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To Degree or Not to Degree. That is The Question.

Discussion in 'ALS Discussion' started by MedicMcGoo, Jan 7, 2019.

  1. Tigger

    Tigger Dodges Pucks Community Leader

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    Any degree helps teach critical thinking and shows some degree of dedication to study. Perhaps employers see value in that more than they do with job specific skills?
     
    DesertMedic66 and mgr22 like this.
  2. RocketMedic

    RocketMedic King of the Improbable

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    Having a degree is an investment in yourself. It’s like packing the bolt cutters along on a patrol or bringing a spare Mewtwo to the Elite 4- you don’t necessarily need it, but it’s awesome to have when you find an opportunity that might need it. Also gives you lateral entry into teaching, government and a host of other roles.
     
    mgr22 likes this.
  3. SpecialK

    SpecialK Forum Captain

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    You blokes are still arguing about needing a two-year qualification for paramedics? australia was doing that in the 70s and a bit of searching said we needed that in 1996.

    I guess you need to quickly decide if you want to come up to par with other first world countries or not then eh ....
     
    Last edited: Jan 9, 2019
  4. VentMonkey

    VentMonkey calpuleque Premium Member

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    I don't believe I've ever doubted the importance of a degree, nor what it is that a degree brings to this field in general. I was asking as more of a broadly generalized question for others similar to myself. Not to say that I wouldn't obtain, or have completely ruled out obtaining my degree altogether; I have not.

    I agree that we need to take a page from other first world countries with regards to prehospital education and its fundamental platforms, but again this horse has been beaten to a pulp. Ultimately my goals remain very much in line with many on this forum. True education-based, clinically-driven decisions are hard to make without formal education and training in any discipline.

    I didn't feel @DrParasite was picking on me, but merely helping to illustrate the value of my questions in general (as did @mgr22). I absolutely think all things aside, we as a profession have no dog in "progression of the field" fight without education from the bottom up. Restructuring may take decades, however, perhaps the minute EMS (in The States) rids itself of traditional mantras the lines in the sand will begin to dissipate.

    With all that, the problem to me remains that much of what we focus on in this country when discussing prehospital medicine, and/ or its education is of little value to both personal, and professional long-term growth.
     
  5. aquabear

    aquabear World's Okayest Paramedic

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    If the IAFF is against a degree requirement for paramedics, I am for it.
     
    akflightmedic, GMCmedic, Eir and 3 others like this.
  6. Eir

    Eir Forum Probie

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    The U.S. seems to have lost interest in trying to be a first world country.

    I'm working on my two-year paramedic degree now, though I'm 35 and ten years out of my first, unrelated, college experience. Maybe it's just my program, but there seems to be a disconnect between the academic and practical aspects of the program that makes me wonder what a four-year degree in EMS would look like beyond requiring an additional fee for the certification soup that passes for advanced training now to also come with college credits. It seems like the demand for such programs really needs to come first.

    I feel like fire is a big piece of what is holding us back. Newly certified Basics are nowhere near ready to start working in the field, but fit perfectly into a too-many-Basics-on-an-engine response that fire departments seem to favor. I don't see other first world countries making this same mistake.
     
    Gurby and VentMonkey like this.
  7. Remi

    Remi Forum Deputy Chief Premium Member

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    Yes, because the initial education requirements for paramedics is definitely what defines whether or not a nation is "first world". :rolleyes:

    I certainly support better initial education for paramedics, but if we're being honest, part of the reason it hasn't happened is because there're really no objective, demonstrable need. There's no research out there that I'm aware of that indicates that paramedics with a college degree have better outcomes than those without.
     
    Last edited: Jan 16, 2019 at 6:13 PM
    VentMonkey likes this.
  8. DrParasite

    DrParasite The fire extinguisher is not just for show

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    I couldn't have said it better myself.
     
  9. akflightmedic

    akflightmedic Forum Deputy Chief

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    So no research = no better outcomes? So do not conduct the study because we know it is pointless anyways, right?

    Not calling you out in particular, just rephrasing for the follow on set up...

    Nursing. There ARE many studies that demonstrate a BSN produces more favorable outcomes and better care versus ADN. As much as I dislike comparing nursing to paramedicine, in the same breath they got their **** together, lobbied for higher education and created a demand for themselves which in turn created a shortage and higher wages. After many years of making a degree entry the standard, they then went a level higher and are now making the BSN the standard. And they have studies to support their claim.

