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

DrParasite

The fire extinguisher is not just for show
4,856
1,189
113
The same fire departments that require at least an AS/AA to be in any kind of leadership position...
yes, the same fire departments that requires a degree to be a supervisor, not to be a backstep/rear facing/hose pulling entry level firefighter........
 

SandpitMedic

Shock&Awe
1,759
817
113
Any type of advocacy for paramedics not having at least an AA/AAS cracks me up.... Fire department and old people love the idea though! ;-)
This.

Evolve or die (or at least sit stagnantly complaining about low pay/respect/opportunity/etc).

Why bother to notice all other allied health and clinical professions have increased their educational requirements over time to increase their standing, compensation, quality of applicants, and foundational education?
 

MackTheKnife

BSN, RN-BC, NREMT, EMT-P, TCRN
491
117
43
That’s a great read.
Cited a lot of opinion and nomenclature vs data, but still a good argument for upping the ante.
Umm, did you see all of the references?
 

MackTheKnife

BSN, RN-BC, NREMT, EMT-P, TCRN
491
117
43
Has anyone done the Bachelor's in EMS Administration from Columbia Southern U.?
 

MackTheKnife

BSN, RN-BC, NREMT, EMT-P, TCRN
491
117
43

DrParasite

The fire extinguisher is not just for show
4,856
1,189
113
Umm, did you see all of the references?
Did you actually look at what the references said? And did you note that out of all the references (removing the NHTSA ones), 3 deal with people leaving EMS or keeping people in EMS, one is a joint position statement, and 3 are actually EMS related sources, with the rest involving taking assumptions from other groups and saying it should apply to EMS? And two references are from the 90s.....

the article also states many assumptions (with increased education will result in increased salaries, and with increased pre-requisite classes will make the paramedic certification (since it's the state issued cert that lets you practice, and you need to maintain not the degree) more valuable, completely ignoring the question of where is the additional funding going to come from, as well as saying that providing degrees will make it easier for paramedics to leave the field to pursue other venues.

And of course, it ignores the critical question: if EMS degrees are needed, and important to the profession, and would make everything better, including better pay and better patient outcomes, why are we not mandating an EMS degree (not a generic AAS or BS, an associates degree in EMS) for all existing providers (which NYS did with their nurses and BSNs, and if they don't get them in X number of years, their nursing licenses are suspended until they do), and only forcing this increased cost and training length on new members of the profession?

Did you also consider the author's biases when you evaluated the content of this article, which was written in NAEMSE newsletter? The author is an educated individual; She obtained her bachelors in Biomedical sicneces 15 years before she became a paramedic; her masters is in Fire and EM administration. However, her primarily role has been that of an educator, a role she has had a role she has held since 2001, after being a paramedic for 5 years (she has continued to work as a flight medic until 2009 and recently went back to it part time). She is also a faculty member and program director at the local community college teaching EMS, so she has a financial interest (at a professional level) in transitioning from a shorter certificate program to a longer degree program. So the bulk of her experience isn't from that of an ambulance paramedic, but that of an educator (which I will 100% should require at least an associates, if not a bachelors degree for full time faculty, with a preference to a masters) and a flight medic. And she doesn't had a degree in EMS at any level.....

BTW, I have my bachelors degree, and am working on my masters.... and I know some people who have bachelors and masters degrees (and one PhD) who work as paramedics who make the same amount as a certificate-only paramedic working on the same ambulance.
 

KingCountyMedic

Forum Lieutenant
181
58
28
I'm old and have a high school diploma, EMT card, Paramedic card, and I think a blockbuster video rental card. I'm not anti education by any means but I think the education should be relevant to the job you're doing. We have a lot of newer, young folks with degrees, some bachelors, some masters, and some PhD's and many of them want more money because they have a degree even though that degree in no way shape or form is related to pre hospital EMS or even medicine in general. Just doesn't make sense to this simple minded high school graduate.
 

akflightmedic

Forum Deputy Chief
3,306
1,743
113
While I see the point the non-degree supporters are making....I can only think of the Nursing Profession as a model to better wages and better conditions.

They tossed diploma nurses and many states have phased out even LPN nurses. Does having a degree make one a better nurse? I do not think so, however there are studies which argues that it does. Aside from that tangent, I circle back to....how can we argue for better pay, better conditions, peer respect/support within the medical community, when "we" are unwilling to elevate our entry level education? Even if it does not contribute significantly to the paramedic work itself...
 

