the police SWAT team, hazardous materials technicians and members that are part of an elite regional urban search and rescue team.
We’re the primary field training site for one of the nation’s premier paramedic training institutes. This organization is affiliated with a major university, and offers the students the opportunity to complete a bachelor’s degree in emergency medicine in addition to their national registry paramedic certification.
Our pay is significantly higher than the national average, our pension is guaranteed at age 55, and our union offers strong protection. We enjoy better working conditions, career opportunities, and pay than the majority of EMS providers across the country.
One might assume that we have a large pool of potential recruits, and that people are beating the door down to come work for this organization.
Unfortunately, that’s not the case.
In fact, we’re hard pressed to hire enough providers to fill the vacant spots. Within the organization, there’s a large cohort of providers that are finishing their careers and retiring. Many of the new providers that are hired work here for a few years and then move on to other opportunities such as medical school, PA school and nursing.
Why Aren’t People Staying in the Profession?
As I think about our recruitment and retention problems, I have to compare the experiences of the senior providers finishing up their careers and the young people that make up the majority of our new hires.
The people that were hired in the late 70’s and early 80’s came out of high school, attended a relatively short training program in local community colleges and technical schools and then came to work. Their efforts laid the foundation of the organization. They were able to build solid middle class lives without working secondary jobs, and now they’ll enjoy a well-deserved retirement.
The students that we precept make up the organization’s primary recruitment pool. Frequently, when the students arrive to the station for their first clinical shift, it’s their first time ever setting foot on an ambulance.
I’ve gotten into the habit of asking my students what their goals are during the initial introduction and orientation. By and large, the majority of the students will tell me that they hope to go to PA or medical school after they complete their bachelor’s degree. Some will come right out and say that they have no intention of ever working in EMS, and others will say that they plan on working in the field for experience during a “gap” year between undergraduate and graduate studies. The students considering a career in EMS are few and far between.
It’s extremely challenging to train these new providers, who have no experience working at the BLS level and have minimal interest in the actual work of prehospital emergency care. We are tasked with teaching them how to be paramedics, but often we have to spend most of their first semester working on basic assessments and BLS interventions.
In many ways, the system that allows these young people to attend paramedic school without any experience at the basic level has failed them. To me, it’s a symptom of a much larger problem. The current paradigm of paramedic education treats our work as subtext on a curriculum vitae rather than as a career path.
Cultural & Educational Shifts
I would be remiss to ignore the broader cultural trends that have also impacted the dichotomy between our new recruits and the older members. It’s undeniable that, while our wages are higher than average, they have stagnated. The money that was earned in the 70’s and 80’s had much more actual buying power, and it afforded people a level of comfort that’s not necessarily equivalent today.
Our society also tends to thumb its nose at work that includes shifts, uniforms, and unions. Many people come out of high school today believing that a white collar lifestyle is the sole definition of success. Current trends in EMS education that focus on universities rather than community colleges and technical schools compound the problem.
Many university students come from white collar backgrounds and expect white collar lifestyles. When they graduate from college, they have the privilege of choice and a plethora of options which many of our soon-to-be-retired colleagues didn’t have. For many of them, investing in a graduate-level education isn’t an economic hardship. Consequently, many of the recruits that we hire today–even the ones that think they want to be paramedics, will move on after a few years because they don’t like the shifts, the physical labor, and the schedule.
These young providers tend to define success as not having to work nights, weekends, and holidays. Many also believe that the inevitable manual labor of EMS is beneath them and they seek social status beyond being “just” a paramedic.
Where Do We Go From Here?
Increasing the wages and improving the benefit structure might provide a short-term bandage, but it won’t solve the recruitment and retention problems. Our profession is inevitably 24/7/365 work, and the problem has more to do with lifestyle and status expectations than with financial stability.
It’s without a doubt that the advances in prehospital care over the past few decades, as well as the expanding roles of providers, benefit our patients. I understand that our profession will continue to evolve, and things like the use of point-of-care ultrasounds in the field, along with lab evaluations using portable clinical analysis devices will become a part of the standard of care. As we continue to progress, it’s inevitable that more education will be needed.
I’m not calling for a return to the days when a paramedic course could be taught with the material contained in a trifold pamphlet and a one month field internship. However, if we hope to fortify our profession for the future, paramedicine must be more than a stepping stone. We must work to recruit individuals who will work in the field for more than their “gap” year.
I would never discourage a young person from chasing their dreams, but we must find a way to recruit people whose goals and lifestyle expectations are in line with the realities of working in EMS. This may mean separating ourselves from universities and bachelor’s degrees, and focusing on building an educational model more aligned with technical schools and trade apprenticeships.
I don’t pretend to have all of the answers–or even all of the questions–but I love this work and I hope to be a part of building a better future for all of us.
I call on anyone who has a stake in the future of our profession: The time for action is now. We must work together to find new and innovative ways to recruit and retain young people. Apathy is our greatest enemy, and if we continue to stand by, it may soon be too late.
