Cheap, Fast and Easy

I listened quietly as the young woman in my office told her story. She had been offered a promotion that came not only with more responsibility and more compensation, but also with a future opportunity to transition into upper management at the ambulance service where she works. Everything was looking fine, until the question of having a degree arose. The company was adamant that the person in this job should have, at a minimum, an associate’s degree. But senior management also wanted her to do the job, so they agreed to work with her schedule to allow her to complete her degree; however, she had to demonstrate continuous progress with her efforts to do so. That was what brought her to me—to see what credits would or would not transfer in her degree quest.

I asked for a copy of her transcripts, but received only a copy of a letter stating that she had passed a paramedic course. The letter broke down the various hour requirements to graduate, which as I recall was about 650 total hours, but there was no mention of credits awarded.

In the end, I found that she’d taken a state-approved paramedic course, but not one that was affiliated with a degree-granting institution. This meant I had to break the bad academic news—eight months of paramedic school, no college credits. She would have to start at square one.

While researching her situation, I spoke with Gregg Margolis, associate director for the National Registry of EMTs. A veteran EMS educator, Margolis hit the nail on the head when he noted that, almost without fail, stories like this involve an ambitious EMT-B getting tangled up with a training program whose three main qualities are “cheap, fast and easy.” This month, let’s look at the impact on you and your future when you select a paramedic program based on the wrong reasons.

Cheap

Making the jump from EMT-B to paramedic is both time-consuming and expensive, usually totaling somewhere between $2,500–$10,000. Coupled with the fact that most paramedic students have to work while attending school, but they only get in about 12 to 30 hours a week, it’s easy math: less income, big outlay. Not a pretty fiscal sight for young people just a year or two out of high school, who are still coming to grips with being on their own and responsible for their own bills. Under these circumstances, it’s only logical that program cost would be a major factor in deciding where to go to school. However, it’s important to recognize how much service and support are cut in pursuit of cheap.

First, let me make a couple of points before I launch into the matter of cheap. One: There are some fine nontraditional outreach courses taught around the country. Two: Cost is by no means a sole measure of quality, nor is academic-based training, but both are certainly important factors.

That being said, most bargain-basement medic courses are taught off campus, often by a medic who has decided to branch out into education or an instructor who is moonlighting. The instructor may be affiliated with an institution of higher learning, or may have attained course approval through the state EMS office—usually the latter.

When someone has a limited budget because of small class size (4–8 students) and is trying to make a living as a freelance EMS instructor, it can turn into cost-cutting at every corner. At a National Registry test site, a student once told me that at the paramedic program she attended, there were no actual skills labs. The class learned about various pieces of equipment only by seeing pictures. The young lady was touching the equipment that she was going to be tested on shortly for the very first time. As you would expect, the results were poor.

Few to no handouts and printed materials, one instructor, no support staff to provide student services, and shoddy or inadequate equipment for skills practice are just some of the more common circumstances when cheap is the choice.

Last is the matter of obtaining college credit. Many EMT-Bs see an industry that, for the most part, doesn’t pay a medic with a degree any more than a medic with a course-completion certificate, which usually leads to the decision, “If I don’t need it now, why pay for it now?” When the inevitable time comes that you need a degree and must return to school to get it, you will have paid for those credits a second time.

My recommendation is to always invest in your future. Take college credit coursework and look for paramedic programs that are accredited nationally by CoAEMSP, as that stamp of approval provides yet another assurance of quality.

Fast

In some cases, EMTs looking for a medic program let time be the driving factor. Those with families to support want to keep lost shifts and time away from their family to a minimum. While that is a great idea, it is much more difficult to actually pull off, given the huge volume of content, significant diversity of subject matter and depth of learning required in a medic program. Like it or not, learning at higher levels takes time. Most credible programs take about nine months, and many even longer.

As such, be leery of programs that are structured to run as close as possible to the published minimum state hours requirements. As a program cuts hours, the inevitable result is less teaching and fewer learning opportunities. At its lowest level, the program focuses solely on teaching to the test—teaching no more and no less than how to pass the state or national exam. Important as that state or national certification may be, there is also the matter of competency.

Believe it or not, the real impact for graduate medics comes when they get a job. They may do OK on routine calls, but when they encounter challenging paramedic-level calls that require them to perform at a higher level, it just doesn’t get done.

Paramedics must have that wide and relatively deep knowledge base to draw upon when challenges arise. They must be proficient with their skills performance and confident that they have mastered the essential job skills. But when the program’s focus is more on fast, learning is often limited to how to pass the test rather than how to do the job competently. In the end, if that knowledge is lacking, or the skills were never mastered, the result is a provider who can get certified and hired, but is cut loose during probation—i.e., can get a job, but can’t keep a job—another undesirable outcome.

It comes down to “less teaching, less learning.” Be suspicious of overly condensed or intensive learning-style programs. It takes time—in the 750- to 1,000-hour range (my best guesstimate)—for the average student to learn what they need to be a competent entry-level paramedic. Just ask yourself, “What can I learn in 400 hours?”

Easy

Last, but not least, are the easy programs. Not only does everyone pass an easy program—they pass with an “A.” Then, they sit for the Registry exam and take a bath with a 40% or 50% fail rate. That’s a huge “oops.”

The term easy is usually also used to describe courses that are fast. It’s easy subject matter to learn, because only the superficial content is presented.

Under no circumstances should a paramedic program be easy, as the course content is hard to learn and the skills take lots of practice to master. This is high-end medical practice. Describing paramedic class, one student said, “Every day, I go get my head torn off and buckets of knowledge poured down my neck.” Very visual, but quite descriptive of the content load.

Make no mistake, I understand fully why some folks choose courses based on cheap, fast and easy. Still, understanding the true cost of getting where you want to be professionally is important “must-have” information that will help facilitate making better choices.

Be cautious of any program that looks cheap, fast and easy—in the long run, it probably isn’t. You may save cash now, but you’ll pay for it in hard dollars in the future, when you have to pay to retake coursework for credit or in lost wage opportunities. Sometimes, it’s both. Think about it.

Until next month…