# Masters degree in EMS: An old idea rehashed



## ExpatMedic0 (Apr 5, 2014)

I saw EMS world recently rehashed an old article, "Graduate Degrees: Are They Worth It for EMS?" link can be found here http://www.emsworld.com/article/10319539/masters-and-doctorate-degrees-in-ems

The article is pretty basic, but interesting for those in EMS considering higher education. However, what I really love is a comment made by Bill Brown in the comments section of the article.

 Bill states _"This is a great article and should be taken seriously by EMS professionals. Years ago I received a copy of a ruling by the US Immigration Service regarding a "Paramedic," who wanted to immigrate to the US because he was a member of a "profession." The INS ruled he was not because EMS was not a profession because it lacked two characteristics they said were required to obtain the classification of a "profession." One was a national certification examination and the second was the requirement to enter the field, at a minimum, required a college degree. I believe EMS has now met the national certification issue because 46 of the 50 states use the NREMT certification as part of their licensure process. The degree qualification is a distance away! Degrees indicate not only attendance in college but movement beyond a "technical" approach to solving problems but one based upon scientific evidence where there is a unique body of knowledge. I believe EMS has a unique body of knowledge but our science is lacking. And I would say it is lacking because our "science," is being conducted by another profession; medicine (mainly emergency medicine). EMS does not possess its own body of scientific evidence. That evidence must be gathered by scientists and scientists require education over the scientific approach; which means graduate education. While I was at the NREMT I helped start the first EMS Research Fellowship. OK, thats a start, but it really hasn't caught on to the degree we were hoping. Three graduates in about 10 years. Three are better than none, but applications are not in the hundreds for the free PhD program that pays a reasonable salary and has benefits while one attends graduate school at Ohio State. And finding jobs after completion of the PhD has not been simple (of course finding any job isn't simple today). So, we have some distance to go. Mandating college degree can't happen when we need 10,000 new Paramedics a year because medics are leaving the field. Research has shown they are not leaving for any other reason than low pay! How is the pay to increase when 10,000 new people enter the field per year? Why do we need 10,000 new Paramedics per year? Who is leading the resolution to this problem. It won't be government. It can't be our 15,000 member association. It can't be the 250,000 or so Paramedics; they don't participate in their own associations and won't even respond to research survey's. EMS must embrace the standards of a profession, demonstrate willingness to push for the standards of a profession, and participate and demand research in order to jump start the tasks necessary to be a profession. So, if you think the INS is not the body who defines a profession, well maybe but in the case I read, it referenced multiple court decisions regarding INS applications regarding a profession. They could be wrong but their interpretation can be a guide to follow. I certainly believe EMS personnel are "professional" in the delivery of care. It is the job classification of EMS that doesn't meet the standards of a "profession." Did you know that the Department of Labor lists a number of health occupations and that EMS is one of only three that doesn't require a degree but only a high school education? Did you know that the DOL lumps EMTs and Paramedics together under one occupation? Do you know people have been trying to change that for years without avail? Much work needs to be done in order to accomplish our goals and receipt of graduate degrees by EMS personnel is one step toward reaching a level many ascribe to achieve. Those who believe in the advancement of EMS need line level support by EMS personnel. This can not be a top down approach. I have witnessed the pain it took to require Paramedic programs to be accredited. I was subjected to much criticism by some "EMS leaders," regarding that decision. I didn't see tens of thousands of street level Paramedics demanding states, associations and educational institutions to obtain accreditation. Most were too busy managing the day-to-day activities of EMS. Everyone must support advancement in order to become a "profession." Thanks to the authors of this article!"_

I think Bill really hit the nail on the head, what do you guys think?


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## MrJones (Apr 5, 2014)

ExpatMedic0 said:


> ...I think Bill really hit the nail on the head, what do you guys think?



He makes some valid points, both for and against requiring a college degree. 

For what it's worth I'm a strong advocate for a degree requirement (baby steps, though - let's get an Associates requirement in place and go from there) and for divorcing EMS from Fire. Or at least reworking the paradigm so that a fire fighter is a fire fighter and a paramedic is a paramedic, and neither is expected to do the other's job.


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## Wheel (Apr 9, 2014)

I think he provides some great insight. I would love to see it happen, along with more stringent requirements for instructors.

I actually saw an advertisement for a thesis based MSc in advanced emergency care from the UK, and I'm trying to find out if any American medics have done it. It might be something cool to look into when I finish my degree in a few months.


