If you’ve spent any amount of time in EMS, then you have probably met two very different types of providers. The first provider is very easy to recognize. They know their truck inside and out. They know every shortcut in their service area. They can tell you where every nursing home, dialysis patient, and ER is located without ever opening their phones GPS. They show up, take care of their patients, complete their PCRs, and shoot straight back home. They’re extremely dependable. Usually very experienced. And most of all, they are reliable. EMS needs those people.
But… then there’s another type of provider. They’re the ones asking questions. Not just clinical questions. The questions that open a new world.
Why does our service bill the way it does?
How does Medicare reimbursement work?
Why are ambulance services struggling financially?
How do ambulance contracts get negotiated?
What exactly does an operations manager do?
Why do some EMS agencies have great relationships with their hospitals while others seem to be constantly fighting with them?
How are laws passed that affect EMS?
Why are some services able to recruit employees while others can’t keep people for six months?
What causes one ambulance service to thrive while another slowly falls apart?
Those providers aren’t necessarily smarter. They’re not always the best clinicians. They aren’t always the most experienced. But the one thing they are that is arguably more important than anything, is curious. In my experience, curiosity may be the single most valuable skill a person can develop in EMS. Not because it helps you pass an exam or because it helps you obtain another certification. But because curiosity changes the entire way you see the profession. It absolutely changed the way I see it.
I didn’t set out to learn any of this. When I first got into EMS, I wasn’t thinking about leadership. I wasn’t thinking about healthcare policy. I wasn’t thinking about reimbursement, advocacy, public relations, community engagement, or organizational culture. I was thinking about the best EMT I could possibly be. That was my entire focus. I wanted to be the best EMT in the country.
Like most new providers, I was completely fascinated by patient care. I wanted to learn assessments. I wanted to understand medical emergencies. I wanted to improve my skills. I wanted to gain experience. Medicine was my entire world. Honestly, that’s where it should be in the beginning. You have to learn the fundamentals before you can understand the bigger picture. I gained experience on the ambulance as well as high volume emergency departments. I stood side by side with physicians for 12 hours at a time. I asked every question that popped into my mind no matter how stupid. I soon learned enough and used that knowledge to help understand the whole picture. I knew the process from the 911 call to hospital admission or discharge. I understood labs and lab values. Diagnosis and comorbidities. It made me a valuable asset on the ambulance. If you’ve ever heard the term “well rounded education,” that is the example.
But eventually, something happened. I started asking questions. Not because I had some master career plan. Not because I was chasing a management position. I was curious. I wanted to understand why certain things happened. Why did one ambulance service have newer equipment than another? Why did some communities seem to support their EMS providers while others barely acknowledged they existed? Why did some organizations have employees who stayed for years while others constantly struggled with turnover? Why were some leaders respected and trusted while others were constantly criticized? The more questions I asked, the more I realized I had only been looking at a small piece of the EMS profession. The ambulance was NOT the entire picture. It was just the part I could see.
Most people think EMS begins when a 911 call comes in. In reality, that’s when the visible part starts. Before that call ever happens, hundreds of things have already taken place behind the scenes.
Someone negotiated contracts.
Someone developed policies.
Someone worked through regulatory requirements.
Someone hired employees.
Someone trained those employees.
Someone built relationships with hospitals.
Someone attended city council meetings.
Someone met with county officials.
Someone managed payroll.
Someone balanced budgets.
Someone maintained vehicles.
Someone monitored quality assurance programs.
Someone advocated for legislation.
Someone worked to secure funding.
Someone spent countless hours making sure that an ambulance would be available when the public needed it.
Most providers never see those things. And that’s completely understandable. When you’re focused on patient care, it’s easy to assume all of those systems simply exist. But they don’t exist by accident. People speaks large amounts of time and energy to build them. People spend the day maintaining them. People fight tooth and nail to protect them. The longer I stayed in EMS, the more fascinated I became by those unseen parts of the profession. Because I started realizing something important. Many of the biggest challenges facing EMS have very little to do with medicine. EMS has never really had a medicine problem. That statement usually surprises people. EMS certainly faces clinical challenges and has done so throughout its history. Medicine evolves. Protocols change. Technology improves. Education requirements constantly change.