    Having said that, couldn't we try to make a degree for entry the requirement for starters, over several years it will thin the heard appropriately and raise demand and wages for degreed paramedics. There are studies which show too many medics on scene is less beneficial so this is a step in right direction. Once we have thinned and made degree entry standard, then we actually have a demographic to conduct studies on and evaluate whether or not the care is better. The tricky part is studies like that would need to be evaluated across the entire continuum of care to determine whether treatment started earlier on moved through the system appropriately and ended with favorable/better outcome.

    One of the issues in general is our short life spans as medics career wise. This is an unsupported statement by me, however it seems not enough of the "good ones" stay in the field long enough to effect change in the right direction. Maybe, just maybe they would IF we made getting in the industry a degree requirement and raising wages, they would stay.

    Chicken and Egg...repeatedly.
     
    mgr22 likes this.
  10. mgr22

    mgr22 Forum Asst. Chief

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    Just to build on Akflightmedic's remarks, I think there's danger in concluding something isn't true just because there's no research that supports it. It's ok to learn from the experiences of others, even if skepticism is part of that process. The problem, in my opinion, is when unresolved cognitive dissonance -- e.g., I don't have a degree, so I don't need a degree -- affects quality-of-life decisions and limits career-related opportunities.

    Or something like that. :)
     
    akflightmedic likes this.
  11. DrParasite

    DrParasite The fire extinguisher is not just for show

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    That isn't what he said at all... he said there was no research to support the claim that more education leads to better outcomes. If anything, he said that research has not been conducted to either support or disprove the claim.
    so in a time when their are many EMS agencies that are desperate for paramedics, you want to thin the heard of available cattle? Most EMS agencies I am aware of have paramedic jobs posted; very few are overstaffed with experienced paramedics. If you look at career fire departments, many will put you on the short list to get hired if you are already a paramedic, because they are that desperate. And how many agencies do you know that are constantly paying paramedics OT to staff trucks? And even these agencies that are desperate, how many are still paying their medics **** wages?

    We can argue that we have a paramedic allocation issue, not an actual shortage, but that's a different issue.
     
    Remi likes this.
  12. Remi

    Remi Forum Deputy Chief Premium Member

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    My original reply to this thread was specifically in response to the implication that EMS care in the US was somehow woefully behind that of the Commonwealth nations. From a systems and educational standpoint, I know that's true. But from a clinical outcomes standpoint - which is really what matters, right? - I don't think there's any evidence to support that idea.

    As I wrote in that reply, and as a perusal of my old posts on this site would demonstrate, I am a strong advocate for better training for paramedics. I've been making that argument since long before many members of this site were even involved in EMS.


    I didn't say either of those things, I just said it hadn't been demonstrated by research. However, remember that, "what can be asserted without proof can be dismissed without proof".

    Outcomes research in EMS is notoriously challenging because there is so much variation in protocols, drugs, response times, experience levels, etc. from state to state, county to county, even agency to agency, not to mention the hospital care that follows. That said, if you could find a way to do such a study with all those variables controlled for, then sure it should be conducted. Why not?

    I had to endure having that absurdity shoved down my throat during my BSN program. Those studies are all done by the nursing educational industry in an effort to convince nurses and hospitals that they need to buy more of what the nursing educational industry is selling. As such, they lack rigor and objectivity. Most are based simply on outcome differences between hospitals that have a higher % of BSN holders vs. those that have lower percentages, but do not even attempt (not that you really can, anyway) to control for the many other factors that affect outcomes. Also, most of the outcomes that they are looking at when they make these claims aren't even the types of outcomes that we typically think of as important in healthcare in 2019. They are looking mostly at things that relate to patient satisfaction, not length of stay, 30-day readmission rates, cost, or anything like that.

    It's like saying King County has it's excellent survival rates from out-of-hospital cardiac arrest BECAUSE all of their paramedics are trained at Harborview, and completely discounting their extremely high rates of bystander CPR, rapid first response, high-performance, evidence-based resuscitation protocols, state-of the art hospital care, and all the other things that clearly impact survival but have nothing at all to do with where the paramedics are trained.

    The BSN is good for individual nurses and good for nursing overall, but it has very little, if any effect on direct patient care.

    Considering that a two-year degree doesn't take much longer to complete than the current length of many paramedic programs, it doesn't seem like much of a leap. I'm not sure it would do much to thin the herd, or if that should even be the goal, but I think there should be a strong push for it, for sure.

