Careers in EMS: What Could That Ladder Look Like?

[Mateo_1387]

I thought this was worth sharing.

Careers in EMS: What Could That Ladder Look Like?

Most people who choose EMS love what they do and would love to have

full careers in it. Yet they are painfully aware of several things.

First, most EMS organizations are small and built around flat

organizational structures, so opportunities for advancement are

limited. Second, the same characteristics that make them great medics

make them prone to boredom and driven to seek variety in their work.

Third, as EMS is organized today, it is difficult for providers to

achieve financial security. Fourth, we have failed to build the

infrastructure nationally or at the state and local levels to train

EMS providers for career development.

Let's look at each of those issues in a bit more detail.

Organizational Structures and Career Ladders

Many EMS organizations are small. How many career options can a small

organization provide? It's no wonder these organizations lose

employees to larger outfits that offer them more options. And even

larger EMS organizations tend to have limited hierarchies.

Establishing a career ladder can be daunting. Many medics want paths

that provide increased pay and status for simple longevity. Some

employers have acquiesced. Where this occurs, it reduces

opportunities and incentive to advance.

Another barrier is EMS' lack of a standardized system of rank and

position. We often use functional titles that have different meanings

from place to place and make interagency comparisons difficult. In my

agency, a field training officer is an experienced paramedic with

some special training who is assigned to teach and evaluate a new

paramedic during their first few months of employment. Two counties

away, a person with the same title is a shift-level officer

responsible for the training of all personnel assigned to that shift.

Confusing? You bet! What happens when your HR staff tries to compare

salaries?

Career Breadth and Lack of Lateral Opportunities

"Horizontal," non-promotional career opportunities are almost totally

lacking in EMS. The law enforcement patrol officer, without

promotion, can be trained as a K-9 officer, school resource officer,

tactical officer, bomb technician or more. A firefighter can become a

prevention officer (inspector) or investigator. Why has EMS failed to

develop similar opportunities? The roots lie in the historical

accident whereby insurers pay for ambulance transportation, rather

than medical care.

A common tactic used by private-sector ambulance operators to woo

elected officials has been the "little or no subsidy" offer. To win

local contracts, they promise to operate with zero or minimal tax

funding, and cost-shift to cover their expenses. In doing so, though,

they often provide only what's mandated--often only "ambulance"

response and transportation. Many EMS systems are now strangling

because of the entrenched belief that they should live within the

transportation-based revenue stream.

We now know EMS and ambulance service are not the same thing. EMS

consists of both ambulance operations and special operations--e.g.,

mass-gathering medicine, technical rescue/USAR medicine, and a

variety of other services. It is in the special operations arena that

advancement opportunities lie. After cutting his teeth on an

ambulance, an experienced medic could be assigned to patrol on an EMS

bike team, or work with a service's specialty teams (tactical, WMD,

etc.). And were they freed of the burden of living within

transportation-revenue streams, EMS systems could provide a variety

of additional services--think injury prevention or medication-

compliance programs, school resource paramedics, etc.

Personal Survival and Economics

As opportunities for cost-shifting evaporated, so did the ability of

ambulance services to pay a living wage. Many large private

organizations came to accept that they could get 3--5 years out of a

medic before the medic moved on, so they built their business models

to accommodate the revolving door. Public and non-profit agencies got

dragged along through "market comparability."

And let's not forget about the volunteers. Volunteers are noble, but

they have contributed to the economic difficulties of their career

colleagues. When you look at the cost of providing EMS, it only takes

a few zeros in the compensation column to drag the market average

down. Why should anyone pay more when right down the road there are

communities getting it for free?

Career Development Infrastructure

In EMS, we have failed to develop comprehensive pre-service

educational programs, leaving the development of our new members to

institutions committed only to following a nebulous national standard

curriculum. It's amazing that we're still debating whether we should

teach hazmat awareness or emergency vehicle operations in our EMT and

paramedic schools. Is there an accredited police academy in the

country that doesn't teach EVOC, defensive tactics or shooting?

