Paramedicine: A One Track Career

As a paramedic in a city with a relatively high run volume, one might assume that I have a limited set of responsibilities that I have viewed only through the myopic lens of an ambulance airway seat. However, that is not the case; and frankly, I think it is time for this perspective to change. Of course, I am not suggesting that paramedics stop responding to traumas and the occasional medical emergency. What I am suggesting is that it is time for our culture to mirror a likeness of our brothers and sisters in the military. It is time to give those individuals, who devote their hearts and their lives to EMS, an opportunity to broaden their skill sets, build upon their potential, and become more valuable members of society when they choose to move on.

From my experience in the military, a service member works in a specific billet and moves on after a set period of time. In effect, a person does not work for the same unit for their entire career. However, a paramedic might sit in the same airway seat for 20 years. Let me elaborate, so my argument makes more sense. I will then attempt to explain my proposition. 

Let me provide you with an example of what I mean: A service member is assigned to a , unit, and within that unit they perform a job based on their training e.g. an Aviation Airwarfare Systems operator or Corpsman. As this individual makes rank or gains experience, they move into different assignments within the unit, and then ultimately, into a different unit altogether. Let’s give our hypothetical service member a name. We’ll call him Joe Schmo. Joe was initially assigned to Medical Squadron Alpha soon after departing from boot camp. He stayed there for a period of three years, during which time he made rank twice (Petty Officer Third Class) and ended up supervising a shift of 6-8 junior service members and learning the basic fundamentals of his job.

After Joe’s three-year tour, he had the option to choose a different unit which happened to be a shore-based education unit. He was still a Corpsman but was using his skills to teach younger, less experienced Corpsman. Over Joe’s time in this unit he made rank and was placed in a supervisory role and finally was up for orders again after three years. This time around, Petty Officer First Class Joe Schmo decided to take orders to a hospital-based unit and he was given the opportunity to not only lead but also to practice medicine in-clinic. 

Over the period of one-decade, Petty Officer Schmo was able to work under the same branch of service (in this instance the Navy), maintain his Corpsman training and title, yet he had the ability to learn a variety of skills that will be useful to him and others he will encounter. This way, when Joe finally retires or moves on, he is more versatile and can provide society with more than just a honorable discharge certificate. He is a capable clinician, educator, leader, and overall has seen more than just toothaches.

So here is the point the tale of Joe, as well as my proposition: We need to change the culture of EMS. I think it is only fair that paramedics and EMTs receive a similar experience to that of our Joe. Having the experience of being an educator, working in the emergency department or intensive care unit, performing research, even making rank and supervising, all without having to get there by being a part of the good ol’ boy system. It should not matter whether the paramedic is a hospital-based, county, or city provider. I know that this is not what everyone wants, and it may not work for every system, but it is a conversation that we can at least start. 

My experience has been a blend of both worlds: the military and EMS. I spent a fair share of time in the military doing the same job but moving from unit to unit getting fresh, new experiences with the same skills- all while building my repertoire. After being discharged, I decided to use the GI Bill for something and went to “medic school”. I went to a vocational college and earned an EMS Associates degree while certifying as an EMT-B, EMT-I, and eventually EMT-P. Once certified, I took a job with a local EMS agency and worked part-time as a firefighter / EMT. After that, I moved to a larger city where I was hired as an EMT and began working. I started as an EMT-B, despite my certification and I worked my way to paramedic. The experience was great; I learned scene management, patient-care, and of course how to navigate the city, but beyond that… my scope was limited.

Eventually, I yearned for more. After transporting too many shootings, too many low acuity medical runs, and doing it all for too little pay without a chance of ever being anything other than a street medic, I applied and was hired to work as an educator in a hospital where I gained a plethora of knowledge from the other instructors and through experience, learned how to teach. Eventually, an opportunity came along to work as a community paramedic and I eagerly accepted this position. It was a great experience, and I learned so much about medicine that it would be impossible to confine it all to one blog. Sadly, that program moved in a different direction and I was forced to make a difficult decision. Knowing that I was looking for alternative employment positions, a friend suggested critical care medicine for a local flight program. I applied and went through the process, ultimately being hired. And now here I am, learning this area of paramedicine that was never anything I imagined would be within my realm of opportunities. To put it simply, it has been nothing short of wonderful. But my experience is not the norm.

If I was able to experience all of this, I feel that it is possible for others to have similar experiences as well. It should be far less difficult, perhaps with a specific track. We are becoming a world of individuals who work at one company for less than a career these days. So why not make it possible for paramedics to spend their careers in one place, yet have the opportunity to do more, experience more, help more, and become better health care providers? The military may not be perfect but giving people opportunities and variety is better than just sitting around waiting for that next tooth ache.