    Nursing didn't require (essentially, it still isn't mandatory anywhere) a BSN until BSN programs had existed for a long time and had already become pretty popular. It seems like the best way for EMS to move to a degree requirement is for paramedic programs to voluntarily become two-year programs first. It's already happening in some places.
     
    akflightmedic likes this.
  13. akflightmedic

    akflightmedic Forum Deputy Chief

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    Come on....both of ya are smart enough to not miss this sentence which I deliberately inserted to clarify the issue I was framing...and not implying it was your position. But kudos to both for grabbing that ball and running with it...(Remi and Parasite)

    As for the other comments, we agree. However, THEIR actions and the path they took (RNs), shows that higher wages and demand will follow higher level entry. It is marketing, business and lobbying...I get that. In my desire to see longevity of paramedics, yes you absolutely need to think the herd, cut the chaff, whatever analogy you want to use, because once we have a higher standard, do away with medic mills which are a plenty, we can then start to change our profession for the better. When the IAFF is one of the biggest funders AGAINST this, that alone should tell you it is the right move.

    And yes, I know one of my favorite quotes, and I do realize many studies start out with a hypothesis they will prove come hell or high water....my point was how they banded together and shored up the profession as a whole and get to reap the benefits of such actions. What other course of action can we take? None I can think of other than an entry level degree in order to add validity to your claim that you deserve more. Yes, I agree a lot of the course work in pursuit of a degree does NOT make one a better paramedic. Overall, the image of everyone having a degree and then arguing for more or better conditions will be taken more seriously by those who control the purse strings and the general public.

    Like it or not, this is a marketing/PR move I am suggesting for now....and once that foundation is done (which requires Medics to have degrees) then we can start doing the really cool stuff of being involved, respected and considered on a serious/scholarly level of impacting patient outcomes, improving early care and participating in studies which stretch across the entire team with many of the variables you mention and I alluded to in my first post...THEN we can have studies done, make changes, increase wages, working conditions, etc.

    It is time for a top down overhaul.

    Or we can say no, no no and chicken egg this until ironically we get degrees in other fields and move on, leaving the battle to the next gen.
     
    VentMonkey likes this.
  14. akflightmedic

    akflightmedic Forum Deputy Chief

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    Exactly! And why are there so few experienced paramedics hanging around...?
     
  15. Tigger

    Tigger Dodges Pucks Community Leader

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    Aside from pretty middling cost of going from a certificate program (~80% of an AAS), what are the disadvantages of getting an AAS in paramedic studies? Legitimate question.
     
  16. DrParasite

    DrParasite The fire extinguisher is not just for show

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    Cost is probably the big disadvantage; AAS programs are typically longer than certificate courses.

    the certificate program I was in was 12 months from start to finish, from January to December. The degree program is 5 semesters, so about a year and a half. Scheduling was also difficult; my program was monday and wednesday from 6pm to 10pm, with the occasional saturday. other schools run monday/thursday or monday/friday, from 9am to 5pm, on alternating weeks, to accommodate the shift workers. The degree program is usually during the day, on set days, which means it's hard to attend if you work a full time job.

    Of course, the other legitimate question is why get a degree when all you need is a certificate to get the job.
     
  17. cruiseforever

    cruiseforever Forum Captain

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    I worked for a place that started to require an AAS. The requirement was dropped after a couple of years when they failed to get enough medics or hired. There is even a problem getting good emts. Our area offers what I feel is a good starting wage and it keeps increasing. For some reason people are not interested in going into the emergency fields any more. This includes fire and police. The colleges have cut way back on the classes they offer due to lack of interest by the public.
     
  18. mgr22

    mgr22 Forum Asst. Chief

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    Because striving for more than the minimum can be a gratifying experience. If everything we did were based on cost-benefit analyses, we'd live in dormitories, drive scooters, and shower once a week.
     
    Tigger likes this.
  19. DrParasite

    DrParasite The fire extinguisher is not just for show

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    No one is saying you shouldn't strive for more than the minimum; If you want to get your AAS in EMS (and I do encourage all paramedics to complete theirs, particularly if they want to do something in EMS aside from being on an ambulance), than absolutely go for it, especially once you have a job in EMS and have some experience under your belt. And I will also agree that earning your degree can be a gratifying experience.

    But that's a lot different than mandating a degree when many the industry doesn't require it, and mandating a degree where there is 0 evidence that a degree will have any actual impact on the provider's ability to do their job.
     
  20. mgr22

    mgr22 Forum Asst. Chief

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    Did you not just ask the question I answered? Wait, let me check...yup, there it is: "Why get a degree when all you need is a certificate to get the job?" Asked and answered. As for your comment about lack of evidence for mandating a degree, we've been through all of that. I get it: You don't think EMS providers need degrees.
     

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