Licensure or Certification?

Welcome to my second installment in a series of guest editorials. My goal for these articles is to shake up and change the EMS establishment for the better. To do this, I need your help. Here’s one way you can participate: Drop me a line and let me know how you would change EMS as a career field. No area is sacred and all your ideas and opinions count. You can reach me at Docbeaker@aol.com. Put “Solutions for the Future” in the subject line.

Here’s a question for the prehospital professional: Are you licensed or certified? Or maybe, since you chose EMS as a career, I should ask: Are you certifiable? Never mind that. Chances are, if you work in EMS in the United States, you are only certified. Licensure and certification are two words that aren’t all that different to most people, but depending on how your state office classifies you, it can make a big difference in your job.

What exactly is the difference? The definitions found in Webster’s unabridged dictionary speak in non-medical terms, but offer some assistance. “Certification” and “certified” speak primarily to a verification process that guarantees something reliable or safe, the holder of an official certificate, or having fulfilled certain requirements. Examples include a certified check, a certified public accountant and advanced cardiac life support certification.

The Brady paramedic textbook defines the words more closely to their EMS application.1 The textbook defines certification as a recognition granted to a person who met the right qualifications. In other words, certified means that you met the minimum requirements. You passed an examination and received a certificate and wallet card for your trouble. The Brady book goes on to say that you are now “permitted” to work under a physician medical director. Once certified, you get the privilege of working under a doctor.

Licensure sounds a little more professional in both the dictionary and the textbook. Webster’s speaks of formal governmental permission, the right to carry on a practice or engaging in a professional practice. The Brady book goes on to mention that licensed people are competent to help ensure the public’s protection.

Licensure sounds like a whole different ballgame because it is. It’s not even in the same league. Even though both distinctions only require minimum competency to pass required testing, licensure is a much more formal and professional designation.

Very few states currently require licensure. In my home state of South Carolina, we are only certified. Because of the certification process, there are plenty of degenerates running around with a wallet card and a rock-bottom testing score who are anything but professional. Will licensure get rid of them? Not completely, but licensure will raise the bar of professionalism enough to eventually rid us of many of the lowlifes. It will also help those of us who know what we’re doing to enjoy a better career and hopefully an improved pay scale.

Take a look at some of the professionals who are licensed in most states: General contractors, tradesmen (plumbers, electricians), teachers, social workers, barbers, cosmetologists, insurance agents and registered nurses.

And then there’s the profession so proud of its licensed status that they’ve included it in the job title: licensed practical nurse. LPNs have a medical designation that is licensed, even though they can’t perform half the skills of a certified medic.

Many of the occupations that are licensed don’t even require an examination, just an application. Compare that to the education, testing and recertification that paramedics go through. Licensure allows people in those jobs to work with a great deal of independence. Many of those professionals set up their own businesses and don’t have to work under anyone. Paramedics, however, get the privilege of working under a doctor, instead of with one as nurses do.

What Would It Change?

EMS has outgrown the certification phase of our industry—now it’s time to move forward. Licensing prehospital professionals would greatly increase the professionalism of our occupation. Licensure will make us more a part of the healthcare team, instead of complete outsiders. But beware, because licensure would make us just a little more like nurses, individual nurses and nursing groups will fight our efforts to change things. Nurses are still in denial that we can do more than they can with less: less pay, less equipment, less control over the chaos. They’ll fear it will endanger their jobs, because licensure would give us just a little more recognition, independence and autonomy. Licensure would also move us closer to my ultimate goal of reclassifying paramedics as prehospital emergency nurses.

Because licensure will move us onto the healthcare team, it will also move us further away from the hose-draggers and fire-eaters. No offense; firefighters have their own jobs and I respect them for it, but that job classification should not include paramedicine. As long as paramedics are part of the fire service, we will never move up to the prestige that nurses and other healthcare professionals enjoy. When EMS finally becomes licensed nationwide, it will be imperative to separate from the fire service. Otherwise, the persistent notion of a firefighter with medical training, instead of a full-time paramedic on an ambulance, will continue to hold us back.

The Solution

If paramedics and EMTs are not licensed in your state, it’s up to you to change it. First, contact any state or local EMS associations or groups in your area. Find out if they have any initiatives at work on the subject. If they do, offer to help. If not, offer to help them start one. Next, contact your local politicians—from the governor to your city council. Chances are, they’re not aware of the issue and never knew there was a problem. Educate them and make them aware. Then convince them to help you make changes in state law that will allow licensure for EMS personnel. Who knows, you may get lucky and some bit of legislation might be named after you for all your efforts.

Conclusion

For paramedicine to move forward as a career, we must do all we can to increase our level of professionalism. Converting from certification to licensure is one way to do that. It won’t automatically increase your pay, but it will improve your image and raise your professional status. The status and recognition may also open up new doors to paramedics that never existed before, such as travel jobs, easier reciprocity and more independence. A major benefit of licensure is that it will steadily move us away from non-medical jobs like those of the fire service and into more healthcare-oriented roles.

Reference

Bledsoe BE, Porter RS, Cherry RA. Paramedic Care: Principles & Practice Textbook Volume 1–5, with Drug Guide. Upper Saddle River, NJ: Brady/Prentice Hall, 2001.