Is a Degree for EMS Providers Needed to Advance the Profession?

This article is an in-depth consideration of this question for American EMS providers.

 

The EMS community is split on whether EMS needs to add a college degree to the minimum requirements for all paramedic training. Currently, it’s not a requirement that students receive a college degree to be licensed as a paramedic. In the United States, paramedic programs must be nationally accredited and meet all other state requirements for licensure, but that doesn’t mandate the provision of a degree.

Will a college degree advance the EMS profession? Let’s look at the issues.

EMS is something all fire departments are engaged in at some level. There are four recognized levels of EMS provider:

  • Emergency Medical Responder (EMR)
  • Emergency Medical Technician (EMT)
  • Advanced Emergency Medical Technician (AMET)
  • Paramedic

These levels were developed or updated in the 2007 National EMS Scope of Practice Model. This model established the minimum competencies of each level and included flexibility for the unique needs of each state to determine its requirements for licensure or certification. Accreditation of paramedic programs started 40 years ago but has only been mandated since 2013.

The cry for making a significant change to these programs by requiring an associates degree has been discussed in the past several years but has increased recently with the EMS community’s look at the Agenda for the Future 2050 and the Scope of Practice updates. While the current talk is to require an associates degree, the ultimate goal is to require a bachelor’s degree to graduate from a paramedic program.

The training programs for the levels of EMR, EMT and AEMT are generally considered too short for a degree program. The typical paramedic program is over 1,000 hours and lasts from 10 months to 2 years. Four kinds of programs deliver paramedic education:

  • Certificate
  • Diploma
  • Associates degree
  • Bachelor’s degree

As of March 2018, there are 612 accredited paramedic programs. Another 78 are in the process of obtaining accreditation, resulting in a total of 690 programs.

Of those programs, 356 offer an associates degree as part of paramedic training. There are 11 bachelor’s degree paramedic programs. It should be assumed that programs that only provide a certificate or diploma wouldn’t provide paramedic training if an associates degree were required.

Programs not located in a college or university wouldn’t be able to offer a paramedic program. That would include all the fire department-based, hospital-based and consortium programs.

Every paramedic program requires that the school have a memorandum of understanding or articulation agreement with an academic intuition that accepts the program’s certificate for college credit to allow the student to apply for matriculation with that college or university. This requirement provides that every student can pursue a college degree, should they wish to obtain one.

The premise of paramedic education is

“to prepare competent entry-level Paramedics in the cognitive (knowledge), psychomotor (skills), and affective (behavior) learning domains,” with or without exit points at the AEMT, and/or Emergency Medical Technician.”
Standards and Guidelines for the Accreditation of Educational Programs in the Emergency Medical Services Professions: II.C. Minimum Expectations (page 4 - PDF). 

The key is that these students are entry-level practitioners and don’t have years of experience. Even with a degree, these students will require orientation and field supervision to help get them started working in EMS.

Here are five arguments for the minimum requirement to require a degree, each followed by a counterargument:

  • Other allied health fields, like nursing and respiratory therapy, have required a college degree to enhance their professions, resulting in better pay.
    • There’s no way to compare jobs like these to EMS since all those jobs’ employers are compensated differently by the Center for Medicare and Medicaid (CMS) or the insurance companies than a fire-based EMS service is. None of the other allied health programs has any, much less a large component of, volunteers.
  • Paramedics from a degree program will be better trained.
    • While there’s no evidence that this is the case, many of those in academia or in state government profess this will be true. What is the benchmark for a better-trained paramedic? National Registry pass rates? Currently, there’s no way to measure or compare the difference in students based on their education.
  • The current level of paramedic education is failing to provide the needed level of competency in the field.
    • This assumes that new paramedics should be street-ready when they graduate. That isn’t the model in place. They still need supervision and some field experience to operate within a specific system. Every program now has to be accredited; that has only been in place for five years. If anything, the level of paramedic education is at the highest it has ever been. Every paramedic program has in place a program director with a minimum of a bachelor’s degree.
  • Some think the American emergency service should look at paramedic programs in other countries, like the United Kingdom or Australia, as models to consider.
    • Since medicine and how medical care is compensated is different in these countries, why would that analogy transfer to EMS in the United States? All education is different between countries.
  • Some argue against the status quo as the reason to make a change in order to be futuristic.
    • Change occurs over time and so there will always be the opportunity to look at the development of new procedures for EMS education. In the past there was a set process for making these changes that involved a great deal of input from all the stakeholders. It would be a good thing to involve more people in the discussion of proposed changes.