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## Ridryder911 (Apr 9, 2014)

Education is the *only*way we will ever be able to become a profession period. Bill and I have had many discussion in regards of this over a few bottles of wine and drinks. Ironically and a shame both of us obtained the higher education in a different field because there were no true legitimate academia in the profession that we prefer and love. 


Although Bill can be often misunderstood or be perceived wrongly, his ideas and fights in EMS had been instrumental in getting NREMT as a true standard of testing, attempting to have EMS to obtain higher academic levels and educational sourced be accredited. 

We are *never* going to be reimbursed appropriately as long as there are ten month courses and short methods to obtain license and certifications. Without an increase in reimbursement rates, salaries will also never increase. the viscous cycle never ends. 

Unfortunately, those in EMS are mainly just _lip service_ and sure can grip and biitch: but when and where it really counts, they take a back seat and await for someone else to do it for them... Sure they will work 100+ hours but to actually go to legislature & committee meetings for chang?.. Usually the same old folks. 

The old adage _you get what you pay for_ can never be more correct here


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## mycrofft (Apr 9, 2014)

With the cost of vehicle purchase or lease and ops and insurance, plus government permits and licenses for the entire operation, and the high cost of equipment and supplies and maintenance and training, is it realistic to assume anything but a civil service form of field ALS (with top quality field pros and adequate compensation) is reasonable over time?

 Remember, in the Seventies when this all kicked off, every major hospital would have a helo and a mobile ICU too.

Higher education is necessary as the root of a professional status, with concomitant unique education, ethics and research, and self-regulation by the profession. Nursing barely gets this as it is and some say it actually doesn't (most nurse research is exploratory studies, or gilding the lily about how to insert some catheter or other).


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## Wayfaring Man (Apr 11, 2014)

A master's degree would be a reasonable enough option if only because presently many medic programs are already 2 year degrees culminating in an associate's.  One reason that myself and many other people have generally opposed degree requirements is that we already have degrees in other fields, and that the educational system in the US is profit-oriented to the degree that a "degree" really just represents a lot of debt, and not necessarily a lot of education.

At least with a master's degree, we're moving forward and above.  On the other hand, a lot of communities would suffer from essentially requiring 6 year degrees (4 year BA/BS + 2 year MS) in order to work as a pre-hospital provider.  For the same amount of education, a person fresh out of high school could be a nurse practitioner or physician's assistant, making more money and having a better scope of practice.

I like the idea of increasing our scope and our level of training, of requiring more and better education, and while I generally oppose the higher education system in the US, if that's the way it needs to be done, then that's the way it needs to be done - but it needs to be set up in such a way that we get an equivalent scope to an equivalent degree.  A master's level nurse is a practitioner with a script pad and no need for a physician's oversight in many states.  A master's level PA is similarly equipped.  If we're going to require or desire that level of education, I should hope we get a wider scope of practice - so this works very well with the general "community paramedicine" movement.

A paramedic with a master's degree should absolutely be able to write a script for a Z-pack and a referral to definitive care.


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## Ewok Jerky (Apr 11, 2014)

Wayfaring Man said:


> A paramedic with a master's degree should absolutely be able to write a script for a Z-pack and a referral to definitive care.



But how is this paramedic with a Master's going to afford his loan payment of >$1000 / month while making $14/hr and being treated like crap by his employer?  S/He is going to leave EMS for a hospital job where s/he can practice at the full level of his/her training and not risk a career ending back injury.

I am all for more education in EMS, but I don't think a Master's is the way to go.  There are a lot of broken pieces in EMS and I don't pretend to have a solution.  I think starting with an Associate's is a better idea, as well as improving the CE requirements and medical director involvment in advancing our SOPs.  It s far too easy to survive as a cook-book medic without developing any kind of critical thinking skills, and this is where any attempt to advance the profession stalls.


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## Chewy20 (Apr 12, 2014)

Honestly, unless the scope of practice were to change with a higher degree there is no point in my opinion. Private EMS schools have been pumping out EMTs and Paramedics for a long time, and most of those EMTs and Paramedics have done exactly what is asked of them in the field. 

So unless something comes out and says you can have a wider scope with a degree, then people aren't going to waste the extra time and probably money to end up with the same pay rate in the end.

To me the only benefit of that AAS degree right now is if you decide to further your education into nursing or whatever. 

Now granted I have not worked as a Paramedic yet, what kind of skills would you like to have in the field that you have not already been taught in "medic mills"? That is an honest question and not made to sound like you should stop asking for more. I am actually interested in what you want to be able to do. I guess my point is, with a lot of areas having short transport times, what else could you ACTUALLY be able to perform during that 5-10 minute transport that will serve the patient better than what you already have on the rigs.

