# Increase in education requirements for medics.



## Level1pedstech (May 16, 2009)

I have been meaning to start a thread on the ever increasing education requirements for pre hospital providers and after reading through some old posts on the topic of education I think now would be a great time to discuss a few things I have been thinking about.

 I will start by saying that Im all for education and I know Im not alone in that area of thought. One of the reasons I work as an ER tech is for the opportunity I have to learn from the best in the field of emergency medicine every time I work a shift. One of my tech duties is to record on traumas, this requires me to ask the transport medics questions about what happened prior to arrival and make the required notes on the trauma chart, in the course of a twelve hour shift I may write on five or more traumas giving me the chance to soak up allot of information that I can use later in the field. I am a hands on learner and this way of ongoing self education works well for me. I believe that when a person makes a choice to enter the field of pre hospital emergency medicine they need to make the commitment to continue to educate themselves when ever possible.

I think the trend towards making the paramedic program a two year degree is spreading and I have heard Washington state will soon be following the state of Oregon. I was talking to one of our new RN's who used to work with me as an EMT/ER Tech and the subject of medic school came up, he really made a good argument for changing my future education plans. Without going into all the pros and cons of prehospital EMS compared to the RN route, I know both sides very well, I have to ask myself why spend two years+ in school and come out making what we all know can be very low wages as a medic when you can spend two years+  in school and come out as an ER RN and make very good money. I know the two are different paths but I cant be the only one that has to be thinking which way is really going to work out the best in the long run. I am not looking for a medic versus RN fight so don't even go there. I simply would like some intelligent feedback on the subject.


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## DrankTheKoolaid (May 16, 2009)

*re*

You don't become a paramedic to make money.

Obviously we all want to make more money, and if that's your main goal at the time then go straight to RN.  Otherwise do what makes you happy.


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## Level1pedstech (May 16, 2009)

I knew I should have cleared that one up from the start. Its not a thread about money its about education. I have been in this field for ten years, six of those years I never was paid a dime for my service or the 300 plus hours of classroom time I have put in. It was not until I started in the ER that I finally made some money with my certs. I am well aware that its about the love of EMS not the money you can make. Im not asking for advice just some thoughts from those who might be facing the some dilema. 
,


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## fortsmithman (May 16, 2009)

Corky said:


> You don't become a paramedic to make money.


You do if you live in Canada.  We have medics making in the low six figures.


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## DrankTheKoolaid (May 16, 2009)

*re*

Then i would say continue with your education and knock out your RN pre-req's if you haven't already.  Apply for a RN program and while on the wait list do your medic.  It's the best of both worlds and once your an RN you can stay in the field as  Flight nurse or CCT-RN, or you may find you love ER/ICU/CCU/Shock Trauma and decide to stay indoors


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## Level1pedstech (May 16, 2009)

Corky

Now thats a good way to look at it. I just want to make the most of the education time and I would like to continue working at some level in the outside end of the field.

Fortsmithman

I have read lately about the potential to make very good money at some departments. LA city is under scrutiny about their overtime practices as well as a handful of other municipal departments. Lets not get that going but it calls into question the quality of life you desire. I like to have the new people think about having a life doing what they enjoy not working 20 24's and in a short time having real doubts about your decision to enter the field.  We all know if you go fire you can make a good living  and retire fairly young but how long can you keep the fire in your belly. I don't see two many non fire medics with more than ten years of service. Job burnout is one of the big cons of being a medic, fire or otherwise. On the RN side you can make good bucks and have a very easy 36 a week schedule. I do know some agency RN's that work  72 hours a week and make close to what first year resident MD's make. Pick your poison.


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## 46Young (May 16, 2009)

Level1pedstech said:


> Corky
> 
> Now thats a good way to look at it. I just want to make the most of the education time and I would like to continue working at some level in the outside end of the field.
> 
> ...



