Those of you who know me know that I believe initial EMT education is, to use a play on words, way too basic. I have also told many of my friends, particularly those in EMS, that a paramedic certification, even without a degree associated with it, is an excellent return on investment. I’ve mentioned that there are a lot of degreed professionals (teachers, social workers and even more than a few lawyer positions) that earn less than many paramedics, particularly if the paramedic works for a public EMS agency.
I’m also a conservative, so I have some skepticism of government trying to “fix” a problem. I’m reminded of Ronald Reagan’s famous quote, “The nine most terrifying words in the English language are ‘I’m from the government and I’m here to help.’” And during the pandemic, everyone reported there was a shortage of EMTs and paramedics. So, in many places, the government came in to help. At least in Texas, the state created a fund to reimburse tuition for people getting initial EMS education at any level contingent on working or volunteering for an EMS provider.
And I think this very well intentioned and noble piece of legislation is about to create an affordability crisis similar to that which many are experiencing in higher education, which we see manifest itself in two ways. First, the amount of student loan debt that people have accumulated to get a college degree. Second, the increased prevalence of degrees and advanced degrees has meant that employers are even more selective, leading to situations where people with degrees can’t even get interviews for entry level positions. Worse yet, student loans are funded and guaranteed by the Federal government, which means that colleges have no pressure to control costs as the Federal government guarantees the loans in the event of default — and unlike much other debt, student loan debt is not typically dischargeable in bankruptcy.
Just this morning, I saw a Texas hospital offering an EMT class for $1875. To provide some frame of reference, I paid $500 for my EMT class in 2004. My class was held in the classroom of a suburban fire department and taught by a few local medics who thought that teaching an EMT class was a better way to make extra cash than overtime shifts. In 2006, I paid $3000 for the only night paramedic class offered in the Austin area, a class that was run by a private EMS company.
In part because of the indirect state subsidization of EMS tuition and the increased requirements of EMS education accreditation (at least at the paramedic level), going from mild-mannered attorney to EMT to paramedic for the total of $3500 (plus, of course, random incidental and indirect expenses) is no longer achievable.
These subsidy programs come with a few challenges.
- Not everyone may receive the subsidy or grant.
- The funding (at least in Texas) requires you to work or volunteer on an ambulance for a set amount of time. As I’ve mentioned before, at least in my area, part time opportunities for EMS are not what they used to be and volunteer opportunities are slim. (This presents a challenge for both volunteer providers and for those potentially considering a career change.) Additionally, at least in Texas, this state funding requires that you work on an ambulance. Texas has a separate category of non-transporting EMS entities called first responder organizations that provide EMS care until transport arrives.
- Unlike attending a college or university, EMS education programs (at least those not operated directly by an institution of higher education) don’t award academic credits, hours, or credentials that are portable elsewhere.
Alas, despite the increased requirements and costs of EMS education, working conditions and salaries are not keeping pace. Many of the same challenges in EMS retention that the pandemic made worse are still there. I still stand by my assertion that EMS pay isn’t the problem. Rather, it’s what EMS providers have to put up with for the pay. (Read that last sentence SLOWLY if you want to understand the volunteer crisis.) If we’re going to fix EMS recruitment and staffing, we have to address retention. All of the subsidized tuition in the world won’t fix EMS retention. We fix that by professionalizing EMS management. All the clinical education and expertise has little correlation to being an effective EMS supervisor, manager, administrator, or leader. (See also: my regular assertion that the best degree for an aspiring EMS chief/director is a public administration degree. You already know how to do EMS things. You DON’T know how to manage, lead, and administer people and an organization.)
At the paramedic level, the accreditation requirement has created a virtual monopoly for college-based EMS education programs. The colleges, by virtue of being the primary providers of paramedic education combined with subsidized tuition, have created a monopoly which, in particular, has limited access to EMS education for rural providers or nontraditional, working students. While there are indeed online programs outside of a college setting, these programs often must pay to affiliate with a college as a “satellite” campus and again can charge whatever they want because they’re the only game(s) in town if you’re working elsewhere or living outside of a metro area. While accreditation has likely driven some of the worst EMS education programs out, accreditation largely only guarantees that the education program is organized and has policies to administer the program. Accreditation does not guarantee the quality of the education provided.
If we think that higher education alone will improve EMS, I’d caution you to examine the example of Australia, a country that many in EMS consider to be “excellent.” The universities in Australia have no incentive to control the number of paramedic graduates for a relatively low number of paramedic positions in their country. This means that one of Australia’s more notable exports as of late have been Australian paramedic graduates. Whether they’re working in London for the London Ambulance Service or in Texas and Louisiana for Acadian, Australian paramedics aren’t working in Australia because the jobs aren’t there, but the degrees are.
In conclusion, I’m worried that we’re making EMS education less affordable and less accessible while still leaving our retention issues unaddressed. If only we had EMS leaders with an understanding of law, policy, economics, business, and the political process than in the current clinical trends on EMS social media. Interestingly enough, many of the hurdles involved in adopting these latest clinical trends would be lessened if we had EMS leaders with an understanding of law, policy, economics, business, and the political process.
Meanwhile, enjoy the current EMS staffing challenges — which an $1875 tuition for an EMT class isn’t going to improve one bit.
