EMS is exciting work. There is something powerfully attractive about emergencies and responding to urgent calls for help. People who do this kind of work are drawn to it and often speak about “EMS getting in your blood.” Even on a slow day, there is always the potential that the next moment may bring you to a life-and-death situation full of action, meaning and relevance.
But with all that EMS promises, many people today are not finding satisfying and successful careers in EMS. Re-registration statistics from the National Registry of EMTs suggest that a sizable portion of the EMS workforce turns over every year. The retention of good EMS workers is a serious concern in many agencies. The reasons for the high turnover are complex and involve labor issues, the work itself, funding for EMS, the treatment of workers and the way EMS has evolved in the United States to include volunteer and paid workers all being fielded by a variety of public and private agencies.
Yet surprisingly, a number of people have created long and satisfying EMS careers. How are they doing it? For some, it’s about being in the right place at the right time, but that is the exception more than the rule. Most great careers in EMS are creations. They are the result of climbing over barriers and taking deliberate action.
Barriers to Great Careers
Many of the people leaving EMS will tell you the biggest barrier to having a long and satisfying EMS career is the lack of a career path. They will claim a person can only do a limited number of things in this field – namely, be a field provider, a supervisor/manager or an educator. Others believe that EMS is simply a necessary stepping stone to a full-time firefighting job, and if you can’t get the union firefighting job, you might as well get out. But the truth is that career paths in EMS are as diverse as your imagination and not limited to narrow definitions. NAEMT has been around for 30 years and witnessed the maturing and development of EMS careers into many diverse paths. This diversity is reflected in the careers of the NAEMT board of directors. Each board member has been involved with EMS for years and each has developed a unique path that far surpasses traditional ideas of EMS careers. The only limits to careers path in EMS are in our imagination.
And, what limits our imagination is our tendency to approach career development like we approach EMS calls. In other words, we simply react – and for an EMT or paramedic, it is very difficult not to just react. Reacting is the predominant working paradigm of EMS. It’s part of what gets in our blood. Think about it. They call us responders because we respond. Tones sound or a pager goes off and we react. We don’t create the emergencies. We can’t plan them. We just react when something happens. When we see pallor and low blood pressure, we react. When we see shallow breathing, we react. When we see PVCs on the monitor, we react. When a physician gives a radio order, we react.
And when nothing is going on, we plop down in a recliner and wait because we know that, sooner or later, another call is going to come and we will simply react because we can’t plan when it will come.
Reactivity is the nature of the work, and we become good at it. If you fail to be a good reactor or responder, you won’t last. But our propensity to react becomes a huge career development barrier. It blocks the imagination and leaves us waiting to be discovered or offered the job of our dreams – and we all know how often that really happens. Reactivity leaves people feeling powerless to change things and make a difference in their lives.
“Many people wait for something to happen or someone to take care of them,” writes success guru Stephen Covey. “But people who end up with the good jobs are the proactive ones who are solutions to problems, not problems themselves, who seize the initiative to do whatever is necessary…” Creating a great career in EMS requires proactivity or action in five important areas.
Proactive Career Steps
1) Know what you want. You can’t get anywhere if you don’t know where you are going. Creating a future requires a dream. Because EMS sits at the intersection of public safety, medicine, public health and emergency management, you can take your career in any number of directions - but only you know what you really want. This is the part of career development where you ask and keep asking: What attracted you to this work? What do you find most satisfying now? Where do you want to be in the next five, 10 or 20 years? And, what are you most passionate about now? Even if what you want seems remote and totally unachievable, it’s important to have a clear picture of your desire. There’s tremendous energy in a dream.
2) Assess Your Dedication. This is where you begin to match your dreams with your motivation, energy and willingness to sacrifice. Great careers rarely come without some cost. You may want to be a flight medic in a busy helicopter service, but you will need to assess how dedicated you are to the steps it will take to get there, which may include additional education, moving and paying your work dues until you are hired by a service that matches your dreams. Many EMS workers are unwilling or unable to relocate and must honestly assess the implications of such a decision.
While facing your dedication level can be a cold-water reality check, it may also tell you something important about your dreams. In concert with your dreams, what else is important to you? Career dreams cannot be assessed in a vacuum. They are intertwined with the dreams we have about family, hobbies and every other aspect of our lives.
3) Make a Plan. Many people have dreams, but few have plans. Just like you need protocols that outline the steps to managing a cardiac arrest, you need to outline steps for creating a great career, and you need to do it on paper. Reactive people often hate to make written plans, but once they do, they find them very helpful. A plan for your EMS career will be a changing document that reflects the fact that life rarely moves in a straight line. But as your plan changes, make sure it always includes the following elements: a vision statement of where you are going; specific and measurable goals to get there; and action steps that are do-able and realistic. Your plan will help you chart your progress and will direct your efforts when you encounter the inevitable weariness and frustrations of trying to do something great.
4) Find Help. No one creates a great career alone. While only you know what you want and what you’re willing to do to get there, refining your plan and accomplishing the steps will take the help of others. So much about building a career is indeed about who you know. While making your plan, start identifying people who can help. Find people to advise you. Most EMS people like to talk about what they do and are willing to tell you their stories. Find people who can open doors, write recommendation letters and compliment you. Finally, find people who can encourage you when the going gets tough. If possible, try to identify someone who is close to living your dream and find a way to learn something from them. All of the particular information you need about building your career – education, resumes, testing, interviewing and so on – is all going to be more accurate from the people who are on similar paths. If you are stuck trying to identify what you really want, get some help from some of the great career planning books out there.
5) Be Persistent in Your Execution. EMS patient care usually takes place in a very short space of time. We’re used to doing things quickly and seeing immediate results. Careers are about a much longer space of time and require a different kind of attention. Chances are, if you aspire to having a great career in EMS, it will take a lot of diligent work to execute the many steps of your plan. The good news in career building is persistence often pays higher returns than talent, genius and even education. If you keep working at improving yourself and living in the direction of your dreams, you will see results.
This article was written by John M. Becknell, who has been creating a great career in EMS for 30 years. He has been an EMT, paramedic, flight medic, educator, manager, consultant, writer, editor and publisher. He is the author of Medic Life: Creating Success in EMS (Mosby 1995). Currently, he is the publisher of Best Practices in Emergency Services and a communications consultant to NAEMT.
Links to more EMS career articles:
How to Become a Flight Medic
Become an EMS Entrepreneur