There are a number of problems with the degree requirement:

  • A decrease in the number of qualified programs resulting in more demand to get into paramedic programs. Fewer programs doesn’t equate to more students. This could result in paramedic students needing to drive several hours to the next paramedic program that offers the degree.
  • Many paramedic programs are limited now in the number of students they can admit. That limitation is not based on the space or number of instructors, but the number of clinical or field sites for the paramedic students to attend internship and capstone training.
  • Longer education time means employers would wait longer to get new trained personnel and would increase the amount of time students would have to be in school, which impacts their ability to work and go to school at the same time.
  • There’s a shortage of paramedics trained at this time; this requirement would add to that shortage.
  • Increased costs for longer training can be expected. Often the main reason students don’t opt to get a degree, even when it’s an option, is the increased cost.
  • Every state would have to change either their statute or EMS regulations, and most of those changes take years to complete.
  • Most if not all job-entry requirements by employers don’t include the requisite of a college degree.

Pushing education of paramedics to only academic intuitions would decrease the number of programs, making it harder to get into a paramedic program. With a smaller number of programs, students in rural areas would have to travel greater distances to attend school.

So what’s behind this push for requiring a college degree for the minimum requirement for paramedic training? Listening to the undercurrent of discussions, it seems the goal is to get the associates-degree requirement in place to begin the work to require a bachelor’s degree as the minimum requirement. Adding the associates degree only requires the student to take general-education classes; it doesn’t provide for more EMS education.

Currently no state requires a college degree for paramedic training. Any change to the minimum requirement would mean changes in either a state’s statute or regulations. Ten years after the 2007 Scope of Practice Model and the development of the Educational Standards, there are still states working to update and change the language about EMS providers. This requirement would necessitate a significant change in the EMS requirements in every state.

Training versus Education?

How many fire departments expect candidates for fire chief to have begun their career in the fire service with a bachelor’s degree? Rhetorical question; I know the answer is none.

Why then expect an entry-level paramedic to have a bachelor’s degree? Paramedics need field experience. It’s unlikely that an associates-degree program is going to increase the number of clinical, field or team-leader hours required of a paramedic to graduate. The extra classes that aren’t part of the core content of paramedic training are general-education classes like English, math, science and history. Completing these courses demonstrate a student’s ability to complete a college class but doesn’t add to the amount of paramedic training.

Obviously, a bachelors-degree program can include more clinical and field time, but that time isn’t mandated, nor that there be a consistent approach to what extra medical training is provided.

The one thing that’s lacking in all the allied health programs that moved to a degree requirement is the volunteer component. None of those health programs have a large volunteer population that provides a unique service to communities. The current requirements already place somewhat of a strain on fire departments and EMS agencies that rely on volunteers to staff vehicles.

One expectation is that hiring paramedics who have completed this level of education will result in better-paying jobs for them. So let’s ask the employers what they think of adding a degree requirement. Does that requirement provide a better trained entry-level EMS provider? Are they going to automatically increase the pay for someone with a degree?

Discussions on minimum wages recently had fast food workers demanding $15 an hour. There’s a number of EMS workers who aren’t making that wage; does the addition of an associates degree suddenly create a demand for higher wages?

Would there be the risk that some fire departments would find that the increased struggle to find employees cause them to look at going from an ALS service to providing only BLS services? Is that a better solution for communities, especially in rural areas?

There’s no argument that fire/EMS personnel should be encouraged to complete college degrees at some point in their career. The management and leadership positions need people with more education. Does it need to be mandated to start their career?

Before anyone jumps up and starts a revolution to stop this (or to start the process), note that to mandate a degree for paramedic students would involve a significant number of changes to the process and require the endorsement by many EMS agencies. This would take years; the odds on this beginning in the next 10 years would be very low.

The spirited debate is likely to continue for many years and perhaps into the next generation of educators and providers. At this time, there’s no clear need or mandate to implement the requirement that all paramedic students have a minimum of an associates degree to graduate from an accredited paramedic school.

Stay informed and voice your opinions when you get the opportunity to provide feedback.

 

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