# Certificate vs. Associates?



## Doodoodeedoo (Aug 3, 2013)

Hi everyone. I stumbled across this website when I was trying to find answers to my EMT questions, and I LOVE it. It's one thing to read statistics and information online, but it's better to talk to people who are already trained and working in the field you want to be in. 

So, my question is: I start my basic EMT in the fall. I was going to pursue the Associate Degree, but then I found you can get a certificate. Which one is better? Can you get a job as a basic EMT and build off of that and eventually get your associates while you work?

I'm sure others have asked this question before, so I'm sorry about the repeat. 

Thanks everyone!


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## Akulahawk (Aug 3, 2013)

encmiller said:


> Hi everyone. I stumbled across this website when I was trying to find answers to my EMT questions, and I LOVE it. It's one thing to read statistics and information online, but it's better to talk to people who are already trained and working in the field you want to be in.
> 
> So, my question is: I start my basic EMT in the fall. I was going to pursue the Associate Degree, but then I found you can get a certificate. Which one is better? Can you get a job as a basic EMT and build off of that and eventually get your associates while you work?
> 
> ...


If you're referring to a Paramedic Certificate or an Associate's Degree in Paramedicine, both of which end up with working as a Paramedic, I'd say you should go for the Associate's Degree. If it's an AAS, it's better, but not by much, than a Certificate. The reason for that is the AAS doesn't have quite the breadth of coursework in the General Ed that an AS does. Sure, you learn a lot, but... go for the AS. Also, instead of "just" taking the prerequisite coursework for the AS in Paramedicine, take the RN prerequisites because later on, you may decide to switch careers. Even if you do not switch, you'll have a much deeper appreciation for what the body does and why it does it. Down the road, you'll find that such knowledge makes doing your assessment easier and your findings will lead you down a certain treatment path... and hopefully into a protocol you can use or you will know to call for orders for that particular patient, and you'll know _why _it's an appropriate choice.

While you _can_ work as an EMT and build from there, it may become difficult to work as an EMT _and_ go to school at the same time. If you don't have to work, just work enough to get proficient at doing the basic skills.


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## Doodoodeedoo (Aug 3, 2013)

Akulahawk said:


> If you're referring to a Paramedic Certificate or an Associate's Degree in Paramedicine, both of which end up with working as a Paramedic, I'd say you should go for the Associate's Degree. If it's an AAS, it's better, but not by much, than a Certificate. The reason for that is the AAS doesn't have quite the breadth of coursework in the General Ed that an AS does. Sure, you learn a lot, but... go for the AS. Also, instead of "just" taking the prerequisite coursework for the AS in Paramedicine, take the RN prerequisites because later on, you may decide to switch careers. Even if you do not switch, you'll have a much deeper appreciation for what the body does and why it does it. Down the road, you'll find that such knowledge makes doing your assessment easier and your findings will lead you down a certain treatment path... and hopefully into a protocol you can use or you will know to call for orders for that particular patient, and you'll know _why _it's an appropriate choice.
> 
> While you _can_ work as an EMT and build from there, it may become difficult to work as an EMT _and_ go to school at the same time. If you don't have to work, just work enough to get proficient at doing the basic skills.



I didn't even think of the RN prerequisites. That's a great idea, and you're right. More education only makes you better at your job. I will ask my university and look into it. I read some of the other forums and everyone says to go for the associates. 

Thanks for the help! I appreciate it! : D


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## Mariemt (Aug 4, 2013)

Where I'm at an associates in paramedicine can bridge to an RN. One with a certificate can not. The associates is a a paramedic specialist.


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## Matty (Aug 4, 2013)

In my country you can do the certificate and work towards your Intermediate and Critical care, however, doing it the certificate route prevents you from administering 4 medications, of which I cannot remember off hand, and as such, employers tend to be hesitant with the certificate guys.


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## Achilles (Aug 4, 2013)

Why not a bachelors :blink:


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## takl23 (Aug 4, 2013)

Achilles said:


> Why not a bachelors :blink:



A bachelors in what? Last I checked EMT-P was an Associates degree. Sure someone could go on to get the bachelors or get theirs first (like me) then do EMT coursework.


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## Akulahawk (Aug 5, 2013)

takl23 said:


> A bachelors in what? Last I checked EMT-P was an Associates degree. Sure someone could go on to get the bachelors or get theirs first (like me) then do EMT coursework.


A few universities in the States have a Paramedicine Bachelors. They still get their Paramedic stuff done like all Paramedics do, but they have additional education in the areas of statistics/research, management theory, writing (lots of writing), more in-depth pathophys, and probably some pedagogical content so that they will be far better prepared to teach what they know. In short, it's getting a Gen Ed/Science Bachelors and a Paramedic license all wrapped in one neat package. 

