The Next Paramedic Shortage

EMS 2.0 is a term coined our FireEMS Blog neighbors, The Happy Medic and Life Under The Lights earlier this year.

Here is Happy’s original description of EMS 2.0:

A concept started at HMHQ and spread through other media and users is EMS 2.0 This refers to the reboot and reload of the mission of EMS in the near future to accommodate the changing requirements put on the system. Whether Fire based, EMS based, hospital, clinic, SUV, bicycle…however it is that you deliver EMS needs to be drastically re-invisioned, re-trained and re-deployed. we are no longer an Emergency service but an Encompanying service, and Empowered service, an Evolving service. (go HERE for link).

Chris Kaiser, the Ckemtp in  Life Under the Lights, provides a great rant summarizing the issues in his first blog entry in the new digital neighborhood.  (read it HERE)

THE MEDICS ARE REVOLTING

I experience déjà-vu when reading about the professionalism of the paramedic trade. As an unfocused community college student I thought I wanted to be an engineer.

About a quarter of the Intro to Engineering class was devoted to the whine that Professional Engineers were not getting the respect or money that physicians or lawyers enjoyed. I also remember the 1971 picture of a professional engineer at work, wearing a loud sports jacket, wild tie and porkchop sideburns offsetting a receding hairline.

My heart ached when reading a 1990’s NFPA Fire Journal article about the Phoenix Fire Department. They seemed to have integrated paramedics into a fire-based ems system in a way that I felt my department would never accomplish.

It is clear, after visiting many urban ems systems, that the phenomena of “paramedic as second class citizen” is a consistent theme. Even in Phoenix.

Pay is an issue for many private, for-profit, hospital and third service agencies. Paramedics move into higher paying and more professionally flexible jobs as nurses. Fitch and Associates posted the JEMS 2009 Salary Survey, go HERE to download a copy.

Respect is an issue at fire-based agencies, regardless if paramedics are single role or dual role.

I appreciate Chris providing a vivid picture of the gap between EMS 2.0 and what he deals with daily.

WHO IS GOING TO EDUCATE THE EMS 2.0 PROVIDERS, PROFESSORS AND ADMINISTRATORS?

At this point, the discussion revolves around getting undergraduate and graduate degrees. There are a handful of academic institutions that offer EMS or related areas of study.
(insert shameless plug for my institution here).

The medical professional model is similar to the engineering professional model. Our United Kingdom firefighter colleagues adopted the engineering model in 1918 with the Institution of Fire Engineers. Most UK chief fire officers have graduate degrees in hard science or engineering. Most USA chief fire officers are working on their bachelor degree.

The nursing model is not perfect, we see Nurse Practitioners, with master or doctorial degrees, competing with Physician Assistants for their share of the health care reimbursement pie.

A lasting lesson from the 1980’s extended practice paramedic experiment was that reimbursement drives health care. Wake County is trying a different approach with their 2009 Advanced Practice Paramedics (article HERE).

HIGHER EDUCATION ECONOMICS

You need PhDs to deliver on a need articulated by Kelly Grayson in Ambulance Driver:

First of all, until paramedics define themselves by a unique body of knowledge rather than by a patch and a skill set, we’re not going to be taken seriously by other health care providers. That body of knowledge is going to require education far broader and deeper than most current EMS educational programs offer.
(quoted from this earlier Firegeezer blog entry HERE)

There is no Doctorate of Paramedicine. You need to sell the program to a university, showing that (a) there is a need (b) the program will generate more revenue (tuition, funded research) than expenses and (c) this effort is appropriate within the institutions goals and strategic plan.

We are slowly getting closer. About 40 members of the National Association of EMS Educators report an earned doctorate – a PhD, EdD, or other designation of academic achievement.

Mike “FossilMedic” Ward

Oct 19: Mark Glencorse (999Medic) adds to the discussion HERE.

Oct 21:  Fire Critic stirs the pot and asks EMS As A Profession?

Oct 21: The Happy Medic adds to the EMS as a Profession discussion and makes fun of my editing this blog!

Also on FireGeezer…

• Snapshot from the Paramedic Battlefield – October 12, 2009
• What Direction for EMS Education? – November 9, 2009
• Are Justin & Mark the 21st Century Gage & DeSoto? – February 13, 2010
• Advanced Practice Paramedics 2.0 – March 14, 2009