I’m just wrapping up my last shift in fifteen years on the job. What I’m about to say is coming from the perspective of someone who operated almost entirely within private ems. I’ve moved on outside the healthcare sector completely because:

• Medics in decades two and three of experience get their asses kicked just as hard as medics in decade zero of experience. I’ve seen too many medics that were in their fifties and just miserable because the job never really gets any easier. If you get injured such that the doctor tells you you can’t do the work anymore, there’s precious little else you can pivot to; seems like you usually either get a TYFYS on the way out the door or everyone collectively turns a blind eye to the fact that you really shouldn’t still be on the ambulance.

• It feels like there are few options for naturally growing your career in EMS with your experience. In law enforcement, fire, and healthcare, there are more opportunities to naturally pivot out of the front lines and into roles that both make use of your experience and offer more rewarding pay and challenging or interesting work. For example, moving from a firefighter to inspector or investigator, moving from being a patrol officer to a detective, or moving from a nurse to charge nurse. With EMS, your options are basically flight medic or supervisor, and there’s really not that many positions available for either. Kinda related, but going lateral into other roles like RN didn’t always exactly feel natural. I tried to go to nursing school three or four times, and each time I did, my schedule got jerked around and I had to drop the classes; every paramedic to RN bridge program I heard about had just finished getting shut down (likely because it limited the college’s ability to milk the students by playing RN program fuck fuck games, and that made the admins sad).

• Seems like EMS as a whole still has the mindset of a job, and not a career. You can stay and flip burgers for as long as you like, basically. There’s little institutional support within agencies to help people advance within either healthcare or emergency services. There’s also not much support to help people be the best they can be at their job, you’ve really got to self motivate and care about being as good as you can. Agencies themselves often feel uninterested and disengaged in trying to make even incremental improvements to the way things are done, and seem to insist on only changing when acted on by outside forces.

Anyway, it’s a well known fact that EMS struggles with long term worker retention, and we’re all worse off for a lack of institutional knowledge and experience. What can be done to change it, though? As far as things go on the private side, I have no idea; the money has to be there, and the only thing that makes money is running calls. I’ve become increasingly convinced that the private model has largely reached the end of its life and needs to be replaced wholesale by fire and third service providers that don’t depend on a private healthcare style pay-for-service model.