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The Four-Year Plan

      You are working the overnight at Regional EMS with your usual partner, and during a pause in the call volume, the conversation turns to plans for the future and your respective careers.

   "What future?" you say. "There is no future in EMS." Then your partner tells you about the management classes she's started taking at the local college--just in case a supervisor spot opens up sometime soon. This gets you thinking about your own options, and you realize that maybe finishing up that bachelor's degree wouldn't be such a bad idea. Before you can think it through any further, though, dispatch comes over the radio with an assignment.


   There have been endless discussions about the academic development of EMS professionals. Discussion points traditionally focus on the realities of education versus training, how education relates to present/future compensation, and professional versus nonprofessional development. Is there value to a college degree for the EMS provider? What about the EMS supervisor or manager? Does the achievement of a bachelor's degree mean anything tangible? Do the answers to these questions differ if you ask them on behalf of the EMS provider or from the perspective of the EMS system?

   One of the most frustrating conversations an EMS leader can have with a promising subordinate involves encouraging that subordinate to get engaged in higher education. This is because the question is always framed in the negative. We are often asked, "Why, for the salaries we see today, should I bother getting a college education?" We would like to utilize this article to frame a different question in a different way.

   Many in leadership positions have visions for the future of EMS that involve stronger, more sophisticated organizations delivering more diverse mixes of services to larger populations--in short, EMS systems that are more than the "one-trick ponies" we've seen in the past. We know this future depends on the development of a new breed of EMS provider, one who is trained in the art and science of EMS and sufficiently educated to lead and participate in the development and operation of this new system. And we know this will require education, at the baccalaureate level and beyond. Like the immigrants who came to America seeking better lives for themselves and their children, we want more for our EMS system and the next generation of EMS systems and providers.

   To build this new system, we will need people who know EMS from the inside out, both practically and theoretically. They will have to have experience in delivering patient care in the field and knowledge of evidence-based medicine. They will require the ability to analyze complex situations and systems, describe them in context that outsiders will understand, communicate effectively, think critically and think outside the box. These tools are developed only through education.

   But what about the individual? Earning a college degree is a long process, requiring a substantial investment of time and energy.

   For the most part, baccalaureate, or bachelor's, degrees can be divided into two large subcategories: Bachelors of Arts (BA) and Bachelors of Science (BS). Both are traditionally four-year degrees if pursued full-time; however, most EMS providers do not exercise the full-time academic option and complete their degrees in more than four years. As an aid, some schools--mostly junior colleges and community colleges, but some four-year schools as well--fer associate's degrees for two full years of study, often in preprofessional areas. These may stand alone, or sometimes be applied as credit toward completion of the four-year degree. This credit option for associate's degrees can be exceptionally useful for the EMS professional.

   Don't worry about choosing an academic major. Except for a few specific fields leading to specific professional licenses (accounting, engineering and a few others), it won't matter whether your degree is anything from anthropology to zoology. No matter what field you're in today and what field you wind up in later (most people change careers several times over the course of their working lives), the ability to read critically, conduct research, write effectively, speak persuasively in public, work with numbers and work in teams will always be valuable attributes. If you have those capabilities, you can deal with almost any subject matter with which you are confronted. With careful course selection, you can develop those abilities in almost any academic field.

   Having said this, it is also important to point out that several high-quality bachelor's degree programs specific to EMS exist. These include programs at the University of New Mexico, George Washington University and the University of Maryland, Baltimore County (UMBC) as well as others (see the sidebar Bachelor's Degree Programs in EMS).

   These programs generally have two tracks, or options for study: clinical care and management. These programs have well-developed curricula that, aside from encompassing the core curriculum of the bachelor's degree, include classes--such as research methodology for EMS; EMS leadership development; EMS system design; EMS operations and management; leadership in EMS; special operations; EMS strategic planning; financial management of EMS systems; and coursework in disaster management/emergency preparedness--that reflect the reality of what EMS providers will see in the field. They are usually taught by faculty that are considered experts in EMS.

   Remember that employers in EMS and nearly every other industry are looking for promotable employees. Executive seminars are filled with discussions about the importance of leadership development and succession planning. Pursuing and eventually earning a bachelor's degree speaks volumes about the character of the individual--specifically about their ability to set long-range goals, prioritize and follow through to the completion of a complex project. That's what leaders do, and completing an undergraduate degree attests that the individual can apply those essential traits to real-world situations. Some are concerned that if their degree took a long time to earn, it will appear less significant than one earned by a graduate who went the four-year, full-time route. To the contrary: A working man or woman who spent 10 years pursuing their BS at their own cost and in their spare time will appear, in the eyes of a promotion board or hiring manager, to be a determined, dedicated, capable individual--one who would be a tremendous asset to the organization.