The nurses also have similar issues... Sure, an ADN is also a nurse, but that BSN prepared nurse is just so much more knowledgeable... or are they? Believe me, that can spark a war of words on another forum...


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## Clipper1 (Aug 5, 2013)

Akulahawk said:


> A
> The nurses also have similar issues... Sure, an ADN is also a nurse, but that BSN prepared nurse is just so much more knowledgeable... or are they? Believe me, that can spark a war of words on another forum...



I have noticed a huge difference once an ICU has adopted the BSN policy. The days of "we are just as good" are gone and a new generation moves forward towards advancing professionalism.  I think EMS might see this also when the 3 month medic mill grads become a thing of the past if more were to get the Associates degree. The skills only mentality is what keeps a lot of health care workers from knowing the difference between a profession and a trade. This goes for nursing, Paramedics and many other professions which have been moving forward.


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## Akulahawk (Aug 5, 2013)

Clipper1 said:


> I have noticed a huge difference once an ICU has adopted the BSN policy. The days of "we are just as good" are gone and a new generation moves forward towards advancing professionalism.  I think EMS might see this also when the 3 month medic mill grads become a thing of the past if more were to get the Associates degree. The skills only mentality is what keeps a lot of health care workers from knowing the difference between a profession and a trade. This goes for nursing, Paramedics and many other professions which have been moving forward.


On another forum, it's been said that some ICUs do better when you have a majority of ADNs on staff because they don't have the same turnover rate as the BSNs. Why? In some of their experiences, the BSNs stay only as long as it takes to get into one of the MSN programs... sometimes that's CRNA. The ADN/BSN issue has been going on for decades now. It is entirely possible for an ADN to have a very similar education as a BSN, minus a couple courses. 

I've also heard (and read) along the way that of the new grads, the ADN is better prepared for working and after about 2 years, the BSN becomes the better Nurse, assuming identical work environments. 

Don't get me wrong: I'm all for education. If there's any profession that's in great need of a step up it is the Paramedic Profession. We don't need to re-invent the wheel... we just have to use a very good template that has already been developed for us. That template belongs to the Nurses. We simply replace the Nursing stuff with Paramedic stuff, leaving the pharm and pathophys in place and require the same prerequisites, and I'd quite imagine that our Paramedics would be a LOT better out of the gate than they are now. 

The other thing that needs to happen is to divorce EMS/Paramedic from Fire. EMS shouldn't be a ticket to a Fire job, as the case has often been for a while now. While there are Firefighters that are Nurses, I rarely, if ever, have seen a Firefighter/Nurse in that combined role. 

Lastly, I've noticed that getting EMS folks to band together to do something like this is about as difficult as herding cats. Once the Nurses did this, they achieved some incredible things for their profession. We need to recognize this same fact and do something about it, for our own betterment. 

Yes, that was a mini-rant about this...


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## Clipper1 (Aug 5, 2013)

Akulahawk said:


> On another forum, it's been said that some ICUs do better when you have a majority of ADNs on staff because they don't have the same turnover rate as the BSNs. Why? In some of their experiences, the BSNs stay only as long as it takes to get into one of the MSN programs... sometimes that's CRNA. The ADN/BSN issue has been going on for decades now. It is entirely possible for an ADN to have a very similar education as a BSN, minus a couple courses.
> 
> I've also heard (and read) along the way that of the new grads, the ADN is better prepared for working and after about 2 years, the BSN becomes the better Nurse, assuming identical work environments.



You must be in the ADN program....   
Did you know that the US ADN is an LPN in other countries?
The US is way behind in nursing by still having that degree for entry level. That is a sad statement for this profession in the US. Nursing is way behind many allied health fields and almost every other type of professional like Accountant, school teacher or entry business degreed person.  

But, before anyone says the Bachelors equivalent in other countries only takes 3 years, it much be remembered their elementary and high school years are more advanced. Their HS students are usually where our 2nd year college students are.   The US education system is way behind but that is another topic.



Akulahawk said:


> Don't get me wrong: I'm all for education. If there's any profession that's in great need of a step up it is the Paramedic Profession. We don't need to re-invent the wheel... we just have to use a very good template that has already been developed for us. That template belongs to the Nurses. We simply replace the Nursing stuff with Paramedic stuff, leaving the pharm and pathophys in place and require the same prerequisites, and I'd quite imagine that our Paramedics would be a LOT better out of the gate than they are now.
> 
> The other thing that needs to happen is to divorce EMS/Paramedic from Fire. EMS shouldn't be a ticket to a Fire job, as the case has often been for a while now. While there are Firefighters that are Nurses, I rarely, if ever, have seen a Firefighter/Nurse in that combined role.



