What Does It Take To Be A Paramedic?
Vol 21 No 5
There is a shortage of Paramedics. You have all heard it and many of you have experienced it first hand when trying to find competent providers to hire. Educational institutions are cranking at full bore to try and meet the demands. Yet the shortage still exists. How to meet this amazing demand and keep the quality of the education product (that is good providers, not good technicians) has become a challenge. The hurdles are many, not just from a student standpoint, but from the institutional perspective as well.
What does it take to be a "Paramedic"? Well, all Paramedics must start out as EMT Basics first. The Basic curriculum entails approximately 110 hours of instruction broken out into lecture and labs and also requires a clinical component for a minimum of 10 hours (most think the clinical requirement is way too little and do more). In order to produce the clinical component the students must do agency "ride-a-longs" or comparable time in the emergency room. Many institutions feel that this 10 hour requirement is too little (our institution included) and also require other clinical hours to include ER and ride-a-longs both, but also include rotations in obstetrics and psychology. These rotations require local healthcare institutions to become willing partners in the educational process and while willing, they place many obstacles in the path and certain other requirements that make the process time consuming and very expensive! Case in point, this month I was notified that the area institutions are requiring the varicella (chicken pox) vaccine along with the other necessary vaccinations for students (these are the MMR, DT, a two step TB, and the Hepatitis B series [three shots]). This vaccination alone (the varicella), not including the other necessary vaccinations, cost about $85.00 a shot and two are required. I was also notified that we are now required to have background checks on all students. There's another $50.00 out of the student's pockets. These are just the increases this month! The man hours to manage the background checks are not even calculated. I have to ask, "Where will it end in the 'final costs' to the student?" All of this is just for EMT Basic!
If a new prospective EMS student wanted to "start" their training, here is the breakdown:
CPR card (class) $50.00
Drug screen $50.00
Background check: $50.00
These costs do NOT include the major medical insurance that is required for all students in case of injury within the clinical arena. Remember, they are not employees and not covered under workers comp. All the above numbers are approximations and some of these costs may possibly be picked up a person's medical or insurance coverage, at least in the vaccination area. This begs the question "where will it all end?" Even federal PELL grants will not pay for most of this (except tuition) and the balance falls on the student's shoulders. All of this just to become an EMT Basic. Then it's on to Intermediate training, then Paramedic (some states/systems allow Basics to directly matriculate to Paramedic). The first semester cost for Paramedics in training, in books alone, is around $900.00. That does not include tuition (a few beginning Paramedic students are facing tuition as high as $1,200.00 just for the first half of the training) or other costs the student must bear. This does not at all factor in the hardship to families and to students that also must work in order to provide for those families. These are going to be full time students in academic workload as well!
Now remember who is seeking the training; firefighter wannabes, that's who. It is a well established fact that holding a Paramedic certificate or license make a person a better candidate for employment in the fire service. After all, it saves the agencies the cost of training the individuals. But then it really is the agencies that lose out due to the shortages. At the very end the public pays with inadequate coverage and bears the brunt of all the shortages in health care.
So why would anyone in their right mind go through the hardship, hard work, and family turmoil to become an EMS provider? (This does not factor in the possibility that all firefighters and paramedics are crazy to begin with -- after all, who runs toward catastrophe? I mean really, the rats and roaches are running out and the firemen are running in....what's wrong with this picture???) Jobs in the municipal fire service may start as high as 50K, but I doubt my industrial colleagues are looking at salaries that high to start. Private EMS service providers do not fare well at all with paramedic pay running from $14.00 -$18.00 per hour. I mean come on, blackjack dealers in Las Vegas can make 6 figures, some Valet car hikers make near 80K, and that does not even mention the strippers and hookers! So why do this? The answer is even more bizarre then the problem. It is because we can do it and not everyone can.
Throughout my EMS career, when I told people I was a Paramedic, their gaze always darkened and many stated "I could never do that." To me, it was the only thing I ever could have imagined doing! I am a true type A, adrenaline junkie, and for me the work was not only fulfilling, the personal reward is indescribable. You never get a lot of "attaboys" in this business and the general public is not thankful, but given their situation when they encounter us, it is totally forgivable (except when it comes to voting for increased departmental budgets). So why would I dedicate my life to a business that has long hours, poor remuneration, dangerous working conditions, and in general is a total hardship on anyone who shares my existence? It is because I could DO the work. While training costs were no where near as high as when I went to school, it still would not have mattered in the bigger picture. I would have bit the bullet, and gone for the schooling. When chasing my academic degrees following my initial training, I often found myself deep in academic and personal debt while in pursuit of the dream. It was something I wanted more than anything else. Were the personal costs high? The answer is yes. Were the professional results worth the long effort, the strain on the family, and all the long hours? Who knows, except that I will say that this profession is not for everyone. Those who really MUST do this (and at times it really comes down to must), sail through the work, absorb the costs (personal or otherwise), and step in as our newest colleagues. Those who slack off get buried in the workload (academic or otherwise) and never make it out. A coach of mine once stated, "you gotta want it!" Now, with the increased costs, the severe and continual pressure from other commitments, and the shear huge amount of effort to study and learn the craft, the reality is that "you gotta want it bad. Real bad!"
Shortages, yes there are. The only real solution has to be a similar solution that has been taken by the Nursing profession in their shortage. That is a total commitment from the federal government, the local community and the provider agencies to find the money, train the personnel, and totally see that our emergency workforce is the best it can be. EMS has been the bastard step-child of the fire service and health care since its inception. That perspective must change.
William R. Kerney, MA, EMTP-A, is a professor of emergency medicine at the Community College of Southern Nevada.