Look at the advertisements for senior EMS positions in our trade

journals. A college degree, some experience as a supervisor and a

paramedic license, and you're eligible, whether or not you've ever

managed an MCI or built a budget. What are the competencies truly

required of a chief EMS officer? Where is the road map? What does an

intelligent, energetic and ambitious young medic do to set his or her

course for the future?

Conclusion

Those of us in EMS leadership may have failed our followers. We have

not effectively advocated for career options within EMS, and we have

failed to provide the structure and infrastructure for our providers

to see and effectively navigate career paths. What can we do now to

improve this situation?

1. The EMS community must understand the difference

between "ambulance service" and "EMS" and work to ensure every

community enjoys a full spectrum of emergency medical services.

2. We need to decouple EMS funding from transportation. Elected

officials must understand that EMS is an essential element of

communities' quality of life, and that using tax dollars to fund it

is not inherently wrong.

3. We need to develop career breadth for medics whose aspirations may

not involve supervision.

4. We must build a commonly recognized rank structure and adopt it

across the industry.

5. We need to develop an accepted set of educational and technical

competencies for EMS officers at all levels, then develop the

educational and credentialing infrastructure to support them. Any EMS

provider with career aspirations should be able to see a road map

that leads to their desired destination.

Skip Kirkwood, MS, JD, EMT-P, is Chief of EMS for the Wake County

(NC) Department of Public Safety.

[Mateo_1387]

Do you agree with Skip kirkwood?

What do you think should be offered for paramedic to move horizontally or up the ladder?

[Scaramedic]

[align=center:81455b5de9]

Yeah that about says it all! [/align:81455b5de9]

[Dustdevil]

Often, I find myself rolling my eyes at the things that Skip Kirkwood says. Maybe it's just my anti-lawyer bias. But he's hit upon a valid, and oft overlooked issue here. He's absolutely right. Regarding this statement:

2. We need to decouple EMS funding from transportation. Elected officials must understand that EMS is an essential element of

communities' quality of life, and that using tax dollars to fund it

is not inherently wrong.

We have to be careful about how we approach this dilemma. Many communities realise this, and do devote tax dollars to EMS. Unfortunately, when a community comes to this realisation, they usually decide that it's easier to just spend more on the fire department to provide EMS (after all, that's what the big city on TV does!), rather than creating a new bureaucracy to do it. And even more unfortunate, they decide that allowing us to be firemonkeys is the answer to establishing a career ladder for us.

Before we go off half-cocked trying to convince communities to spend money on EMS, we must first establish our individual identity as a profession, so that they no longer automatically associate us with the fire service. Otherwise, we're not going to gain any career ladders. We're just going to continue to lose ground to the firemonkeys. And once that genie is out of the bottle, it's nearly impossible to stuff it back in.

[Arkymedic]

[align=center:317bfcbad6]

Yeah that about says it all! [/align:317bfcbad6]

OMG LMFAO!! That made my day Scaramedic

[Mateo_1387]

Often, I find myself rolling my eyes at the things that Skip Kirkwood says. Maybe it's just my anti-lawyer bias. But he's hit upon a valid, and oft overlooked issue here. He's absolutely right. Regarding this statement:

I too share this sentiment. I think Skip is a well intended person, but I do not always view things eye to eye with him.

Dust, thanks for the thought out comment. I really thought this would bring in some good discussion. I am not sure where this letter was published because I came across it on myspace. I do think he brought up some good points about career development in EMS.

The options of movement within an ems system and not being just a paramedic or a supervisor is great. With more opportunities I would think that it would improve EMS as a whole, by combating the whole Medic Mill system working to counteract the burnout rate. I think it will help because to do some of these positions that Skip talked about you would need better education. Also with these movements in the system the paramedics I would think would stay with the system longer, which would hopefully help agencies realize they need to start looking at how to keep employees interested in their job. With these experienced providers more skills will come about which will put us more along the lines of medicine and not public safety. With these advanced skills the noOb medics will have to have a better education and understanding of the body to be able to function.