Don't get me wrong I am all for more education for our "profession" as I am working towards an AAS in Paramedics, but I highly doubt it will make me better at my job by taking a couple extra gen ed classes.


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## BoonDoc (Apr 12, 2014)

The masters degree will benefit paramedics if they choose to join the academic community. Paramedic trainers with graduate level work will get teaching jobs much faster than non academic paramedics.

Thankfully here in Europe there are master's degrees that are affordable. There is a MSc degree for paramedics with at least five years of experience. Paramedics can take this degree even if they don't have a bachelors degree. It is work based learning. Also, it is all online.

http://www.merit-training.com/courses/master-of-science-in-remote-medical-practice/

This degree costs £6110 ($10k). That is not per year, that is the full cost. Plus Middlesex University is registered with FAFSA. 

I wish that I had seen this option when I did my masters degree in the US. That  degree was over $50k and I am still paying it off. 

Having a graduate degree as a paramedic has opened doors that I could not have gotten through without it.


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## ExpatMedic0 (Apr 12, 2014)

ya Boon is correct, there are plenty of other western countries in the world which utilize them. However, for the purpose of this article, it was really emphasizing non-clinical masters degree's for EMS leaders and educators. After all, how are we suppose to advance in the U.S. and help improve EMS for patients and EMS workers if we don't poses highly trained and educated leaders who can actually conduct research within our field, navigate and pass health policy, and develop regional and federal programs? 

In terms of a clinical masters degree for medics, of course I support this concept, its proved successful in the UK and Australia. Then again, those are VERY different education and healthcare systems. As of right now, why would an American paramedic go out and get a bachelors or even an associates degree in EMS? The motivation can be broken down into intrinsic motivation versus extrinsic motivation. Sure there is the possibility of being more competitive for a flight job or high paying municipality job, or going to grad school and leaving behind field duty. However, the main reason one would do this is strictly intrinsic motivational factors. Imagine if a bachelors degree became ENTRY LEVEL requirement for paramedics. Sound crazy? Its what other countries have done and even other allied health professions in the U.S. As a result of this, patients benefited from a better quality provider; providers benefited from higher salaries and a lower number of medics in a previously over saturated field. If the U.S. health care system continues to change, you may one day see a pseudo PA-C hybrid pre-hospital provider called "paramedic practitioner"  Don't believe me? It already exist and they cover for after hours emergency physicians in the UK, check it out http://www.paramedicpractitioner.com/


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## MrJones (Apr 12, 2014)

In my version of a perfect world, circa now, this is the Readers Digest version of the required education - Certificate for EMT, Associates for Paramedic, Bachelors for supervisory positions and Masters for Director/Chief positions. In this paradigm, the Bachelors and Masters requirements would be focused on Management/Organizational Behavior/Administration type degrees, and qualification as a Paramedic would also be required. And, ultimately, I'd like to see a  clinical BS for medics as a requirement.

Of course, Paramedics in my perfect world wouldn't have to also be fire fighters in order to work for Fire/EMS services....


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## Rin (Apr 13, 2014)

I can't see investing that much time and money into even a bachelor's degree when there is such a lack of protection for our health that I'm likely to hit that career-ending back injury before I could pay off the student loans.  Let's get some OSHA protections for safer lifting expectations and then I'll be happy to invest more into my career.  In the meantime, we're dropping like flies out here...


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## Carlos Danger (Apr 13, 2014)

Rin said:


> I can't see investing that much time and money into even a bachelor's degree when there is such a lack of protection for our health that I'm likely to hit that career-ending back injury before I could pay off the student loans.  *Let's get some OSHA protections for safer lifting expectations and then I'll be happy to invest more into my career.*  In the meantime, we're dropping like flies out here...



You have got to be kidding right?

What steps would you like to see the federal government take to protect your back? Should OSHA enact a regulation saying that fat people can never live above the first floor, or ever be in any position in any room that would make it difficult to carry them out? Should OSHA mandate 4 people on every ambulance? Maybe they should require you to go to the gym at least 3 times per week for an hour each time? Would that last one be OK? It's probably the most effective of those those options, after all...

Actually there seems to be a lot of talk about the potential for back injuries on here lately. And it seems to be a surprisingly-frequently-cited excuse for lack of professionalism.

Look, back injuries happen in any field. I doubt they are even any more common in EMS than in many other jobs. So sure, they are an important thing to think about and take steps to prevent, but I'm not sure how you get to "I might get a back injury, so I'm not getting more education". That reasoning is backwards anyway. Don't you think that if you had more education you'd be in a better position to find another job if you ever COULDN'T do EMS because of an injury?

