Where To Fix EMS

We all know the problems with EMS.  Mostly they revolve around low pay, low standards, and unreliable sources of funding.  Easily fixed, right?  Well, maybe.

But there’s an ongoing problem in EMS. Most EMS systems operate under the belief that good clinical skills (or even worse, good clinical outcomes) are the primary determinants of who gets promoted.  Being a good clinician involves more than clinical skills.  And being a good clinician doesn’t mean you’re going to be a good educator or a good manager. Being a good clinician doesn’t correlate with much besides being a good clinician.

What does EMS lack?  And more importantly, what do most so-called EMS “Leaders” lack?  They lack the “soft skills” besides how to read an EKG, intubate, or start an IV. They may have a professional network, but they don’t know how to use it.  They rarely understand politics at any level — from the local government who decides how to fund and provide EMS to the state officials who regulate EMS to the federal officials who determine how Medicare and Medicaid reimburse EMS. They don’t understand the value of public relations.  They rarely understand budget and finance.

Ok, so you get the picture. So what is EMS doing about it?  Well, we’re doing the same thing as always.  We’re promoting folks on their clinical skills at best and most often based on who they know or how much management likes them. We’ve created a system where most EMS employers don’t have much of a career track.  And we continue to tell our best and brightest to move into another medical field, whether nursing, medicine, or physician assistant.

What should we be doing?  Simple.  Let’s actually grow our own EMS leaders and not just the usual gang of experts/idiots who speak at every conference simply because they’re loudly exclaiming they’re leaders.  Let’s encourage the best and brightest to remain in EMS and further their education.  They already know how to be EMTs or paramedics.  What they don’t know is what to do next.  Let’s get people degrees in adult education to become clinical educators.  Let’s get people degrees in business management or public administration so they can effectively manage and lead an EMS organization.  Let’s get people educated in finance to figure out how to keep the crews paid and fuel in the trucks. And maybe even get a few of us into law school and admitted to the Bar.  After all, we’re in healthcare, one of the most heavily regulated fields in the marketplace.  Having someone who knows how to navigate the legal, regulatory, and political landscape might just help advance EMS a bit more than just another guy who says “Narcan” at the right time. And since EMS is a business, maybe having someone with some marketing or public relations skills might help the public (and the politicians) understand that not all EMS is created equally and that, like anything else, you do indeed get the EMS system you choose to pay for.

Or…. we can keep doing what we’ve been doing.  The current results speak for themselves.

Comments

  1. Gene Gandy says:

    Wise words, my friend.

  2. What you describe is classic Peter principle (https://en.wikipedia.org/wiki/Peter_principle) at work: if you promote people based on how effective they are in their current role, rather than how effective they would be at the role they are being promoted into (which, particularly for managerial roles, requires you to take into account someone’s “soft skills” much more), then they will eventually and inevitably rise to a level at which they’re no longer effective.

    It’s endemic in literally every industry that has a hierarchical employment structure, but particularly troublesome in medicine where, as you said, so much emphasis is placed on clinical/technical skills.

    I’m a volunteer wilderness EMT, not a full-timer/professional, so I’m admittedly talking a little out of school, but when we recruit for our SAR team, I’m much more inclined to push for someone who’s clearly smart and has a good demeanor over someone who comes with a ton of skills. I can easily teach someone to navigate with a compass or do a quick assessment; I can’t easily teach them how to be good teammates, or how to comfort an Alzheimer’s patient we find lost in the woods.

    Anyway, great writing. Keep up the good work!

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