Yes, you're spot on with the medic burnout observation. I think it's a combination of low pay, disrespect/no appreciation, working conditions, and the need to work several jobs to do well financially. The medic profession pays just enough to attact you, but not enough to be comfortable. I'm happy as a firemedic, paid well. If I could do it all over, I would become a RN, challenge the medic exam, then apply for firemedic. I want to earn my assosciates RN for part time work, but I'll have to do it online through a community college. It's not ideal, but it's the only way with my rotating schedule. Working conditions/bennies/perks are highly desireable for the field at my current employer, so I won't be leaving anytime soon. Your 20 24's reference reminds me of Charleston County EMS, where the 24/48 was more often a 48/24. Medics there either became RN's, left to work EMS for MUSC, or left the area altogether. This happens all over the country. If you want to be a medic, do it on the side. Per diem life is great. You can make your own hours, and it's liberating knowing that the agency doesn't "own" you.


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## wehttam (May 16, 2009)

i know the post is not about money as the starter of the thread pointed out but i will say this ,more money will come once the educational requirements begin to increase,its not going to happen over night but the more people get there associates degree the better it will be for the profession in the long run and put us in a position to DEMAND higher wages.I am sure nurses didnt start out with high wages but they have advance not only there educational standards but there professional standards as well. 

Until EMS sees the importance of a good education(associates degree as an entry requirement) then the profession will never improve.As someone who loves this line of work (4yrs as an emt-B) my mind is in a state of uncertainty,and the more i think about it i do believe i may persue a career in nursing sooner than later and i have this forum and some of its members to thank with my decision making.my decision to persue nursing would be base on the following

 1)The educational requirements are more. meaning i don't have to go out and do extra courses because i feel like it. its part of there curriculum.not trying to offend anyone 

2) The opportunities are endless so many different specialty better opportunity for career advancement as well once you're willing to put in the work 

3)As a nurse i can do the paramedic course anytime and it will also take less time and that time varies from state to state again no professional standards  

what i find so amazing and laughable is the fact that some of us are fighting to increase the educational requirements to have an associates degree as a minimum requirement and other profession have now stepped up there minimum requirements to a bachelors degree 

the other sad part of this is the paramedic profession well it was around for as long as some of the other professions who have SEEN THE NEEED TO INCREASE THERE STANDARDS and have surpass us in that respect.

Some may say that its to much education to work the streets you dont need it etc etc but i think we need to stretch our imagination a bit we can also function in a hospital setting plus work the streets come on the possibilities are endless i get so excited thinking about it but the sad thing is its going to take another 20 years by that time other professions would have already increase there educational requirements plus maybe even there scope of practice. 

Now as to the disrespectful attitude we experience in this profession again i say its the lack of standards when you have programs that are three months in length(medic mills) pumping out paramedics what do you really expect from emt-b to paramedic in three months no A&P, no bio, no foundation nothing at all but can set the NREMT exam in three months how much respect do you want?

paramedics dont even respect such programs as i said its all about standards so i say yes educational requirements needs to increase and professional standards need to increase as well. then you will get the respect that paramedics soo deserves from the other profession ems is my passion and it will always be my passion no matter my career choices will still get my paramedic certs. that's all for now


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## VentMedic (May 16, 2009)

Level1pedstech said:


> Without going into all the pros and cons of prehospital EMS compared to the RN route, I know both sides very well, I have to ask myself why spend two years+ in school and come out making what we all know can be very low wages as a medic when you can spend two years+ in school and come out as an ER RN and make very good money.


 
Do you know how much RNs made before they changed their educational requirements to finally be recognized as a profession?  What to you think RT, PT, SLP and OT use to bargain with to get increased reimbursement from the insurances and legislators?   Each profession presents their position from a nationally required minimum education standard with national minimum testing requirements and with only 1 or 2 different titles for levels of care.   Then, you have EMS that shows up in Washington D.C. with 50+ different titles labeling various levels of care with varying education requirements for many of the same titles in the different states.    As one legislator has been quoted to saying, "How can we help you define your profession when those in EMS can not agree on how to define it".