The FD vs Private gets old. The Paramedics usually go to the same Paramedic school and some fire departments may even have more time and resources to spend on continuing education. A lot also depends on the individuals. There are some really bad county or private Paramedics just like some FDs.  There are some Paramedics who make really bad nurses because they also can not separate the two professions or go into nursing just for the money as many have expressed on EMS forums. 

Many BSN programs have the same number or more clinical hours as the ADN. Plus, the BSN students and new grads are eligible for externships or residency programs in addition to the set clinical hours. 

At least making a commitment for 4 years gives one to think about what they are getting into and a chance to grow up a little. Those what get their RN or Paramedic license at 18 or 19 years of age probably are not always ready for the responsibility. 




Akulahawk said:


> Lastly, I've noticed that getting EMS folks to band together to do something like this is about as difficult as herding cats. Once the Nurses did this, they achieved some incredible things for their profession. We need to recognize this same fact and do something about it, for our own betterment.
> 
> Yes, that was a mini-rant about this...



Nurses are actually very separate with many, many different specialties. But, if they are represented by a union, it is one that specializes in the nursing profession and not different "trades" like United Steel Workers". They are also very visible as bedside caregivers.  Their titles are also very consistent. If you are called an Registered Nurse in one state, that is what you will be called in another state. Their credentialing and licensing agencies also don't change titles every 10 - 15 years.

EMS has one focus whether you are employed by RM, AMR or some fire department.


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## Akulahawk (Aug 5, 2013)

So many assumptions... 



Clipper1 said:


> You must be in the ADN program....   Yes, I am. Not the point.
> Did you know that the US ADN is an LPN in other countries? Yes. Well aware of that. I'm also well aware that BSN programs really are 2 - 2.5 year (or 4-5 semester) programs. Both types of programs require all the LDGE to be completed, all the prerequisites done, and in the case of a BSN program, the UDGE/Writing to be done prior to entry because when you're done with the program, you're expected to graduate.
> The US is way behind in nursing by still having that degree for entry level. That is a sad statement for this profession in the US. Nursing is way behind many allied health fields and almost every other type of professional like Accountant, school teacher or entry business degreed person. I wonder how complete other foreign BSN (say Philippine ones) programs are when their grads have a difficult time passing the NCLEX-RN.
> 
> ...


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## Clipper1 (Aug 5, 2013)

Akulahawk,

I am tired of arguing with you. A Bachelors degree in any profession opens doors. You can find crappy degree program everywhere including those for Paramedic. Nursing is moving their degree status forward even with your ADN. The BSN gives them opportunities for other degrees, more employment opportunities and advancement if they want to go more towards management later. I personally think it is silly to spend almost 3 years in college and walk away with a very limiting ADN degree when another year would get you a BSN and more opportunities. 

Many will pick their employers to hopefully have a stable career. I applaud those who do join the fire department with dual certifications to give them more stability and choices. Maybe not everyone can be a firefighter which is what leads to hurt feelings. Rejection is hard for some.  Nurses are the same. Some try to get a position to allow them a good retirement and a nice coast to that point. Maybe some Paramedics and nurses just have the foresight to plan ahead instead of drifting from job to job and wasting time complaining on forums like them about x company and y company and the horrible fire departments. There are probably enough private Paramedics who could also make a difference if they cared to in the past 50 years.  Both the FFs and the private Paramedics have equal access to education. You can not always blame your mistakes or bad choices in life on others.  It is not so obviously to see FFs complaining about their FD jobs or at least not in public.  NonFD EMTs and Paramedics complain about working in a hospital even if they have great benefits and pay. They complain about their ambulance companies. They complain about volunteers in rural communities which can not afford to pay people for 1 call a month.  It might have been wiser to check one's career options before choosing a particular career.