PotatoMedic

Has no idea what I'm doing.
2,063
946
113
One thing nursing did well was tie reimbursement to degrees. Hospitals that want higher reimbursement rates need to have 80% or more of nursing staff with a BSN. That has been the reason for the big push for degrees in nursing recently.

I honestly think paramedics should be at minimum an associate degree. I believe general education such as psychology, writing classes, stats are both part of the core education of any degree but very useful for a paramedic. Add in more robust prerequisite such as full a&p with a lab, microbio, biology, chem, round it out with paramedic school and you have yourself an AA degree. Yes not all programs will be able to adapt... Harborviews program will have to change, but I believe we will have better providers.
 

KingCountyMedic

Forum Lieutenant
181
58
28
One thing nursing did well was tie reimbursement to degrees. Hospitals that want higher reimbursement rates need to have 80% or more of nursing staff with a BSN. That has been the reason for the big push for degrees in nursing recently.

I honestly think paramedics should be at minimum an associate degree. I believe general education such as psychology, writing classes, stats are both part of the core education of any degree but very useful for a paramedic. Add in more robust prerequisite such as full a&p with a lab, microbio, biology, chem, round it out with paramedic school and you have yourself an AA degree. Yes not all programs will be able to adapt... Harborviews program will have to change, but I believe we will have better providers.

I think Harborview has an agreement with some other program now for those that want to get the AA Degree. It wasn't around when I went through. They do a full A&P course now prior to start of Training.
 

DrParasite

The fire extinguisher is not just for show
4,856
1,189
113
Because your making several assumptions based on a different field with a completely different funding model.

Increasing education does not always correlate to more money: if it did, social workers (who must have a bachelors degree, and most have a MSW) wouldn't be starting in the lower 33k.

And if't not just nurses who have raised their education requirements: PAs have also raised their educational standards, It used to be associates degree program, and then they faded way and BS took their place... now almost all the programs are masters degree level programs, but they all take the PA-C exam to be called a physician assistant.

I'm not against raising the educational standards: in fact, I think the current ones are pretty embarrassing, especially when you discuss A&P with a paramedic certificate student and they have no clue what the lymphatic system is. But do we need to raise the standards? And by that I mean, where is the Evidence Based stuff that shows that a degreed paramedic is better than a non-degreed medic? Are the graduation rates on the NREMT-P exams much higher degree vs non-degree? Are the non-degree medics failing to meet the standard that is currently set for them? If the education isn't sufficient, than our current standard for certification (the NRP practical and written exams) should validate that claim, and provide definitive proof that the education is lacking, needs to be raised so more people pass the entry level paramedic exams.

Nurses were able to tie reimbursement rates to education level (which was organization specific, not provider specific, so I do question it's validity, but I digress): do you think EMS will get more money for having providers with degrees? And if not, where will the money come from? Do you think AMR will cut into their profits just because you have a degree, and are doing the same job you did for the past 10 years?

If CMS comes out tomorrow and tells every agency that their ALS 1 and 2 bill will be automatically rejected if the paramedic writing the chart does not have a degree in EMS, than we have a good reason for everyone to get that degree.

And why should those degree requirements only be applied to new paramedics? if the industry wants it, because it makes the profession better, and increases standards across the board, then EVERYONE should have to get an AAS in EMS (not a generic associates, or a bachelors degree in an unrelated field). If the education is needed, than everyone should get it. If the state regulatory body says "in 10 years, if you don't have an AAS in EMS , than your paramedic certification is suspended, than we have a good reason for everyone to get degrees. If you want to continue to be a paramedic, you have plenty of time to complete the requirement to help the industry: if not, than maybe your not as dedicated to the field as you claim.

for the TL:DR crowd, there is no evidence that a degree paramedic is any better than a certified one (remember, we are going away from unproven dogma "which obviously must be correct" and transitioning to EBM). However, if it's better for everyone, than everyone should be mandated to have a 2 year EMS degree or their paramedic certification is suspended, no exceptions.

BTW, there is a county EMS agency in NC that recently started their own paramedic program. The county college runs a 2 year AAS program that is CAAHEP-accredited ; the county EMS agency's isn't, so they won't be able to take the NR exam, but as long as they finish and take the state exam, they don't care, because they will be paramedics.
 