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## VentMedic (May 16, 2009)

46Young said:


> I'm happy as a firemedic, paid well. If I could do it all over, I would become a RN, challenge the medic exam, then apply for firemedic.


 
That actually is a good route.  I know many  Fire Paramedics in FL that got their RN degree while waiting for hire at a FD.  Then, they either challenged the Paramedic test after EMT-B or went through a quick medic mill on their own or through the FD after hire.   The 2 year degree from the RN program gave them a head start on a 4 year degree in something that could help their advancement on the Fire career ladder.   And, they have a 2nd profession as a nurse that pays well and keeps their interest in medicine to be a better Fire Paramedic.


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## Ridryder911 (May 16, 2009)

I will not disagree what is being written however; I never want to encourage anyone to enter nursing without really wanting to be a nurse. I  don't care how many one might have worked with, dated or married or thought they understood their role. I also never want to give the idea that nursing is even similar to EMS when it is definitely NOT. The philsopohy, the ideas, the mode of educational delivery and even the main goal is nothing similar to that of EMS profession. Nothing wrong with nursing education  but at the least have an understanding of the profession you will be entering. 

It might be a regional thing at this time but most nursing programs that I have became aware of; it is very difficult to enter them. The average waiting time is about two years to be accepted to enter and usually based upon certain criteria as GPA and points weighted upon credits earned. So no matter the area you want to focus or concentrate upon obtaining a good foundation of general education is essential. 

I do laugh though about the money though. I have just hired two more experienced nurses that is returning to EMS, as the increased demands and then to realize they will be making the same yearly salary and actually have better benefits. I try to keep in touch with nurses nationally and I am no longer seeing the money or the stated shortage as before. Oh, I still do believe there is a shortage of nurses and staffing; but the patient nurse ratio has been increased in many areas as well as many of the nurses that usually stayed at home are now suddenly returning to the job market. Again, yes there is a shortage of nurses but the question is how will they fix it?

I know even in my area two things are frequently occurring. Brand new grad's are receiving poor pay or one must have extreme experience plus all the additional education and certifications to be hired. 

I don't believe this is not just isolated in my area.
http://www.examiner.com/a-1982157~D_C___Md__hospitals_say_nursing_shortage_no_more.html
http://jacksonville.bizjournals.com/jacksonville/stories/2009/05/04/story2.html
http://www.boston.com/business/articles/2009/04/18/staffs_full_nurses_struggle_for_work/

Again, I don't believe the shortage has been resolved but I have talked to Department Directors and have seen an increase in the patient load assigned to staff. I also have seen the wages drastically been reduced within the past 6 months from almost $3.00-5.00/hr and the bonus and the usual perks have been totally dissolved. Also an influx of "foreign" nurses that major hospitals have recruited. These nurses sometimes will work for about half the salary of the traditional nurses. Within the past two months I also noticed in the decline of wanting those to travel nursing. My phone/e-mail would be full of offers now is less than half it had been recently. 

I of course have been a nurse long enough (20 years) to realize also that I have seen this type of pattern to previously occur. Usually, the pattern does not last more than a few years and the demand increases again and of course the salary and benefits. Hopefully; it is just that a pattern but something to consider. I will admit nursing schools are much more smarter than those in EMS and in adjusting the number of students allowed in nursing programs to the work demand. It is a good idea of not flooding the market for the profession; just maybe harder to enter nursing school. 

Nursing is a great career and I will probably return to it full time in the near future but just be informed and gather as much information as possible to make a rationale decision. 

R/r 911


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## VentMedic (May 16, 2009)

Ridryder911 said:


> I do laugh though about the money though. I have just hired two more experienced nurses that is returning to EMS, as the increased demands and then to realize they will be making the same yearly salary and actually have better benefits. I try to keep in touch with nurses nationally and I am no longer seeing the money or the stated shortage as before. Oh, I still do believe there is a shortage of nurses and staffing; but the patient nurse ratio has been increased in many areas as well as many of the nurses that usually stayed at home are now suddenly returning to the job market. Again, yes there is a shortage of nurses but the question is how will they fix it?