But when you look at the issues keeping EMS management and leadership awake at night, very few are clinical. The biggest conversations in EMS today revolve around workforce shortages, reimbursement, retention, leadership development, burnout, community expectations, healthcare integration, and system sustainability.
Those aren’t medical problems. They’re operational problems. They’re leadership problems. They’re relationship problems. They’re financial problems. A service can have the most clinically skilled providers in the world. But if they can’t recruit employees, they have a problem. If they can’t retain employees, they have a problem. If they can’t generate revenue, they have a problem. If they lose community support, they have a problem. If they lose political support, they have a problem. If they fail to build strong relationships with hospitals and healthcare partners, they have a problem.
The future of EMS will be determined by so much more than clinical excellence. It will be determined by how effectively we manage the systems that support clinical excellence. That’s why being curious is so important. The curious EMT or paramedic eventually starts seeing those connections like one huge spiderweb covering the world. I remember when i started to see it and now I understand how everything in EMS is interconnected. Curiosity also makes you better at patient care. Some people hear discussions about leadership, operations, reimbursement, and advocacy and immediately think:
“That’s administration stuff. It doesn’t affect me.”
I used to think that too. Then I learned how connected everything really is. Take documentation, for example. Most providers understand documentation is important. But many don’t understand why. When you learn how reimbursement works, documentation suddenly becomes more than a report. It becomes part of the financial health of the organization. It becomes part of compliance. It becomes part of quality assurance. It becomes part of legal protection. It becomes part of keeping ambulances staffed and operational. Understanding the bigger picture changes how you view your responsibilities. The same thing happens with community engagement.
At first glance, attending a community event may seem unrelated to patient care. Until you realize those relationships help build trust. Trust helps secure support. Support helps secure resources. Resources help improve service delivery.
Everything connects. Relationships are the foundation of a successful EMS service. The providers who understand those connections often become stronger contributors to their organizations. Not because they have more authority. Because they have more perspective. Curiosity creates opportunities. One thing I’ve noticed throughout my career is that opportunities often appear in unexpected places.
Almost none of the opportunities I’ve been fortunate enough to experience started with a formal application. Most started with curiosity. Writing started because I became interested in telling EMS stories. I wanted people to learn and see the things as i have learned and seen them. Advocacy started because I wanted to understand how legislation affected ambulance services. Community engagement started because I wanted to understand how organizations build trust. Public relations started because I wanted to understand how agencies communicate with the public. Leadership development started because I wanted to understand why some organizations succeed while others struggle.
Every one of those paths began with a question. Not a career plan. Not a promotion… A question. That’s why I try to always encourage newer providers to focus less on where they want to be in ten years and more on what they want to learn next. Career growth is rarely a straight line. Most of the time it’s a series of curiosities that gradually lead you somewhere unexpected. The future of EMS belongs to the curious. The EMS profession is changing. Healthcare is changing. Communities are changing. Technology is changing.
The expectations placed on EMS services today are dramatically different from what they were like twenty years ago. Today’s EMS leaders need to understand finance. They need to understand public policy. They need to understand community relations. They need to understand workforce development. They need to understand strategic planning. They need to understand data. They need to understand healthcare. And those future leaders are just sitting in an ambulance somewhere right now. Some are EMTs. Some are paramedics. Some are supervisors. Some don’t even realize leadership is anywhere in their future. I never did. The difference often isn’t talent, education, or even experience. It’s all of that mixed together, but topped off with a curious mind. The willingness to keep asking questions. The willingness to learn something outside your comfort zone. The willingness to understand the profession beyond the next call.
One question can change everything. If there’s one lesson I’ve learned throughout my career, it’s this:
You don’t have to know exactly where you’re going. You don’t need a perfectly mapped out career path. You don’t need all the answers. You just need enough curiosity to ask the next question. Read an EMS leadership article. Attend a local government meeting. Learn how ambulance reimbursement works. Study a piece of EMS legislation. Ask your director how the budget process works. Talk to someone whose job is completely different from yours. Learn something about EMS that has nothing to do with medicine. You might discover an interest you never expected. You might uncover a career path you never considered. You just might develop a deeper appreciation for the profession you’ve chosen.
Most importantly, you might begin to understand that EMS is so much bigger than an ambulance, way bigger than just one shift, and so so much bigger than a single call. And it all starts with a simple question.
“What do I want to know more about?”
The answer to that question might just change your entire career.
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