I’ve always found Brian Behn’s posts at emsqaqi thought-provoking, forward thinking, and reasoned. His “The Empty Suits of EMS” was a bit different. It took a more negative edge than normal… something I felt with each paragraph. This time, his pithy, lighthearted needle poking at EMS was a rusty machete swung with the vigor of someone exacting revenge. Behn’s victim in this case were leaders of an industry that is changing struggling.
I did read his atonement at the end. Alas, by then it was too late. Behn’s vitriol exposed his disdain for those not working the streets anymore. Be they C-suite suits, educators (maybe working one shift a quarter for “street cred”), or CCEMT-Ps and flight medics showing off like Top Gun pilots at a Civil Air Patrol conference.
Empty Suit or Bad Leader?
Empty suits? I cannot defend. There are great leaders, poor leaders and leaders quickly forgotten because they were neither. There are too many individuals; and for every one admirable leader, each of us can recall one or more leaders we regret knowing. Yet poor leaders and those quickly forgotten do not push boundaries of EMS. Rather, they maintain the status quo and look out for their own career. They fear failure and micromanage subordinates as to prevent their reputation from being tarnished. On this Behn is correct. Yet not all leaders can be categorized by the worst amongst them. Exceptional leaders figure out how to make gains by working to better the profession through their agency. The best try to mitigate pain. Yet on occasion, pioneers create situations where pain cannot be completely avoided. With change bumps are inevitable, organizations grow from them.
There were many points to address in Behn’s blog article. Yet degree bearing paramedics is a crucial item that needs to be discussed ad nauseam. This does hit close to home. I work for an agency that now requires new paramedic hires to have (or complete with in six months) his or her Associates Degree (AD). It is difficult to know for sure if scant applications are due to this requirement or an industry-wide shortage.
Why a Degree?
Throughout my undergrad and graduate coursework (which was always focused on EMS), I argued the same point. Currently, demanding paramedics earn a degree is a barrier. Paramedics want to get out there as quickly as possible. There are extrinsic attractors to prehospital work that are not necessarily more powerful than two or four years of college work. And the reality is, many paramedics are not interested in writing ten page papers. Hell, including pertinent negatives is a chore for many. And it is true, more paramedics outside the United States have university degrees. From reading, however, foreign paramedics are not much happier. They spend four or more years getting a university degree to do roughly what we can do in America or work with physicians on their rigs.
With that said, like Behn, I promote the idea of paramedics getting a degree. For an upper level research class, I designed a prospective study to measure certain differences novice paramedics with an AD and those without. Assuming an AD would focus on general education college-level classes and not advanced A&P or pathophysiology, logic and cognitive ability would be the focus of study. Other fields have shown some improvement in performance when degrees are required. But, does that necessarily translate to prehospital practitioners? No one has studied this according to my literature searches.
Advanced, To What Degree?
This begs the question, which will come first: Degreed paramedics or advanced prehospital practitioners? Will a wider scope of practice simply be bestowed upon paramedics out of legislator benevolence? Will medical directors find it in their hearts to allow more autonomous treatment decisions for no reason? Or do we need to stock ambulance services with more educated clinicians before these events happen? I harp on this point because it needs to be addressed. Do we continue to avoid demanding degrees because college educations are inconvenient or those attracted to EMS are less didactic and more hands-on? Doing what we’ve been doing is an easy way out. One that leads to keeping us trusted as technicians rather than clinicians.
Perhaps we stop dwelling on what prevents paramedics from earning degrees and begin encourage degree bearing colleagues. Yes, pay is low. But wages are derived from reimbursement. [Put high call volume and staffing shortages aside.]. Higher reimbursement follows higher capabilities. CMS compensate physicians who use new technology at higher rates to help defray costs of new technology and compensate for the learning curve. If EMS never pushes barriers, stays in present mode, there is no incentive for third party payers.
I did suggest leaders make some bold moves, which may cause discomfort within their agency. Such moves, if failures, may sacrifice their careers. Why can’t we suggest new paramedics take a similar risk? I earned two degrees for intrinsics, the extrinsic have yet to pay-off. In six years to rack up almost debt amounting to 2/3s of my annual income. I get it, my career was solid and it was a personal choice. My degree was a goal of mine regardless of where it took me within EMS.
Cognizant of this, I respect that my situation does not fit all. And one’s situation is a poor template for a whole field. Going full steam into “entry requires a degree” would be detrimental. Studies have shown when supplementary education goes up but permissions and capability does not, paramedics leave the field. Those who desire more leave disillusioned and frustrated. If they stay in medicine; in fields where they’ll be able to apply what they’ve learned. One logical choices is RN.
There I said it. RN. The group paramedics love to elevate themselves above. Yet registered nursing is not an allied health profession. It is a full-blown licensed profession. Leaps-and-bounds beyond what protocol-bound adrenalin junkies are in reality. Consider this, by the year 2020, the Institute of Medicine (IOM) desires to see 80% of registered nurses hold a BSN. Where are we as a profession? Complaining of low pay, no freedom to treat patients and getting treated like crap from nurses and doctors. Therefore, comparing RNs to Paramedics is like apples to oranges.
We are What We Are.
What other allied health professions are out there? [What is an Allied Health profession? Read U.S. Code here.] There is a sizable list by the Association of Schools of Allied Health Professions (ASAHP). Most therapists (physical, occupational, speech) are allied health professionals. I learned that Master degrees for physical therapists are no longer offered in the United States, after certification the default degree is a Doctorate (DPT). We are eons away from this!
Hold the Phone, Now it Makes Sense
I planned to continue my unsolicited rebuttal. Then I stopped to read the linked article after which Behn modeled his. To be honest, I now can see what Behn tried to do. Unfortunately, it did not work. Perhaps it was too personal or Behn wrote it with one leader in mind. Regardless, I stand by my analogy of hacking away with a machete fueled by a personal vendetta. Behn linked to a post by Nassim Nicholas Taleb, critical thinker extraordinaire. In it, Taleb lampoons everyone who thinks themselves so intellectual to be better. Not only do “Intellectuals Yet Idiots” (IYI) only understand scientific “realities” on a superficial level. IYIs are prone to be hypocrites who jump on the next scientific fad, often doing a 180 degree turn from what they once held as sacrosanct.
Taleb did not pull any punches for groups on either side of an (scientific or political) issue. I believe Behn missed the equal opportunity skewering to make his post more palatable. To be in concert with Taleb, Behn should have addressed those in the street who suffer a Mightier than Thou mindset. Instead, Behn’s theme implied: If you are not in the street, you are not EMS. Again, I am not discounting his sentiments wholesale; rather, valid points are lost for me by Behn’s inelegance. Ok, so your EMS Chief may not have been the most adept at scene management. Conversely, could the average Tip-of-the-Spear medic gain votes on legislation to buy body armor or provide line of duty death benefits? Can one be both the tip of the spear, focusing on day-to-day minutia and the one wielding it at targets far and abroad? How about extending or winning contracts with municipalities? How long would day-to-day operations go on smoothly or otherwise without “disconnected” management? We all play a part in EMS. Often left off of EMS is “system.” Systems that provide 24/7/365 medical care are not comprised of 16 daily two person ambulances alone. Nor do we, as a profession, grow without leaders who take risks and suffer the occasional miscalculations or stretch of pain.
Well written. Loved this rebuttal.