PotatoMedic

Has no idea what I'm doing.
2,063
946
113
You are correct that their is no evidence, absolutely zero, that shows degrees paramedics provide better care. Their is a lot of evidence that shows degrees nurses provider better care and prevent hospital acquired infections. All we can do immediately is extrapolate from allied professions till we are able to do our own research as a profession.
 

MackTheKnife

BSN, RN-BC, NREMT, EMT-P, TCRN
491
117
43
Did you actually look at what the references said? And did you note that out of all the references (removing the NHTSA ones), 3 deal with people leaving EMS or keeping people in EMS, one is a joint position statement, and 3 are actually EMS related sources, with the rest involving taking assumptions from other groups and saying it should apply to EMS? And two references are from the 90s.....

the article also states many assumptions (with increased education will result in increased salaries, and with increased pre-requisite classes will make the paramedic certification (since it's the state issued cert that lets you practice, and you need to maintain not the degree) more valuable, completely ignoring the question of where is the additional funding going to come from, as well as saying that providing degrees will make it easier for paramedics to leave the field to pursue other venues.

And of course, it ignores the critical question: if EMS degrees are needed, and important to the profession, and would make everything better, including better pay and better patient outcomes, why are we not mandating an EMS degree (not a generic AAS or BS, an associates degree in EMS) for all existing providers (which NYS did with their nurses and BSNs, and if they don't get them in X number of years, their nursing licenses are suspended until they do), and only forcing this increased cost and training length on new members of the profession?

Did you also consider the author's biases when you evaluated the content of this article, which was written in NAEMSE newsletter? The author is an educated individual; She obtained her bachelors in Biomedical sicneces 15 years before she became a paramedic; her masters is in Fire and EM administration. However, her primarily role has been that of an educator, a role she has had a role she has held since 2001, after being a paramedic for 5 years (she has continued to work as a flight medic until 2009 and recently went back to it part time). She is also a faculty member and program director at the local community college teaching EMS, so she has a financial interest (at a professional level) in transitioning from a shorter certificate program to a longer degree program. So the bulk of her experience isn't from that of an ambulance paramedic, but that of an educator (which I will 100% should require at least an associates, if not a bachelors degree for full time faculty, with a preference to a masters) and a flight medic. And she doesn't had a degree in EMS at any level.....

BTW, I have my bachelors degree, and am working on my masters.... and I know some people who have bachelors and masters degrees (and one PhD) who work as paramedics who make the same amount as a certificate-only paramedic working on the same ambulance.
My head is bowed! As stated, I read it quickly on my phone. You obviously took more time than I did. Kudos.
 

DrParasite

The fire extinguisher is not just for show
4,856
1,189
113
All we can do immediately is extrapolate from allied professions till we are able to do our own research as a profession.
how about before we push for a major major change to our professional, we complete the research to validate our thinking? It's not like there isn't a large enough pool of both degreed and certified paramedics out there....

After all, for how many years did we strap everyone's curved spine to a hard flat piece of wood (and later plastic), because we (or some super smart people) knew that was the best way to prevent a spinal injury from getting worse? And even if they were in a minor fender bender, or a fall from standing height, we knew that it was in the patient's best interest to strap them to a LSB, just in case? or how high flow oxygen was indicated for everything? how long did we know that was the correct way to do things? 30 years? 40 years?
 

PotatoMedic

Has no idea what I'm doing.
2,063
946
113
how about before we push for a major major change to our professional, we complete the research to validate our thinking? It's not like there isn't a large enough pool of both degreed and certified paramedics out there....
By that logic we should NOT be using CPAP in the prehospital setting as there is NO research that shows that CPAP is beneficial in the prehospital setting (least there was none when King County Medic One came out with their statement on why they do not use CPAP and that was the reason given (about 4 years ago now)).

Yes we need to do changes that are sound and make sense I agree there. I just happen to believe that we can use other allied health professions research to show that their might be benefits to use doing the same. Kind of like EMS using hospital research that showed benefits to patients who go CPAP and extrapolating it to the EMS world.
 

SandpitMedic

Shock&Awe
1,759
817
113
Dr. Parasite, I think you're going full apples to oranges here. I'm sure you are highly intelligent, and you've got all your ducks in a row however, I have to ask. Why are you so staunchly opposed to raising the bar for paramedics, and why do you find it necessary to for an outside entity, such as a reimbursement organization or insurer, to come out and say "you need this degree for this amount of reimbursement?" Why does CMS or the state have to come out and say, "ya'll need degrees by X date?" Should we not be entitled to police ourselves in this regard and to voice our opinion as paramedics and prehospital EMS professionals about the direction of our own field? Should we base our probable outcomes on those who have done what we are arguing to do and whom are closest to us on the professional medical spectrum (RN, RT, PA, MD), or should we go based on what the social workers have accomplished with their degree requirements? Apples to oranges, in my opinion.