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## Akulahawk (Aug 5, 2013)

Clipper1 said:


> Akulahawk,
> 
> I am tired of arguing with you. A Bachelors degree in any profession opens doors. You can find crappy degree program everywhere including those for Paramedic. Nursing is moving their degree status forward even with your ADN. The BSN gives them opportunities for other degrees, more employment opportunities and advancement if they want to go more towards management later. I personally think it is silly to spend almost 3 years in college and walk away with a very limiting ADN degree when another year would get you a BSN and more opportunities.
> 
> Many will pick their employers to hopefully have a stable career. I applaud those who do join the fire department with dual certifications to give them more stability and choices. Maybe not everyone can be a firefighter which is what leads to hurt feelings. Rejection is hard for some.  Nurses are the same. Some try to get a position to allow them a good retirement and a nice coast to that point. Maybe some Paramedics and nurses just have the foresight to plan ahead instead of drifting from job to job and wasting time complaining on forums like them about x company and y company and the horrible fire departments. There are probably enough private Paramedics who could also make a difference if they cared to in the past 50 years.  Both the FFs and the private Paramedics have equal access to education. You can not always blame your mistakes or bad choices in life on others.  It is not so obviously to see FFs complaining about their FD jobs or at least not in public.  NonFD EMTs and Paramedics complain about working in a hospital even if they have great benefits and pay. They complain about their ambulance companies. They complain about volunteers in rural communities which can not afford to pay people for 1 call a month.  It might have been wiser to check one's career options before choosing a particular career.


Clipper1, you won't find me disagreeing with you that a Bachelor's opens many doors. It's also well known that in the nursing world, since there isn't such a huge demand for new grads, employers are looking primarily at BSN grads, when they look for new grads at all. In my particular situation, I wasn't able to get into a BSN program because the local University was closed to 2nd Bachelor students. All 2nd Bachelor students. The others were too expensive with too low of a Pass rate on the NCLEX. So I went where I had to go. That doesn't mean that I'm stopping at ADN. It's an alternate route to where I want to be. So don't assume that someone made a choice to attend an ADN Program vs attending a BSN program without checking out the available options. Effectively, I had no options beyond ADN for starters. Had I been able to attend that BSN program, it would have been a 2 year program for me. 


I just hope you haven't forgotten that I actually do champion education. If you were to actually see what I advocate on another forum, you might actually be shocked to learn that I actually advocate for people to go for BSN over ADN, if they have a choice in the matter, and it's NOT on the grounds of actual clinical competency as a new grad.


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## EpiEMS (Aug 5, 2013)

Don't forget about selection bias.


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## Clipper1 (Aug 5, 2013)

That is good to know because some of the points you made earlier would apply to Paramedic cert vs degree.  If skills and base education are the same it would be of no benefitto get a degree if it would only be ridiculed by your peers as pointless. I am sure there are just as many cert Paramedics who would say the degree program puts out only book smart Paramedics.


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## Akulahawk (Aug 6, 2013)

Clipper1 said:


> That is good to know because some of the points you made earlier would apply to *Paramedic cert vs degree*.  If skills and base education are the same it would be of no benefit to get a degree if it would only be ridiculed by your peers as pointless. I am sure there are just as many cert Paramedics who would say the degree program puts out only book smart Paramedics.


One issue between the Diploma, ADN and the BSN nurses is that they take the same exam. If you really want something to bend your mind, California in particular requires all RN programs to offer a "30 unit option" for LVNs that want to become an RN. A 30 unit option RN doesn't get a degree, even if the student went to a university program. That's the case at Sac State. The local Community Colleges have a "Career Mobility" program that's 30 units, but their LVN-RN students end up with an ADN. Their resulting license is actually more useful going from state to state. 

The nurses realized there was an educational problem many years ago. They knew the Diploma RN program had to largely disappear for nurses to get a collective raise. That's why they banded together and collectively raised their minimum entry standard to Associates. Now with all the prerequisites and LDGE, both ADN and BSN programs are actually nearly identical in length from start of studies (assuming starting from HS grad) to completion/graduation. It's taken Nursing around 40 years to get to the point where having BSN as the entry point might actually happen. This was actually being discussed and pushed for back in the 70's and 80's. 

The nurses already have done much of the work for us to do the same thing. They've built a skeleton that we can use. That's why I suggested that Paramedics don't have re-invent the wheel. We Paramedics simply have to choose, collectively, that we want our minimum entry point to be an Associate-level (or higher) Degree and begin making that happen. It will be a long road there though. We can take that same basic course skeleton that a nursing program has and replace nursing-specific stuff with Paramedic-specific stuff, leaving all the rest in place. End result is a more well-educated Paramedic would be far more able to function in a CCT role, as a CCT provider and yet be able to bring that knowledge base to the 911 side of things and not have to rely on strict protocols built for the LCD, but would be able to use good clinical judgement in providing care for a patient. If we're lucky, have the right Pro-Education Paramedics placed in the right positions, perhaps we can speed the process along by preferentially hiring Degreed Paramedics. 

I'm also an advocate (and have been for a long time) of weaving the clinical/field experiences throughout the didactic time, so the skill base grows as the knowledge base grows. It's something that other allied healthcare fields do, not just nursing. Do things this way and you could easily have students become proficient Paramedics without ever going through an EMT program to begin with. 