Man up, learn proper lifting mechanics, build some strength, and understand that bad things might still happen and you aren't some EMS prima-donna who deserves to have the federal government protect them from every bad thing that might potentially happen. 

If you don't want to go back to school, that's fine. But it is what it is. You are just not interested. Or you are lazy and unmotivated. Or you just don't think it's a worthy investment. Whatever. Those are all acceptable reasons. But do not hide behind some ridiculous excuse like "But what if I hurt my back? Whaaa".


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## MrJones (Apr 13, 2014)




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## Rin (Apr 13, 2014)

Wow, that's a lot of assumptions you've made about me.  I work for a company who's lift assist guidelines are motivated by profit instead of safety, and I've watched coworkers go out on medical one after another.  Yes, we need to move heavy patients in difficult to access areas, but there are safe and unsafe ways to do things.

Every other industry has safety guidelines to protect it's workers, but apparently we're such big damn heros in emergency services that our bodies are somehow super-human.

I mean, are you seriously saying that back injuries _ aren't_ a problem in our line of work?  Or maybe you just work at a place that doesn't need government oversight to care about your safety and you haven't experienced the :censored::censored::censored::censored: a company can get away with when no one's watching.


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## Chewy20 (Apr 13, 2014)

Rin said:


> Wow, that's a lot of assumptions you've made about me.  I work for a company who's lift assist guidelines are motivated by profit instead of safety, and I've watched coworkers go out on medical one after another.  Yes, we need to move heavy patients in difficult to access areas, but there are safe and unsafe ways to do things.
> 
> Every other industry has safety guidelines to protect it's workers, but apparently we're such big damn heros in emergency services that our bodies are somehow super-human.
> 
> I mean, are you seriously saying that back injuries _ aren't_ a problem in our line of work?  Or maybe you just work at a place that doesn't need government oversight to care about your safety and you haven't experienced the :censored::censored::censored::censored: a company can get away with when no one's watching.



He didn't say anywhere that back injuries are not a problem. He actually agreed with you. All that was said is that being scared of a back injury is no reason not to improve yourself or the EMS industry. If you are not happy with the way your company is handling things, then I am sure they won't miss you if you move onto another company or career field. Go to the gym and strengthen your back, lift properly and back injuries should be the last thing on your mind.


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## vc85 (Apr 13, 2014)

I would love to see higher education for EMS; but I do have questions.

For example, if we were to require masters' degrees to be a paramedic how long do you think you would keep those people, before they realize they could find something better than 16 hour overnights sleeping on a street corner assigned by a SSM computer.


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## Chewy20 (Apr 13, 2014)

If I had to get a Masters to be a Paramedic I would just go to school to be a Physicians Assistant. Like I have said, I am all for more education but a masters seems to be a lot for a profession that deals with a patient for 20 minutes or less in a lot of areas.


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## Medic Tim (Apr 13, 2014)

Chewy20 said:


> If I had to get a Masters to be a Paramedic I would just go to school to be a Physicians Assistant. Like I have said, I am all for more education but a masters seems to be a lot for a profession that deals with a patient for 20 minutes or less in a lot of areas.



For ems to really become a true profession we need people in positions to conduct and interpret research. We will also need strong leaders and managers. Having an ems specific education will enable providers to remain in ems. Self regulation is also a requirement of a profession. I am sure some day there will be a mid level paramedic hybrid. 

I have experienced what the story was speaking of. I am Canadian and have an associates degree in ems. I was not able to get a work visa as a skilled worker because there was no degree requirement qnd emt and medic were lumped into 1 category. An adn can apply and be accepted on the spot at a port of entry. My program had more class, lab and clinical hours than the nursing program. Yet I am viewed as a non degree holding basic emt.


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## MonkeyArrow (Apr 13, 2014)

Well, I think the main point being made here is that not many people will go to a 4 year college program just to get an EMT cert. Most people would rather go get a PA or RN in the time (and money). As we see time and time again on the forums, many people do this because they can get a cert and start making money in 8-10 weeks. Not many people grow saying I want to be a paramedic, and a drastically lower number of people will go through with it when there are better options in the medical field. 