 
In Fire based states such as Florida and Southern CA, it is not uncommon for RNs to work for a FD as Paramedics for their retirement benefits and decent pay.

The one link you posted was to an article in the SF Examiner. In SF, new grads can still start out at $45/hr which is considerably higher than what a Paramedic makes in the Bay area. Thus, few are running off to join AMR or the FD except for CCT positions since Paramedics are rarely used for those. The Bay area is still filling the positions held by travelers. Florida in the past had relied on travelers during the season but now have offered attractive options for per diem positions which can fill the void during that time. 

Many states have also legislated the nurse to patient ratio number. That is what has caused a perceived shortage over the past 10 years in some states such as California and New Jersey as they complied with the regulations.



> Also an influx of "foreign" nurses that major hospitals have recruited. These nurses sometimes will work for about half the salary of the traditional nurses.


 
These nurses are licensed by the state they work in. Thus, State and Federal laws do apply to them. This is an old and outdated practice from the 1970s and early 80s that is not tolerated today. I seriously hope your state is not still offending the Canadian or nurses from other countries today with this ridiculous discrimination by country of orgin or color of their skin. Nurses have achieved some professional status and deserve to be treated as such.


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## daedalus (May 16, 2009)

VentMedic said:


> That actually is a good route.  I know many  Fire Paramedics in FL that got their RN degree while waiting for hire at a FD.  Then, they either challenged the Paramedic test after EMT-B or went through a quick medic mill on their own or through the FD after hire.   The 2 year degree from the RN program gave them a head start on a 4 year degree in something that could help their advancement on the Fire career ladder.   And, they have a 2nd profession as a nurse that pays well and keeps their interest in medicine to be a better Fire Paramedic.



Respectfully to Ventmedic, I believe these RNs do me a disservice. They perpetuate low standards for Paramedics who chose not to attend RN school, like myself. I will not accept a medic mill graduate as my peer just because they also have gone through nursing education (which is very intense in its own right).


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## BruceD (May 16, 2009)

Level1pedstech said:


> On the RN side you can make good bucks and have a very easy 36 a week schedule. I do know some agency RN's that work  72 hours a week and make close to what first year resident MD's make. Pick your poison.



Heh, first year resident MDs earn 41-43k, I sure hope nurses earn more than that for 72 hrs a week! (Would mean the average nurses pay would be 9.55/hr)

(data from http://www.valuemd.com/moonlighting-forum/11686-first-year-residency-salary.html )

Stay safe
-B


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## Level1pedstech (May 16, 2009)

Great stuff all. Its nice to have some different perspective. I find it a positive that most everyone is giving a thumbs up for higher education no matter what roads they plan to pursue. 

BruceD

I will check on the first year MD,s pay at our facility but I thought it was more. Could I be thinking senior resident ED docs? Either way those agency RN's I was speaking of are making in the area of 85.00 p/hr.


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## HotelCo (May 16, 2009)

BruceD said:


> Heh, first year resident MDs earn 41-43k, I sure hope nurses earn more than that for 72 hrs a week! (Would mean the average nurses pay would be 9.55/hr)
> 
> (data from http://www.valuemd.com/moonlighting-forum/11686-first-year-residency-salary.html )
> 
> ...



About the same pay for a first year resident here as well.


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## Ridryder911 (May 16, 2009)

VentMedic said:


> Many states have also legislated the nurse to patient ratio number. That is what has caused a perceived shortage over the past 10 years in some states such as California and New Jersey as they complied with the regulations.
> 
> These nurses are licensed by the state they work in. Thus, State and Federal laws do apply to them. This is an old and outdated practice from the 1970s and early 80s that is not tolerated today. I seriously hope your state is not still offending the Canadian or nurses from other countries today with this ridiculous discrimination by country of orgin or color of their skin. Nurses have achieved some professional status and deserve to be treated as such.



