Ask EMS: How Can I Breach the Business Side?

Advice on the best way to advance for an ambitious EMT

There’s so much more to EMS than is covered in our classes. All the textbooks, practicals and time on the streets can still leave you needing enlightenment. That’s where Ask EMS comes in. With this new column, we invite you to submit any EMS-related question, dilemma or issue you may have, and we’ll find an expert to answer it for you. You can remain anonymous. Submit your stumpers to

I received my Bachelor of Science in Emergency Medical Services in 2006, and for the last four years have been doing field work as an EMT and hospital work as a tech. I am now looking to get into the business side of healthcare. I am currently in Omaha, NE, and finding it extremely hard to achieve this goal. I would like to stay in Omaha, but I feel there is a stigma here for EMS personnel, and I can only find positions in healthcare that require RN or BSN qualifications, especially in hospitals. I feel I’m qualified for many of these positions, but because I do not have an RN or BSN, I am turned away before my application even gets past the recruiter.

At this point in my career I am not looking to go back to school; I’d just like to find a position that will show me how the business side of healthcare works. I’ve been looking for a few months now and am disappointed in the results thus far. I was wondering if you have an idea or source where I can find jobs outside of field work with my EMS degree. Any thoughts as to what this degree would qualify me for or how and where I can apply my skills to advance my career?

First, congratulations on earning your BS degree. That is a major academic milestone and a personal achievement of which you should be proud.

Since you elected to get your degree in EMS, I assume you have (or at least had) aspirations to move up within EMS. Otherwise, you might have been better off with a hospital administration degree, although those usually require a master’s degree as an entry-level “from the outside” credential.

If EMS is your passion, don’t walk away from it. To move up in most EMS organizations, unless you are a specialist (like an accountant), the path requires that you first be an excellent field provider. In most EMS organizations, that means 3–5 years of exemplary service as a staff paramedic (few organizations promote EMTs to supervisory positions, unless BLS is all the agency provides). After that, the next step involves service as a field training officer (FTO), where you will demonstrate your dedication, leadership ability and teaching ability with individual subordinates. After that the pathway is first-line supervisor, middle manager and senior executive or officer.

Typically, people move up in healthcare organizations from one of the service lines or specialties (e.g., nursing, physical therapy, laboratory technology) by becoming first-line supervisors, then middle managers or department heads, and only then move to the executive level. Thus, it’s not that there’s a “stigma” attached to EMS—you’re just not on one of the common pathways. If the hospital you work with is in the ambulance business, that can be where your pathway begins. I know of three major hospital CEOs who came up as paramedics, ambulance supervisors and EMS directors—and as you might guess, all their hospitals have excellent mobile medical and specialty-care transport services.

Wanting to stay in Omaha is fairly limiting, because Omaha is a small city. If career enhancement is your goal and you have the capacity to move for a more advanced position, you will greatly increase your chances by being open to moving—and you will learn a lot if you do. I have enjoyed a lot of career growth that would not have been possible had I stayed in any one place. At this point in my career, I’ve served in EMS systems in nine states—each move involving a step up the career ladder.

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