Now do you see where I'm coming from?


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## Clipper1 (Aug 6, 2013)

There is no doubt the base knowledge of the ADN and BSN are the same but it is the attitudes which often differ. The BSN has been exposed to at least one research associated class and is presented with the value of evidence based medicine. The ADN is presented with a more trade or tech school approach and that sometimes leaves them to argue skills vs a forward thinking approach to patient care. Sound familiar for the EMS side?  The Associates in EMS might be a good start but it may still keep them at the same level in status as the ADN is to nursing. 

Nursing does offer "tests" which are associated with higher education but most start after the BSN.  If EMS is to move forward, the BS would be appropriate and then a Masters. But, why reinvent the wheel for some purposes. There are PAs who specialize in emergency medicine. They already have acceptance and are utilized in a wide variety of areas. Their degrees and certifications are in place without a lengthy process to start up in an economy of cuts.   

The Paramedic has been around 50 years and still less than half of the training facilities offer the Associates. Tech schools or private ambulances and FDs also do the certificate training.  The community colleges offer the certificate as well as the degree to stay competitive.  The statistics still show only 20% of EMS providers hold an Associates degree or higher. This also includes the instructors. This means there are very few mentors to push education. The degrees held may not even been in EMS or a health care field. Some are in nursing and some are in fire science.  This is also why nursing still retains seats on the education boards in EMS.


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## Akulahawk (Aug 6, 2013)

Clipper1 said:


> There is no doubt the base knowledge of the ADN and BSN are the same but it is the attitudes which often differ. The BSN has been exposed to at least one research associated class and is presented with the value of evidence based medicine. The ADN is presented with a more trade or tech school approach and that sometimes leaves them to argue skills vs a forward thinking approach to patient care. Sound familiar for the EMS side?  The Associates in EMS might be a good start but it may still keep them at the same level in status as the ADN is to nursing.
> 
> Nursing does offer "tests" which are associated with higher education but most start after the BSN.  If EMS is to move forward, the BS would be appropriate and then a Masters. But, why reinvent the wheel for some purposes. There are PAs who specialize in emergency medicine. They already have acceptance and are utilized in a wide variety of areas. Their degrees and certifications are in place without a lengthy process to start up in an economy of cuts.
> 
> The Paramedic has been around 50 years and still less than half of the training facilities offer the Associates. Tech schools or private ambulances and FDs also do the certificate training.  The community colleges offer the certificate as well as the degree to stay competitive.  The statistics still show only 20% of EMS providers hold an Associates degree or higher. This also includes the instructors. This means there are very few mentors to push education. The degrees held may not even been in EMS or a health care field. Some are in nursing and some are in fire science.  This is also why nursing still retains seats on the education boards in EMS.


I would most certainly be in that 20%... and probably in a much smaller pool because I have a Bachelor's Degree that's in an allied healthcare field that is probably more closely aligned with EMS than other fields. 

Unfortunately in an economy of cuts, I don't see putting EM trained PAs on ambulances any time soon, in relatively large numbers, because of their cost. I quite suspect that the only US organization that would be able to quickly implement Ambulance PAs would be the US Military. Even then, that's only relatively quickly compared to civilian EMS. 

While a Bachelors should be the entry level for Paramedic, until there's a demand for Bachelors-prepared Paramedics, that won't happen. Getting to that point takes time, people to create and attend the educational programs, and the right people to get onto the EMS boards to push for appropriate changes. Doing that also needs enough people to decide to actually _do_ something to get that ball rolling. Getting enough Paramedics to agree to do that, well, herding cats would probably be easier.


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## Clipper1 (Aug 6, 2013)

Akulahawk said:


> Unfortunately in an economy of cuts, I don't see putting EM trained PAs on ambulances any time soon, in relatively large numbers, because of their cost. I quite suspect that the only US organization that would be able to quickly implement Ambulance PAs would be the US Military. Even then, that's only relatively quickly compared to civilian EMS.



Just on ambulances, no. But the ECP of the UK is a good example since their education is much more like the US PA and NP. This would be much more beneficial than just adding a few more weeks to a certificate Paramedic and giving them a new title of Community Paramedic but with their same scope of practice. Mobile medicine should be just that. Put the money towards bringing the appropriate providers to the patients by bringing the clinics to them. The mobile units available in many cities now are awesome but there aren't enough of them. More attention should be given to a great idea that is already educated and licensed to provide these services. It would take the current US Paramedic system another 30 years to get to that point and that is only if more were motivated to get there.


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