By 2032 the ongoing physician shortage in the United States may exceed 120,000 providers.1 EMTs, paramedics, and other prehospital emergency providers have already begun to be impacted by the growing unmet demand.
There may be legislative solutions to mitigating this shortfall; nevertheless, the U.S. Congress has passed only three bills directly addressing first responders and emergency personnel since 2019—and, previously, only 10 bills from 2009 to 2015.2 Given this backdrop, the United States might want to begin considering how other nations have dealt with similar challenges in prehospital care settings. However, alternative approaches such as those coming out of the U.K. are concerning not only in the context of U.S. first responders but also for that nation’s health system.
The policy that highlights my reservations best is their expedited training program that would allow for nurses and paramedics to become fully licensed doctors in as little as three years.
To discuss the specific proposals from this “fast track” program, let’s begin by outlining the primary factors that led to it. The initiative stems from recent healthcare reforms spearheaded by the U.K. National Health Service (NHS) after the U.K.’s withdrawal from regulations previously imposed as part of the European Union.
I agree with the overarching attempt to increase opportunities for paramedics and nurses. However, reforms such as this should be considered with caution because the impacts of the program will extend well beyond training more doctors. Ironically, the very nature of this program doesn’t focus on improving the greater healthcare system at all, but rather simply shifts providers from one role to another. I can say firsthand that a policy along these lines would cause an even greater shortage in paramedics and nurses because the ones currently serving in these roles will be largely attracted to this expedited physician training program.
The foundation of this policy rests largely on rewarding prior workplace experience rather than solely the time spent pursuing a degree. That is, the NHS sees this program as a way to increase efficiency and equity of care through incentivizing medical professionals who have, for example, a decade of experience as a paramedic to get a medical degree in three years rather than six.
Though the concept itself seems reasonable, you can imagine flaws in the longer-term consequences of such a policy. I worry the approximate overall number of providers will not be impacted much by this plan. As well, if we were to implement this sort of incentive program in the United States, one can foresee thousands of nursing and paramedic positions left to become physicians, creating an even larger shortage in the nursing and first responder fields. This also wouldn’t do much to reform the patient care experience.
This said, I acknowledge some iteration of reform should be embraced. In this case, why not invest in the very root of the problem? Rather than artificially increasing the number of physicians, policy-makers should strive to improve the paramedic role by increasing compensation and offering programs to augment first responder training. Raising salaries and reducing burnout in the field will attract future providers into a transforming profession rather than simply offering another option from which to switch careers. Therefore, as Congress seeks to address the EMS shortage, it makes far more sense to reshift priorities toward investing in benefits for paramedics, subsidizing the cost of training, and improving the equipment and systems being used by paramedics to deliver care.
2. Govtrack.us. First Responders and Emergency Personnel, www.govtrack.us/congress/bills/subjects/first_responders_and_emergency_personnel/6838#sort=-introduced_date¤t_status=28&congress=__ALL__.
Christopher Gaeta is a student at Swarthmore College.