You're rallying from the rooftops about why we shouldn't push for higher education, barriers to entry, and a better overall professional outlook by providing antiquated and barely comparable analogies. Also, by your own measurement, a paramedic who doesn't understand what the lymphatic system is, yet has a patch and a p-card, is indeed embarrassing. Why not push for a degree program that includes a true one-year A&P course to be the standard as part of an AAS in EMS and certification for the NREMT? Wouldn't getting away from the dogma of the backboard be the equivalent of getting away from the dogma that a paramedic should take a one year certification class to get out there on the ambulance and practice clinical medicine?

Why do we need an evidence based medicine study to look into our educational standards as a profession? Did the nurses or the PAs do a medical study about increasing their barriers to entry and educational requirements for degrees/certifications/licensure ? Is there a randomized controlled trial for that? Was that required? Did it work for them with/without a "study"? Taking a look around (as many of us have stated) would lead one to believe it has been of great benefit and reward for professions who have upped the ante in recent history. Meanwhile, we sit here debating the practices of reimbursement bodies and allow the nurses to live rent free in our heads.

We have to wake up and do whats good for us. What is the worst that can happen - we get better educated and qualified individuals (who know what the lymphatic system is) working on the ground and in the air as prehospital clinicians? No, the worst that can happen is we continue the status quo, and we continue our ubiquitous griping and grabassing while we sit on our phones and computers typing here on EMTlife in our downtime instead of plugging away at some college classes.

Your mileage may vary, as always. (Also, there's nothing wrong with grabassing on EMTlife on occasion)
 
Last edited:

DrParasite

The fire extinguisher is not just for show
4,856
1,189
113
By that logic we should NOT be using CPAP in the prehospital setting as there is NO research that shows that CPAP is beneficial in the prehospital setting (least there was none when King County Medic One came out with their statement on why they do not use CPAP and that was the reason given (about 4 years ago now)).
no research at all? what about https://www.emsworld.com/article/10323777/prehospital-use-cpap which is from 2005, or Kosowsky J, Stephanides S, et al. Prehospital use of continuous positive airway pressure (CPAP) for presumed pulmonary edema: A preliminary case series. Prehosp Emerg Care 5:190–196, which was published in 2001? Looks like there is plenty of research, if you chose to look for it.
I just happen to believe that we can use other allied health professions research to show that their might be benefits to use doing the same.
your entitled to your opinion, just as I am to mine. But I think EMS should be doing our own research, not taking the research of others and hoping we can duplicate it in a different environment with several different variables. I will agree, there might be benefits; but before we go all in and half cocked again based on questionable ideas that "in theory" make sense, (remember, every patient needs 15 LPM via NRB, and only gets a NC if they can't tolerate the NRB), lets do the research. Instead of increasing the time that every new paramedic needs to spend in class, and drastically increasing the cost for a paramedic certification (because that's the current bar, not the degree), lets demonstrate why the current system is insufficient, using scientifically validated research.

Kind of like EMS using hospital research that showed benefits to patients who go CPAP and extrapolating it to the EMS world.
The human body responds the same whether in hospital and outside of the hospital. Clinical trials (of meds and equipment) can be applied in hospitals, doctors offices, ambulances, and prison medical units, because regardless of the location, the human body should respond the same way.

Education requirements and patient outcomes are not the same as a patient treatment. You're comparing oranges and watermelons.
 

