To Educate or Not to Educate: An Economic and EMS Role Confusion Conundrum

Recently I was called out by individuals on various social media channels because I haven’t weighed in publicly about the importance of postsecondary education for EMS providers. Although I believe that pursuing higher education is an important piece of a successful progressive career, I’m not ready to “take sides” as to its mandatory requirement for all of our traditional frontline EMS provider roles.

For those who advocate for formal education, the evidence is strong. A postsecondary education provides a foundation for skills development beyond what we learn in EMT and paramedic school, such as helping us develop critical-thinking skills, challenging us to strengthen our emotional intelligence, helping us improve our financial and business acumen, and teaching us skills that make us more astute in our selected specialty and better-informed citizens and consumers, all desirable traits that have value. Furthermore, there’s research and evidence that suggest that individuals with postsecondary education make a higher wage and some in EMS believe that having degrees will also garner us more respect at various tables–not sure on the evidence on this one.

Although I’ve personally pursued both postsecondary and postgraduate studies, I’m not convinced that these items would have helped me earn more respect or a higher wage when I was in a primary clinical role as a 9-1-1, transport and ED practicing paramedic. Rather, these tools have helped me to form a foundation for the basis of pursuing my career aspirations beyond a field provider role, shifting me from a primarily physical role to a mostly intellectual one.

In fact, when I was a field paramedic with my undergraduate degree, I was often on the receiving end of criticism, bias and prejudice by my peers and superiors, who couldn’t comprehend why I “wasted my time and money getting a degree,” and I was often treated differently from what I can only assume was a defense mechanism for those who thought my intellectual pursuits were intimidating. (This was the early 90s.)

Wearing the Grey Collar

EMS is a mix of career types as well as professional roles that sit in two color spectrums, white and blue, and include public safety, healthcare, public health and disaster response functions. Some of these functions are considered white collar in nature and use more intellectual skills, and some are considered blue collar in nature and rely more on physical, hands-on skills.

Given this conundrum, we should really classify EMS in a third spectrum, as a “grey collar” profession, meaning it’s a mix of both blue and while collar skills sets. Traditionally, blue-collar work is vocationally educated, and white-collar work requires postsecondary education. Given our grey-collar status, an argument can be made that the primary role that a provider is participating in should drive the educational requirements.

I consider the public safety and disaster response sides of our mission towards the blue-collar side of our grey collar color spectrum, and our public health and healthcare roles leaning toward the white-collar side of the grey collar color spectrum. Thus, an argument can be made that if you’re in a traditional EMS provider role, then the current vocational education system seems appropriate and has worked for decades. However, if your role is taking you more into the public health and healthcare aspects of our changing mission (e.g., community paramedicine, expanded scope paramedic, etc.), then a strong argument can be made that additional postsecondary education is warranted in order for us to first, do no harm.

Lastly on this topic, I believe that postsecondary and postgraduate education is an absolute requirement for all future EMS leaders, given the forthcoming complexity of disruption that lies ahead. Although my take on this topic will likely be cast as waffling or riding the fence of this divergence, the fact is that for now, given the current environment, both arguments are correct and as is often the case in EMS, one size does not always fit all.

This said, it’s time for us to adapt to our changing environment, and I believe we’ll see EMS diverge into two paths as the future of healthcare reform takes shape: One path will continue our traditional public safety roles, funded by subsidies of which the vocational education system has a proven record. The other path is where EMS becomes more healthcare-focused, funded by value incentivized healthcare revenue arrangements, which will require additional postsecondary education.

Also, I have to call out the belief that higher education for EMS practitioners will result in upward pressure on wages, as I believe this is a chicken and egg argument. On one side, higher education is typically rewarded with higher pay, however on the other side you can’t get blood out of a turnip to pay for it.

Compensation and Salary

In order for EMS to pay better, it needs better reimbursement mechanisms, whether it be from some form of subsidy or an alternative healthcare reimbursement system. The bottom line is that we as an industry have underspent on wages and many other expense categories, especially in the private sector, because our existing healthcare reimbursement system isn’t aligned with what should be our true costs (which includes better compensation), nor is it aligned with the value EMS providers bring to the healthcare continuum.

Because a significant portion of our revenues are essentially “capped,” the ability for us to charge–and actually get paid–based on our actual and/or desired expenditures (e.g., better wages), plus the need for all businesses to produce some form of a margin to at a minimum recapitalize, forces downward pressure on everything when revenues stay flat or decrease against a rising expense base. In these cases, subsidization of some form is needed to pay for what’s desired in order to fill the gap; however, in markets where this option isn’t desirable, wages, margins and dollars suffer with tremendous downward pressure, not allowing an expenditure to exist at all or putting upward pressure on productivity, thus burning out our providers.

Although I agree that higher education is a good thing, to mandate it now for everyone with the expected outcome of upward pressure on wages would also require considerable payment reform for EMS that fully accommodates this upward pressure on expenses. Without this intrinsic tie, we’ll likely hurt and dissolution ourselves by creating an educated workforce without the ability to pay for the value this next evolutionary step could ultimately bring our profession.

Additionally, this situation would likely add additional downward pressures on the available supply of labor, which is already a substantial problem in many communities. For rural EMS and volunteer-based EMS systems, this type of requirement could be disastrous without some form of financial offsets, essential service or critical access status designation.

Lastly, respect is earned not given. This holds true no matter your education, experience or background. If we truly desire to gain the respect of our peers, EMS leaders must focus on creating a culture of trust and respect within themselves and their own organizations if we ever expect to get respect from others.

As Maya Angelou put it, “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” Respect is earned by how you make people feel, not titles, not status, not position–and certainly not just education.

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To learn more about the art and science of EMS, look to NAEMT and AIMHI on the web for resources as well as follow me on Twitter @EMSOLOGY or @JonathanWashko for quick 140 character insights and links to other resources.

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