The current US economy and EMS – An unexplored potential

I’m not one to be consumed by doom-and-gloom type news stories on the state of the economy. I firmly believe that in most cases macroeconomic forces do not generally affect the pocketbooks of individuals. A wise man once said that if you choose not to participate in an economic downturn and instead innovate, strive, and meet all challenges head-on you can and will thrive in any economy.

But this particular time in our history seems to have gotten me down lately, as you can see from some of my past posts which are included in this one. Read this one for the message though, it’s important.

See also “Why Does Being a Paramedic Seem So Worthless” and then please come back to this one.

There is starting to be quite a bit written in the trade journals and big online sites regarding how the economic collapse will affect EMS and the ambulance industry overall. It has been said by others, and I believe it too, that as people lose their jobs and therefore their employer-provided health insurance they are going to be less likely to seek out expensive primary care and will default more to the 911 system and the ER when their condition worsens to the point where they cannot manage. This will affect the EMS system twofold: First, with increased call volumes as people depend more on the healthcare safety net that is the EMS system; and second as more of these patients who have lost their health insurance will not be able to afford to pay for their ambulance care. More of these people will be self pay. Combine that with the already minuscule reimbursement rates from programs like Medicare and Medicaid coupled with the increased demands placed on them by uninsured and unemployed people who now qualify for these programs and we have a real problem on our hands.

With personal finance issues, as coached by excellent books such as “Rich Dad, Poor Dad” by Robert Kyosaki (which you should go to your local bookstore and buy right now if you haven’t) I believe that financial health is increased by creating multiple streams of revenue to swell your pocketbook. Most EMS people, at least in my neck of the woods, do this already by working a full-time and a part-time job. I have three jobs and also support my revenue streams by taking on database projects, MS Excel problem-solving (E-mail me! J and by those nifty Google AdSense ads you see on this blog in a few places. Some people build revenue generating assets, like rental property or by holding instruments that gain value over time. I’m not a financial professional (“never take financial advice from a poor paramedic” is the first thing they teach you in Stockbroker school) so don’t take my advice as such.

I keep hinting that I will write a post about EMS obtaining more revenue streams, stay tuned. I believe that the “fee for service” model for EMS has failed and will write about it soon.

However, there is another phenomenon within this economic downturn that I haven’t seen anyone address as of yet. It involves the fact that when EMS people reach a certain age and age in the profession they tend to gather houses, families, and responsibilities. They realize at that point (and I’m there, don’t you doubt) that their love of the profession is outweighed by their need to increase their income. A lot of them leave the profession for jobs with shorter hours and bigger paychecks. A lot of them further their education beyond the EMS certification level to the degree level that will launch them into a new career. In addition, in smaller communities with volunteer services or with services that allow people to work part-time there are EMS people who work full-time in other industries. It is a tragedy for an experienced EMS professional to leave the field, but it has become an unfortunate rite of passage for many.

See Also: “The Profession that is EMS” – And then please come back, I’m getting to a point soon, I promise.

These people in other industries that hold EMS credentials and have maintained them since leaving a full-time EMS job, downsizing to a part-time or volunteer only role, or have never worked full-time but are credentialed volunteers are losing their jobs. I know five licensed EMTs that worked good-paying jobs in other industries that lost their jobs to layoffs or outright closings.

Newsflash to some: These people view their EMS certifications as marketable credentials on their resumes. They are applying for EMS jobs in droves. For the first ten years of my career there had always been a paramedic shortage. The rules have changed, and people are flocking to open EMS positions in droves. The paramedic shortage has ended. This is a game-changer. Where in the past, dismal compensation for EMS people had at least been buoyed by the law of supply and demand pushing wages higher in the face of a limited workforce, the future does not look like it will have the same rules.

Does this kill our wages? Does the coming overabundance of EMS people drastically lower our wages, making our jobs truly “a-dime-a-dozen”? Look at all of the minimum wage positions you know. They all share one thing in common: low barriers to entry. McDonalds’ Restaurants employ people whose only qualifications are a nice smile and/or the ability to get to work on time. They make minimum wage. Our industry’s barrier to entry? An 8 week EMT-B class. Paramedic school is much harder and longer, but is certainly achievable by someone who could manage a restaurant or do some other like job with the requisite cognitive abilities. People see our industry as stable and almost recession-proof because people will always become ill and get injured. They’re right… but it’s no fun if we’re making as much as the guy who flips our hamburgers.

