This is a slightly different vantage than usual on the question of “what might suffice”? But it is definitely about sufficiency.
I spent a good portion of the weekend at a conference for Emergency Medicine Providers (aka EMTs). In Maine, most EMTs are professional, but quite a few smaller squads also include volunteers. When I got my license, which was less than two years ago, our entire squad in St. George was comprised of volunteers. And that’s a big part of why I joined. Plus, the service was free to people who needed to use it. I loved the idea of neighbors being so fully present for one another in a time of crisis. I loved that people didn’t have to worry that they couldn’t afford help. Loved that when help came through the door, it might even have a familiar face.
This is changing quickly. Partly, it is that folks want a paramedic on call 24/7, and it’s hard to do that for free. Partly, though, and this is the crux of what I want to explore here, it’s that it is getting harder to get and maintain a license. My course was 130 hours, plus two final exams. Apparently, it used to be about half that long. And to remain licensed, I need to get continuing ed units, which is a big part of why I spent my weekend at the conference. I can get a bunch of them here on topics that are relevant. And since our squad is a volunteer squad, getting them in clusters like this is a real help–as we don’t have many opportunities for continuing ed credits at “work.” Sure, we can go to other people’s events, but part of the issue here in Maine is that we are a geographically widely dispersed population. It takes a lot of time to get to, participate in, and get home from training at other stations.
And here’s the thing: of course we should be well trained. But I feel compelled to point out that this increased emphasis on professionalization is happening AT EXACTLY THE SAME TIME that healthcare in the US is in a horrible spending spiral, and is wildly unaffordable, and is spotty in the service it can provide in rural areas. I have to wonder why the group that licenses EMTs is making it harder to get and maintain a license in such a moment.
I don’t think it’s a conspiracy or evil intention. My best guess is it’s a fundamental lack of forethought. While the notion of professionalizing such service is laudable, the down-sides are potentially dire for the very folks who are meant to be served by increasingly well-trained medical folk. Which is where the whole issue of sufficiency comes in. The pretty-darn well trained amateur model was working. A model with well-paid and well-trained professionals can also certainly work. But is it necessary? Was the other truly insufficient? And on what grounds? That’s the heart of it: what are the criteria that are being brought to bear that make a system that celebrated community caring for each other suddenly deeply inadequate?
The old model was very much about good will, about neighbors helping each other for free. And as the fine folks at Freakonomics have amply demonstrated, paying someone just a little to do something that they used to do for free (plus the satisfaction of a deed well done) does not work. Just as paying people to donate blood actually leads to a decline in the number of donors, paying a token to folks to be on the EMT roll does not work very well. When people lose the ‘feel good’ factor, they either want to be paid well or to not do it. And going from an all or mostly volunteer squad to a mostly paid squad significantly increases costs. Which then get passed on to patients, who have to pay for the service. And what was once an inspiring instance of community self-sufficiency becomes a commodified service within a capitalist framework.
For now, I’ll keep up my license, as I wait to see if the local efforts to develop a Community Health Program take off, but I can already read the writing on the wall. Even if my town cherishes volunteers, at the state level, they’re just not that into us.