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Guest Editorial: The Professional and the Paper

The philosopher Marcus Aurelius wrote, “The impediment to action advances action. What stands in the way becomes the way.” With this in mind, what if we in the emergency medical services viewed degree requirements for paramedics as an opportunity—a way to prepare them to stay abreast as a critical part of our nation’s healthcare system? 

As the medical director of a college-based program, you might think I’m biased. The truth is I am, just not for the reason you might expect. 

My bias is rooted in hearing a family member ask which one of us “ambulance drivers” knew where his wife was. At the time my employer, the regional medical director, and the state of New York had entrusted me, at the age of 23, with an ambulance, permission to drive with lights and sirens, a drug bag, and a defibrillator. I couldn’t believe someone would give me a paycheck to do this. The comment made me feel insignificant, but I earnestly enjoyed the work and the hands-on opportunity to learn. I also immensely respected my preceptors for how they could make another human being feel safe. 

Every paramedicine textbook will describe how to assess and treat a patient with an acute myocardial infarction. The book won’t explain how to look your patient in the eye and let them know “all of us, together, are here for you.” I am grateful to my preceptors in EMS (volunteer and paid), who patiently taught and modeled this invaluable skill.

Committed to Learning

A piece of paper alone doesn’t prove a newly minted paramedic understands this. Does a piece of paper make you a professional? Of course not. Being professional in your behavior is a courtesy every healthcare provider is expected to extend to the public, always. Being a professional in the eyes of the public is how we would like every paramedic and EMS provider to be regarded, always. 

We must prepare every paramedic to commit to lifelong learning. A cynical statistic presented during medical school is that “50% of what we just taught you will be proven wrong in the next five years.” This is both a fact and a thinly veiled threat: Prepare to keep learning and prepare to change. A career in EMS means committing to keeping up or risking being left behind, holding a bottle of ipecac and a pair of MAST pants. How can we work together to help future paramedics accomplish this? 

Glassdoor published an article last fall entitled “15 More Companies That No Longer Require a College Degree—Apply Now.” It’s attractive to want to follow decisions made by the likes of Google, Apple, and IBM. They are highly successful brands, and their corporate models are progressive. They, along with others like Whole Foods, Starbucks, and Home Depot, realized that to be profitable they could discard, in some instances, the requirement of a college degree. But because none of the companies on Glassdoor’s list provide healthcare or public safety, my conclusions about the applicability of this shift respectfully differ from others.

Google not mandating a college degree points to the inability of secondary institutions to keep up with the advances in STEM occurring in the private sector. That’s not our circus. A lag between primary education and practice is not applicable in healthcare. The relevant question in the discussion of paramedic degrees is, how do first-pass success rates on the NREMT-P exam compare between students in degree versus nondegree programs?

I am happy to temporarily put aside the question of whether paramedicine is an allied health field, provided we can agree about the tremendous influence of paramedics in the lives of our shared patients. The impact of a paramedic’s care for patients with time-dependent emergencies and the health and safety of the public is where we need to focus. 

Aligning a fire-based paramedic program with a community college benefits the student and our healthcare system. A full-time student in a college program would be eligible for federal financial aid. We can also work together to advocate for loan-forgiveness programs for students who enroll, graduate, and then serve their communities. 

Accumulating college credits will give the student greater power to continue their education. It creates a significantly easier path to more acquiring more skills. Transferring those credits and working toward an RN with the goal of being a critical care transfer nurse, respiratory therapist, or flight paramedic is a win because that provider is still within our healthcare system. Our job will be to remind our students to advocate for those who follow in their footsteps. 

We can achieve this goal with cooperation, respect for tradition, and an understanding of what will become our combined power in the delivery of emergency care. A partnership between community colleges and fire-based training programs is possible. Immersion in the culture of the department will always be a critical element in every student’s education. What if the first move was for community colleges and fire-based paramedic programs was to sit down and talk? I believe the result will benefit the profession, its providers, and our healthcare system. 

Michael W. Schmitz, DO, MS, FACEP, is medical director for the paramedic program at Southern Maine Community College in South Portland, Me. 



Submitted byJeff Toorish on 04/23/2019

All excellent points. I believe we need to be advancing paramedicine toward ultimately requiring a 4-year degree.

Submitted byJTodaro on 06/24/2019

Dr Schmitz, you make excellent points and I would like to thank you for bringing the Medical Director perspective to the discussion.

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