Punishing Your Best People and Longevity

Last week I listened to a great discussion on the EMS Educast about how a service’s best providers can be punished by its continuing education and protocols.  Mic Gunderson, an EMS system consultant, described how both are often geared towards maintaining minimum competence levels of the lowest performers.  A few days later I had the opportunity to discuss Longevity in EMS on EMS Office Hours.

On the Educast, I am happy that  Mr. Gunderson acknowledges that some EMS practitioners are better than others.  We don’t like to admit this.  We want certification cards to be a light switch that guarantees competence.  We want to believe that every member of an organization will perform well in any situation they are placed in.  But we know this is not true. He proposes that providers be evaluated, and that high performers should have opportunities for more advanced education and liberal protocoled than the lower ones.

On Office Hours, we talked about how longevity and experience are not valued by many organizations.  EMS is exciting at first but can become like a prison sentence.  The calls all seem to be for the same things, few organizations have a career ladder, and a narrow skill set prohibits changing careers.  Then a new crop of of EMS people, lured in by lights and sirens, replace the disgruntled ones who finally leave.

For organizations that depend on revenue to survive, reimbursement from transports is the same regardless of its providers’ experience or the quality of care they deliver.  Providers want diverse career options after the novelty of EMS wears off.  Patients, our most important stakeholder, want competent, motivated, and compassionate people to show up after they call 911.

One service found a way to get its best people to the most serious calls, allow them to practice outside of traditional EMS roles, and keep its best performers motivated.  In 2009, Wake County (NC) EMS began an Advanced Practice Paramedic program.  Prospective APP’s apply for the position and compete additional didactic and clinical education. APP’s respond to high risk, low frequency calls and high frequency, low risk calls.  This allows a small number of already elite paramedics to get more experience managing the most serious patients.  It also allows paramedics to safely direct certain low acuity patients to facilities other than an emergency department, such as intoxicated patients to a detox center and psychiatric patients to a psychiatric facility.

When it comes to motivating your best people and rewarding longevity, Wake County EMS gets it.   Their best paramedics are rewarded with novel career opportunities, and the sickest patients get one of the service’s best paramedics.


  1. Good points here Bob. I did a podcast on career options and how providers can use their experience in EMS. The sad part is that most options available like teaching or limited promotional opportunities within bigger organizations have to be sought after by the provider. Then you have the issue you mentioned where those providers may not be the best for the job. Opportunities like the ones mentioned in Wake Cty, I think enourages EMS professionals to train, educate themselves and excel in their careers so that these opportunities not only become available but that they have a shot at getting them.

    Thanks for joining in the show BTW and look forward to hearing your thoughts on upcoming episodes.

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