Alternatively, I think that the most effective way to ensure a professional standard via college degrees in EMS is to fully integrate it with fire (and eliminate private companies by doing so). In 99% of all jurisdictions, fire is run by the government. Therefore, a fire department could institute pre-reqs and pay for and send ff/p to a community college to get the BS. I just feel like the FD could have a lot more leverage on reqs and have much more bearing in its institution (NFPA, ISO, etc.). If FDs can get the money to send their FFs to special training programs and have tech rescue teams and send members to FDIC, then they can also send members to a paramedic training program, whatever it may be. Maybe make a centralized metro training center or state-wide center to reduce costs and increase efficiency.


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## Carlos Danger (Apr 14, 2014)

Rin said:


> Wow, that's a lot of assumptions you've made about me.
> 
> I mean, are you seriously saying that back injuries _ aren't_ a problem in our line of work?



I didn't make a single assumption about you, nor did I say back injuries weren't a risk.

What I said was "I might get a back injury some day, therefore I'm not going to invest any more time or money into my education" is very poor reasoning. And frankly I don't know why you would even stay in a line of work that you feel is so risky.


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## Carlos Danger (Apr 14, 2014)

Back to the original point.....

A graduate degree is great for someone who wants to work in upper level management in any field. However, one can't ignore the economics: grad school is expensive, and if it isn't going to (at the very least) pay for itself in a reasonable amount of time, it is hard to justify financially. 

As for a master's degree being _required_, al la "paramedic practitioner" or something like that......I think we are a very long way from that happening on a large scale. I suppose I wouldn't be too surprised to see something like a pre-hospital PA role developed and utilized somewhere, but I don't see that being widespread for some time, if ever. And it would make far more sense to simply use the PA educational and licensure structure that already exists, rather than develop whole new educational paradigm. 

The demand for relatively low-skilled "ALS techs" to shuttle people around is growing, and it simply doesn't require a lot of high-level understanding. 

For right now let's just focus on making an associate's degree with college-level A&P a requirement, and then go from there.


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## BoonDoc (Apr 15, 2014)

Halothane said:


> grad school is expensive, and if it isn't going to (at the very least) pay for itself in a reasonable amount of time, it is hard to justify financially. .



That is not the case here in the UK. The full masters degree is only £6110. There is no masters degree in the US that can come close to that tuition price. Plus you don't have to have any college prior to taking this degree. 

It is not expensive. It will pay for itself if you are looking to move to management, academia or private business sector.


I also would like to see the paramedic profession advance like it has here in the EU. Perhaps starting with just the associates degree would be an option. It will be hugely difficult to change the culture of EMS in the US. Take a look at the longview. In 20 years the US will still not have a paramedic profession based on academic excellence. Every other country will have long adopted the academic paramedic. US will be left in the dust. 

Academia is the way forward. It has been proved in every other healthcare profession. Why is EMS so willing to stay in the limelight?


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## Aprz (Apr 15, 2014)

beano said:


> But how is this paramedic with a Master's going to afford his loan payment of >$1000 / month while making $14/hr and being treated like crap by his employer?  S/He is going to leave EMS for a hospital job where s/he can practice at the full level of his/her training and not risk a career ending back injury.





vc85 said:


> For example, if we were to require masters' degrees to be a paramedic how long do you think you would keep those people, before they realize they could find something better than 16 hour overnights sleeping on a street corner assigned by a SSM computer.



The idea is that our scope, pay, and respect will increase with higher educational requirements. The supply would supposedly decrease and quality of the provider, scope, pay, and respect would increase.

Many jobs have their own risks or cons. Sleep and risking your back are some of the inherited cons of EMS. I imagine some physicians don't get a lot of sleep and experience a lot of stress too, yet people still seem to become physicians.

The transport isn't always 20 minutes. That's kinda exclusive to urban areas. Also I think the goal may be eventually for paramedics to treat at scene and release, and also community paramedicine.

Something has to change in order for everything else to change. I think it's funny that people pretend that one thing will change (eg pay or educational requirement), and nothing else is gonna change.


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## ILemt (Aug 10, 2014)

I argue against fire based ems all the time. Primarily because many fire departments are extremely political ,excluding qualified people to hire a friends son instead. Further many Fire departments have age caps (no one hired if they are older than X) 
or else they hire veterans to the near exclusion of all others, or they simply do not appeal to someone who wants to work EMS but has a fear of burning buildings.

To me, ideally, an ems service would be a sworn government operation either locally or county based and having parity and pay equal to law enforcement and fire.
I would argue for EMT programs to become a year long certificate program, and for medics to have an AS or AAS. Managers can get a BS while Chiefs and researxhers obtain an MS. 

The thought of a prehospital midlevel excites me, but at $11/hr as a street medic I could barely pay for my AAS and can't afford grad school.


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