Don’t panic. As the eternal optimist I actually see a benefit to the above. While our wages could drastically deflate overnight (not that they could go much lower), there is a big potential for benefit here. The people who have stayed in the profession have generally been able to do so for a few reasons: They were promoted into a management role that pays better than the Street Medics make. They bought and/or founded a service and make income off of company profits. Or, they just aren’t cut out to do anything else in life for um, whatever reason. These people are who are running the industry in most areas of the country folks, and some of them are intelligent, dedicated, and consummate professionals who truly care and strive for excellence. Some of them are the other kind. Who do you know more of?

When people who have deep experience in other industries, have solid educational credentials, and have experience and knowledge regarding how business really works reenter the profession and find the current state of EMS I’m willing to bet they get mad. Then, I’ll bet that they begin to work to change it. These returning EMS people have the potential to breathe new life into a stagnating profession. Their ideas gained from experience in other areas will bring vibrancy and rejuvenation to an industry ran by people whose only qualifications and ideas come from EMS classes.

Folks, this is our “Bailout” and it brings me a combined sense of terror and optimism (“Terroptimism” Hey! I coined a phrase!). No matter what happens, I never see the collapse of EMS in our future. We’re vital and are ingrained into the fabric of our society. There may be dark times ahead, but it is always darkest before the dawn.

I see a coming renaissance. How about you?

  • Mike "FossilMedic" Ward

    Hey Chris,

    I read your blog and and responding to your Thursday email to GWU.

    Christine has sent you our package, I would love to talk with you.

    When is a good time?

    Mike "FossilMedic" Ward
    (202) 973-1525

  • Mike "FossilMedic" Ward

    OK, back to the blog discussion.

    Paramedics are moving from vocational (auto mechanics) to allied health providers. We appear to be following the nursing model.

    I wrote about this change in Nursing Is A Profession, Firefighting Is A Hobby and Paramedics Are Caught In The Middle

    Becoming a paramedic is still a pretty high level of entry, so some of the paramedic positions should retain their salary.

    I think Wake County's Advance Practice Paramedic is one way to go:

    Experienced paramedic handling both the critical calls and doing wellness checks to reduce frequent flyers.

    The recent proposed appointments of Richard Serino (Boston EMS)as FEMA deputy director and Doctor Alex Garza (Washington Hospital Center) as DHS Assistant Secretary for Health Affairs and Chief Medical Officer are great signs.

  • Ckemtp

    I watched the Wake County program with interest, and even started a thread on it (that I can't seem to find the link to) on – While any time I hear the term "Advanced Practice Paramedic" I am happy… in this case, I don't believe that they truly function to the level that I would wish my ideal of an "Advanced Practice Paramedic" to be. Although I have not reviewed the program in exquisite detail, it seems to me like they spend more time responding to "cool" calls than they do providing ER diversion care or wellness checks.

    I would like to see Primary care provided in the field by paramedics. Insurance companies aren't going to be quick to pay for an additional "special" paramedic on a cardiac arrest, but they might be willing to pay for a special paramedic that saves them paying for a $5000 trip to the ER by diagnosing bronchitis and writing a script.

    I like Gary Wingrove's version of the "Community Paramedic" (

    While any step towards furthering paramedic education, and making us into a true profession and not a "hobby" (I really liked that) is great by me, I would like to see us reach our true potential, as true clinicians in the medical specialty of prehospital care.

  • loljon

    lol no one is commenting cos the article blows, reality check

  • loljon


  • That may very well be. I don't always hit em outta the park. I try though. Thanks for the insightful, well thought out, and eloquent comment

  • loljon

    lol no one is commenting cos the article blows, reality check

  • loljon


  • That may very well be. I don't always hit em outta the park. I try though. Thanks for the insightful, well thought out, and eloquent comment