   EMS is at a crossroads. It is moving, ever so slowly, from being a transportation service with a little bit of medicine thrown in to becoming a service that bears responsibility for a growing portion of the community's healthcare needs. Our profession will require a strong educational base as it expands the services it provides and grows into to a stable, meaningful community contributor. Our colleagues who aspire to positions involving leadership, advanced clinical practice or technical expertise will require strong educational credentials to attain those aspirations. The time is now!


   Look at aid packages. Aid packages include:

  1. Grants and scholarships (i.e., money you don't have to repay);
  2. Loans (from both the federal and state governments, with or without subsidized interest payments, as well as from private lenders);
  3. Work-study jobs arranged through the school that offset college costs while also allowing students to gain work experience.

   Most aid is need-dependent--that is, it's based on things like your family income and assets and the number of children in college. Need-independent scholarships are awarded for specific fields of study or are based on a student's background, disabilities or other traits.

   Start with the federal government. By far, the majority of student aid money (about 75%) comes through it. The government has tried to streamline the process of getting that money by creating a unified application form, the Free Application for Federal Student Aid, or FAFSA. Almost all financial aid based on demonstrated need requires that you complete a FAFSA. You need to complete it only once; then the information is available to the financial aid offices at all the colleges you apply to. The easiest way to complete the FAFSA is to go to The application asks for information about your income, savings and other assets. It's best to have a copy of your latest income tax return on hand, since many of the questions ask for information from specific parts of that form.

   Avoid paying consultants. There is an industry of consultants who promise to make finding college scholarships easier and more effective. Some of these services are helpful, but others simply provide you with the same information you can easily access yourself for free.

   Many universities and colleges have offices of financial aid or assistance. Speak to that office to find out about payment options, if you qualify and how you can apply.


You may be asking yourself what a degree in accounting or business or chemistry can do for the person who earns it, particularly if they aspire to a career in EMS.

While you contemplate how to pay for your degree and the various financial realities, mull these facts over as well:

People with bachelor's degrees earn about $25,000 more per year than people with high school diplomas. Over a lifetime, that's a difference of more than $1 million.

College graduates earn nearly twice as much over the course of their working years as high school graduates. Information from the U.S. Census Bureau emphasizes the value of college education: Workers 25 and over with bachelor's degrees earn an average of $59,635 per year, while those with high school diplomas bring home $33,609. Workers with master's degrees make an average of $70,559, and those with doctoral degrees earn an average of $95,785.

Professional degrees earn an average of $121,340.

From a different perspective, high school graduates can expect to earn $1.6 million over their lifetimes; those with bachelor's degrees, $2.9 million; those with master's degrees, $3.4 million. Individuals with doctoral degrees will bring home an average of $4.3 million during their working lives, while those with professional degrees top the list at $5.4 million.

People with bachelor's degrees generally have more fulfilling lives, live longer, etc. An excellent article at by its founder, J.D. Roth, lays out a great number of important points about the value of education for individuals. Specifically to EMS, employers generally look for a bachelor's degree when making promotions to supervisory and management-level positions.

Over the last decade, the availability of distance-learning options has made baccalaureate education more accessible than ever. Even if you live far from a college or university, you can earn a respected degree from a fully accredited educational institution. There are some technological realities that come with this option (these can be software, hardware or Internet connection-related), and this form of education requires a certain type of individual who can commit to this type of learning. It takes self-discipline, self-assessment and understanding in order to read and process the written word. Large amounts of information have to be processed by the student, making the student completely responsible for his or her educational actions and outcomes. Examples of colleges and universities that allow for full or partial completion of your undergraduate degree via this method include the University of Florida and George Washington University. Also, as with the more traditional bachelor's degrees, the curriculum will include core elements as well as EMS-specific classes. Now more than ever, there is no excuse for not obtaining an undergraduate degree if you want one.


   Central Washington University
Ellensburg, WA
h ttp:// (search Courses for 'paramedic')

   Creighton University
Omaha, NE

   Drexel University
Philadelphia, PA

   Eastern Kentucky University
Richmond, KY
859/622-1028, ext. 3

   George Washington University
Washington, DC

   Loma Linda University
Loma Linda, CA
800/422-4558, 909/558-4932

   San Jose State University
Palo Alto, CA

   Univ. of Maryland, Baltimore County
Baltimore, MD

   University of New Mexico
Albuquerque, NM

   University of Pittsburgh, Pittsburgh, PA

   University of South Alabama
Mobile, AL

   University of Texas Health Science Center at San Antonio
San Antonio, TX

   Western Carolina University
Cullowhee, NC

   Youngstown State University
Youngstown, OH

   Source: Consortium of Academic Programs in EMS,

Raphael M. Barishansky, MPH, is program chief of public health emergency preparedness for the Prince George's County (MD) Health Department and a member of EMS Magazine's editorial advisory board. Contact him at

Skip Kirkwood, MS, JD, EMT-P, EFO, CMO, is chief of Wake County EMS in North Carolina and a member of EMS Magazine's editorial advisory board. Contact him at


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