Actually, 60 minutes had a discussion of India & Polynesia loosing many of their nurses to major U.S. hospitals are recruiting for cheaper labor. Many times the education is different and a nurse maybe specialized in one area many opt to challenge the LPN/LVN license level in lieu of the RN. Also the pay is considerable much more than what they offer in their home land even at a cheaper rate. Yes, I agree it may not be considered right and yes even the board of nurses may not approve of their methodology but alas large corporations are always looking for the cheaper method and really nothing the BON can do except license those qualified. Many times room and board is offered as a benefit in lieu of pay and there is where it the problem gets muddy. 

I realize this is a problem within nursing, as well as continuation of patient ratios and they are much more legislative pro than EMS. Here is a link with an interesting video that addresses the move to national ratios.

http://www.calnurses.org/

True some states have mandated patient ratios but as well some also have unions and a strong BON that had to go to legislation just represent nurses, which many states do not prescribe to. Also JCAHO has regulations that are to assist in staffing but in the real world we should recognize that it has a nice meaning but that sometimes that is all it is. 

I believe if one was to investigate the salaries though the starting pay with diff is about $65k for RN's in California which is not bad but again one has to recognize costs of living. 

Again, I do respect fellow nurses and their attempt to change things not just for the advocacy of the profession but for the patient care. 

R/r 911


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## BruceD (May 16, 2009)

Level1pedstech said:


> Great stuff all. Its nice to have some different perspective. I find it a positive that most everyone is giving a thumbs up for higher education no matter what roads they plan to pursue.
> 
> BruceD
> 
> I will check on the first year MD,s pay at our facility but I thought it was more. Could I be thinking senior resident ED docs? Either way those agency RN's I was speaking of are making in the area of 85.00 p/hr.



I believe residency pay is the same across the board with a few places with high cost of living adding a small stipend.  Residents get a small pay increase each year, but I believe with 80 hr work weeks, they probably don't have much time to go spending all that loot. 

Here's a link to UCSD I found: http://imresidency.ucsd.edu/benefits.shtml  it includes pay rates, stipends, and other benefits for residents.

-B


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## VentMedic (May 16, 2009)

Ridryder911 said:


> Actually, 60 minutes had a discussion of India & Polynesia loosing many of their nurses to major U.S. hospitals are recruiting for cheaper labor. Many times the education is different and a nurse maybe specialized in one area many opt to challenge the LPN/LVN license level in lieu of the RN. Also the pay is considerable much more than what they offer in their home land even at a cheaper rate. Yes, I agree it may not be considered right and yes even the board of nurses may not approve of their methodology but alas large corporations are always looking for the cheaper method and really nothing the BON can do except license those qualified. Many times room and board is offered as a benefit in lieu of pay and there is where it the problem gets muddy.
> 
> I realize this is a problem within nursing, as well as continuation of patient ratios and they are much more legislative pro than EMS. Here is a link with an interesting video that addresses the move to national ratios.
> 
> ...


 
Many areas do not use LVNs anymore so that is a moot point. 

Any nurse coming from another country and one that passess the boards in his/her state is entitled to protection under the labor laws of that that state and the United States. 

These RNs are not stupid and uneducated. Most are well aware of their rights when they come over to the U.S. Many have also worked in envirionments that are equal to or above what the U.S. has to offer. 

California already has nurse to patient ratio laws. 

Yes, the cost of living is taken into consideration since RNs earn well into the 6 digits in norther California and I personally find the cost of living cheaper than South Florida.


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## MedicSetla (Jun 3, 2009)

*Adding video to Paramedic Curriculum*

I feel that with the right combination of entertainment and education and animation we can create a curriculum that will become more impactful and help all new paramedics understand how their decisions impact the patients since most of them only see such short life cycles of a disease processes, it is hard to fully grasp the interventions and their impact.  

Most video curriculum is extremely dry and boring, and since we are all seeing CSI or House daily, it only makes sense that we use existing technology to enhance the education of the EMS industry... Edutainment!!!

Ted  (NREMT-P)


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## daedalus (Jun 3, 2009)

I agree! (to the above poster)


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