Internationally, Degrees Are Not the Sole Requirement.
Over the last several years, many leaders in the EMS industry have insisted that a degree should eventually be the lone method for becoming a credentialed prehospital care provider. These advocates of degrees have provided examples of other nations that allegedly require a bachelor’s degree. The United Kingdom, Canada, and Australia are the three core foreign nations that are provided as examples. However, an assessment of the governmental agencies that credential EMS providers in these nations revealed that the three countries support either a post-employment path to advanced credentialing and or a degree path.1,2 Canadian provinces support a “substantial equivalency” procedure for assessing an applicant’s international curriculum for exemption.3,4 One of the most noteworthy findings of this assessment is that Australia is the home to the Australasian Registry of Emergency Medical Technicians (AREMT). AREMT’s certification to practice is accepted in Australia, Oceania, South East Asia, China, the Middle East, Europe, and regions in the United Kingdom. The AREMT accepts education that was received from an approved U.S. DoT program and supports three licensure levels that are similarly titled to their United States counterparts: EMT, EMT-Advanced, and EMT-Paramedic.5
Although there is some concern related to the geographic accessibility of education, the greater concern is accessibility of education for low income wage earners. In this sense, the concern is not solely isolated to the reduced geographic accessibility to education, but also reduced accessibility to a job that may have career potential. Currently, in many states an associate degree in EMS consists of the paramedic curriculum and general education courses. However, despite the relatively small number of general education courses, their exclusion keeps the cost of education lower. Additionally, for municipal services that choose to invest in the workforce, a certificate path provides government with a mechanism to meet the objectives of the public while being good stewards of taxpayer dollars.
It is well known that personnel that provide EMS as part of the core job functions are frequently not paid well, a point that is particularly true for single-role providers. Given this, it is likely that people seeking a degree in EMS will at some point require financial aid to pay for their education. However, it is also likely that without a substantial increase in pay following the achievement of a degree these individuals will lack the means to repay a loan while also meeting life needs. Although industry leaders have insisted that a degree will increase wages, there has been a lack of evidence to support this claim. Furthermore, EMS providers who are employed by government or whose employers are operating on government subsidies because of contractual obligations will likely be compensated on a fixed pay schedule and will not appreciate significant pay increases based on their degree status.
It is counter-intuitive to eliminate a system of certification and licensure that is equal to, or potentially exceeds, degree programs supported in other countries. If it is the intent of industry leaders to emulate the manner prehospital care providers, it is apparent the certification/licensure process should continue to be an option in the United States with the addition of an apprenticeship program. While degree programs are certainly an option for individuals, these programs should be just that, an optional path to a career.