DrParasite

The fire extinguisher is not just for show
4,856
1,189
113
Dr. Parasite, I think you're going full apples to oranges here. I'm sure you are highly intelligent, and you've got all your ducks in a row however,
finally, someone sees it!!
I have to ask. Why are you so staunchly opposed to raising the bar for paramedics, and why do you find it necessary to for an outside entity, such as a reimbursement organization or insurer, to come out and say "you need this degree for this amount of reimbursement?" Why does CMS or the state have to come out and say, "ya'll need degrees by X date?" Should we not be entitled to police ourselves in this regard and to voice our opinion as paramedics and prehospital EMS professionals about the direction of our own field?
I'm not opposed to raising the bar; I'm opposed to the way this change is supposed to be implemented, which requires raising the bar only for new people. I'm not opposed to raising the bar, provided raising the bar will be be beneficial to everyone, and not just more costly for future generations or paramedics. I'm not opposed to increased educational requirements in the area of business and management, especially for supervisors, educators, and administrative positions; in fact, I think it's long past due, but I think if we are going to change the entry level standards, we should have some validatable data justifying the push from within EMS, not taking research from others and applying it to EMS and hoping it works for us as it did for them. Sidenote: you don't need to be a paramedic to do research, but having an MS or PhD does help, esp when dealing with all the statistics and other data analysis that makes my head hurt.

Think of it this way: lets raise the bar to an AAS for every paramedic; nah, lets make it a BS instead. But the wage increase we were hoping for didn't happen, as no additional funding was provided to EMS agencies. retroactive studies showed no statistical difference in patient moralities between the every paramedic has a BS in EMS and 20 years ago. But we have fewer paramedics in the system because the course is longer, those new paramedics are now more heavily in student loan debt (on top of low wages), and every EMS system is short on paramedics, because they can't fill the spots they have open currently. Oh, and that director of your agency? He has a bachelors degree in underwater basket weaving, and his NRP, and has been with the agency with 20 years, the last 8 as director. But he's pushing for every paramedic to have their BS in EMS, but he has no plans of going back to school to get his.

Should we base our probable outcomes on those who have done what we are arguing to do and whom are closest to us on the professional medical spectrum (RN, RT, PA, MD), or should we go based on what the social workers have accomplished with their degree requirements? Apples to oranges, in my opinion.
The argument made was higher education = rising wages. The example of social workers, who work in hospitals too, demonstrates that is not always the case. Similarly. you can't compare the wages of an MD or PA to that of a medic; apples and orange. RN and RT might be more applicable, if they are both in a hospital based system, especially if they are funded out of the hospital general budge and not just what money they make on ambulance transports... what about the fire service (I know, dirty word, but you can't ignore the largest employer of EMS personnel in the US), or in the private for profit EMS world?

You're rallying from the rooftops about why we shouldn't push for higher education, barriers to entry, and a better overall professional outlook by providing antiquated and barely comparable analogies. Also, by your own measurement, a paramedic who doesn't understand what the lymphatic system is, yet has a patch and a p-card, is indeed embarrassing. Why not push for a degree program that includes a true one-year A&P course to be the standard as part of an AAS in EMS and certification for the NREMT? Wouldn't getting away from the dogma of the backboard be the equivalent of getting away from the dogma that a paramedic should take a one year certification class to get out there on the ambulance and practice clinical medicine?
you misunderstood... I'm not against any of that; however I am against implementing it the way many people want to implement it (for the new people only, not the current paramedics), as well as arbitrarily raising the standards without showing a prehospital need for the standard to be done. Maybe I was wrong, and there is no need for a paramedic to know anything about the lymphatic system, so expecting them to be familiar with it is both unnecessary and unreasonable. I don't know, but if they can pass the NRP exam not knowing about it, and paramedics for the last 20 years haven't needed it, how important is it?

Why do we need an evidence based medicine study to look into our educational standards as a profession? Did the nurses or the PAs do a medical study about increasing their barriers to entry and educational requirements for degrees/certifications/licensure ? Is there a randomized controlled trial for that? Was that required? Did it work for them with/without a "study"? Taking a look around (as many of us have stated) would lead one to believe it has been of great benefit and reward for professions who have upped the ante in recent history. Meanwhile, we sit here debating the practices of reimbursement bodies and allow the nurses to live rent free in our heads.
nurses absolutely did research, which was how they got the 80% BSN rule tied to reimbursement rates. Also, that's a BSN, not a BS and RN cert; that's a key difference, one many in EMS are failing to see. Nurses have a completely different funding model, lobbying group, and, quite simply, don't have to worry about becoming too expensive, and then getting outsourced to a lower bidder (which has happened to several well paying municipal EMS agencies in NJ).

We can follow the lead of others..... but what if the causation does not result in coloration? meaning, what if we do raise the standards, and nothing changes, except it puts us in a worse position, with fewer new medics more in debt, and older medics retiring? You are saying if we do what others did, the same thing will happen.... but there is no guarantee of that, and there are increased costs to future generations, costs that you, as someone who supports this change, don't have to pay.
 
Top