But this is not the military, this is the civilian world, and things are done differently. In grand cliché conclusion, it is my opinion that paramedics should be provided with the same opportunities our nursing comrades have. Paramedics, and I am sorry to say this, need college degrees which will ultimately provide us with similar opportunities that nurses are given. If we want more we have to do more, and it seems that the current trend and market place-based incentives are pursuing college degrees (Tamborini, Kim, & Sakamoto, 2015). Furthermore, higher education does not only correlate to better lifetime earnings, it also is associated with overall better quality of life (Baum & Payea, 2005).

Once we have established ourselves as health care providers who are willing to attain higher education and become more than just licensed provider, we will become just as versatile and more of a benefit to the market place. It is then that we will be given similar opportunities that parallel those of our counterpart nurses in the hospital. This may seem contrite, but we are not doing our fair share in the scholastic department yet and in order to compete we must be educated to the same standards as nurses. 

About the Author

Aaron Sheldon is a native of Indianapolis, Indiana who attended North Central High School in Indianapolis before dedicating several years of service to the United States Navy. Aaron and his family currently reside in Indianapolis.

He is a nationally registered paramedic who currently works for a hospital-based critical care flight program. Before becoming a flight paramedic: Aaron worked as a community paramedic, a hospital-based educator, an urban 911 system paramedic, and a certified firefighter/ EMT-Intermediate. 

Aaron currently holds an Associates degree, Bachelors degree, and is working toward a Masters degree in public health. He is a lifelong student and is passionate about education on every level. Although not completely sold, he is weighing the option of returning to school and working toward a Bachelor of Science in Nursing. 

An avid podcast listener, Aaron enjoys all genres of podcasts, but prefers free open access medical podcasts (FOAM). He believes this type of education is not only enjoyable, but is also a way to improve clinical skills and ultimately provide better care for patients in all settings.

Baum, S., & Payea, K. (2005). Education Pays.College Board.

Tamborini, C. R., Kim, C., & Sakamoto, A. (2015). Education and lifetime earnings in the United States. Demography, 52(4), 1383-1407.

4 thoughts on “Paramedicine: A One Track Career

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  1. Good points, Aaron. I’m also a former corpsman, now retired career EMS guy. The problem is not the “culture” of EMS, it’s the structure – the business model. It is a one-trick pony (treat and transport by ambulance) horizontally – which sucks – and it is mostly mom-and-pop shops, which have little ability to provide vertical mobility. Until our business model fundamentally changes, career EMS folks have little in the way of career choice. In fact, they have two – drive or attend!

    1. Skip,

      You make an interesting point that I have thought about quite a bit recently. When I was in the process of writing this article, I had a great conversation with a fellow EMS provider, and he made similar comparisons to EMS that you are. He argued that EMS varies from city to city, county to county, and so forth and will not change based solely on education but rather a change in perception. Which indeed makes this a controversial topic but one that needs to be discussed and I believe this a perfect forum for that to occur.

      I do not disagree, and in many regions of the country, the structure or business model does drive culture. This change is not one that I can imagine happening quickly and will most definitely have much pushback, especially from the “mom and pop” services and likely many of our brothers and sisters in EMS as well as hospital staff who fear that we may take some of their positions.

      However, this should not dissuade us and just sit back, cross our arms, and harrumph. This action should drive a culture change and persuade local cultures to want to change. By advocating for educational requirements, we as an industry will change the structure of the business model thus pushing us into better positions outside of those “mom and pop” shop services. The opportunity for education is all around and does not have to be specific to EMS, although it would be ideal, what matters is that we better ourselves and prepare for roles within systems that have higher expectations and ultimately will reimburse accordingly.
      Skip, thank you for your service and your thought-provoking response. I appreciate you taking the time to read this post. I also hope that we can continue this discussion around the country and make this change occur with the support of all our brothers and sisters.


      1. That’s where the “culture” thing comes in to play.

        Right now, I see a culture mostly of “apathy.” With 900,000 credentialed EMS providers, we could represent a visible block, able to accomplish many things (like self regulation). Hell, even with 20% participation (18,000) we could get some things done. But we have less than 4,000 “real” members of the NAEMT (not the free membership that you get for a year when you take a *.LS class).

        For whatever reason, EMS folks won’t do what it takes – join, pay dues, and do the work, that is necessary to make our lot better.

        Why is that ? Does our business attract an excess number of losers or defeatists, or professional martyrs or victims?

        I liken EMS folks to the “Marines of Medicine” – we have one foot in Public Safety, and one in Medicine – like the Marines have one foot in the Navy and the other on land. Instead of making this unique (and great!) position a strength, we whine about it and fight of whether we should be one or the other – which is a great waste of energy. So, what is wrong with the EMS psyche, where we can’t gain critical mass and take hold of this thing, after 50+ years of modern EMS. (I get tired of hearing that we are a “young profession” – we were born at the same time as PAs and NPs, and professional PTs – and they have made the advances that we are still resisting.)

        So – what’s next? I’m retired now and I had hoped to leave the next generation with some momentum in the right direction – but I’m not sure that I did.

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