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The Next Paramedic Shortage

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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).

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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…

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Posted by fossilmedic on October 16, 2009 • Filed under: Administration & Leadership, EMS Topics, Fire Blogs, Training & Development, ambulances, commentary • Tagged: , , , , ,
  • Thanks for the plug. EMS 2.0 is the advancement of EMS out of the adolescent trade phase and into a grown-up profession. However, how we're going to get there is a complicated journey made up of a lot of competing variables.

    My opinion is that a solid educational base is the way to start. I actually plan on enrolling in your institution's program next semester because I firmly believe that every paramedic should be a degreed professional.

    (Any discount or scholarship available because I plan to blog about it? :) )

    Happy got the ball rolling with the term EMS 2.0 and his ideas on the topic. However, this blog network is where it is going to flourish. We have the opportunity to get the next generation of EMS people engaged in an active conversation about the future of EMS on a personal level. Never before has EMS had something this powerful.

    The change is in the wind. We just have to harness the yearning and turn it into something concrete.
  • No discount is available, but we can construct an Independent Study course (EHS 199) around your blogging/EMS 2.0 effort!
  • Name
    the question is what goal is accomplishing increased educational standards going to fulfill. A DSN (doctor of Science in Nursing) is not a program of study of clinical care typically, but rather focused on education, leadership or research. Just as Medic's don't need a PhD to work in the field, neither do RN's.
    Certainly many medic's, such as myself go back for further education in other related areas (Public Policy and Administration, Adult Education, Public Health...) do we need a PhD in EMS.
  • Medics don't need a PhD to practice, but we do need an MD above us in the current system. That is because when this all started we needed Medical Oversight. I look forward to the day when MDs work WITH us pre-hospital instead of holding on to the "Mother May I" past of EMS. But before we can prove we deserve to be freed, we have to learn at least the same as they did before they specialized. At my BS in EMS program we were side by side with the pre-meds all through organic chemistry, biology labs, A&P and all the other 300 and 400 level classes at the same time as attending our Advanced Clinical Care, EMS Administration, Fleet Management and Systems Design classes.
    Tehy went on to be MDs, we went on to be...the same as the 16 week rapid paramedic course.
    Raising the standards of education will raise the education of your care givers, making them better practitioners and more appreciative of the role they will play in the improved systems.

    Thank you Mike for raising the EMS 2.0 flag, you carry it higher than I ever could. And I encourage anyone out there in any media to write about your aspirations for our fledgling profession and include the term "EMS 2.0" so we can find each other.
  • Thanks for the reply Happy. So you were in the physician assistant model of paramedic education. Very cool!
  • Hi Name.

    Practitioners of the EMS craft need not be PhDs, but we need an academic workforce that can deliver the Scope of Practice goals.

    One of the many surprises working in academia is the different levels of doctoral degrees. I can get a PhD in Physical Therapy that is clinical - that is in my "practice." I still need to get an academic PhD/EdD if my goal is to be a university leader.
  • Now that Ambulance Driver has joined FireEMSblogs.com I have added a link to his item.

    Also did a little editing and formatting.
  • I had a talk with my brother, Captain Lk today who's a volunteer fire captain. His "Real" job is as an engineer with PE cards in Mechanical and Fire Protection engineering.

    He's an avid reader of you, Mr. Firegeezer.

    I brought up how you described Engineering as struggling to find themselves as a "profession" in the 70's as you posted. I said it with the assumption that he would think of engineering as a profession as it has progressed since that time.

    He doesn't. He describes a lot of the struggles that I think that EMS is facing. They're a lot more advanced in the process, but still not where they want to be. At least they have solid academic educational standards and set their own professional guidelines.

    We've got a long way to go.
  • Ckemtp, thanks for the feedback. In my day job I am surrounded by physician-educators ... it is a different experience.

    It is nice to hear from a fan of the site!

    Mike
  • Chris#2
    I think the real problem lies in the outcome of the chosen path. For example, look at when you want to be am M.D., you know in advance of the opportunity and the oncome levels. When you take Paramedicine you get what? Low pay, low appriciation, and more schooling. Most people would look at this option as simply not worth the trouble. I hate to look at it that way, but I believe it is true, and I feel the only way to begin branching out would be better funding into the field for things such as school, exquipment, training, and pay rasies. Don't get me wrong, EMS 2.0 is a definate possibility, but i feel only after other issues are addressed there will be more interest in advanced Paramedicine.
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