Howdy! This post is random, disjointed neural firings. It comes from me trying to reconcile the fact that I really, truly do love working EMS but also hate the fact that I get paid worse than a fry-cook. Itís not the easiest read, and Iím sorry about that, but I canít think of any good ideas.
So really, Iím just complaining about being paid so poorly. Sorry.
Can you help? At the end Iíve put some ideas. Care to expand upon them in the comments section?
A comment I received on my last post got me thinking on this beautiful Sunday. Here it is:
ďLoved the quiz.† It would not only appear that I have another decade left to supplement the two already under my belt, but will most likely be found pulseless and apneic while seated in the rig one day….† I can’t think of anything I would rather do for a living!Ē
(Thanks to JimHaden for the comment)
On that post ďWill Your Career Survive a Decade or More in Full-Time EMS? Take this 3 question quiz!Ē I got a lot of cool comments from long-time EMSers stating how they ďbeat the oddsĒ and have survived upwards of a decade or two in this business. Then, the above comment kinda tied it together for me.
And on a warm, Indian Summer day here on duty, I gotta admit that Iím getting the warm fuzzies from my career choice. Iíve always said that I have an abusive, co-dependent relationship with paramedicine and EMS. I may need it more than it needs me, butÖ
Dang I wish I got paid more.
I love this job. I like the quirky personalities of the people Iíve met that do this. I like the camaraderie Iíve got with them. I like the pressure to perform in challenging conditions. I like having to think on my feet. I like meeting new people. I like making people feel better. Heck, I even like driving fast and breaking things.
I could go on.
Sure, thereís a ton of things about this job that I could do without. Iíd like to be able to schedule calls to handle them when Iím ready. Iíd like to be able to have the 911 dispatchers instruct certain patients to ďTake a shower and then call 911 back when youíre done.Ē Iíd also like magnetically levitating stretchers that can pick patients up with cranes.
I can go on there, too.
How are we going to make this into a profession that pays, heckÖ If not a ďgoodĒ wage, at least a ďfairĒ wage?
Itís not fair what we make. It just isnít. Sure, Iím a rural paramedic but I feel strongly about rural paramedicine and the fact that the lives of people who donít live in urban areas are just as important as the lives of those who do. The fact is though, that rural paramedics make much less than their urban counterparts. Yes, I know that itís because of call volumes, but also because the competition with the overall amount of jobs available in urban areas as opposed to rural ones. Itís also due to tax base and service delivery model issues as well as overall economic conditions and demographics of the areas we cover.
I could go on, but you get that itís a complex issue.
Today I had someone complain to me about their recent ambulance bill that they received for a long-distance transport. They felt that it was unfair to be billed so much for something they felt they could do with a taxi cab. I was very professional like I always am, but honestly Iíve got mixed emotions on this one. I donít know how many people share this opinion, but Iím one to think that ambulance bills are a tad on the too expensive side. I donít think that cost should be a deterrent to people calling for emergency assistance. On the other hand, this person is a resident of one of the jurisdictions I work for and I donít think that our bills are out of line. I wish I could have told this person that they had the ability to help their own problem with the bill by simply paying more of their share of the ambulance service though their taxes. The moneyís gotta come from somewhere, folks. People need 24 hour ambulance coverage and more lives are saved (debatably to some, but not to me) by 24hr paramedic coverage. While I would do this job for free, and do so by volunteering my time in some places, I also have to eat
So I donít have the answer, even though I would like to say that I did. I think that itís too complex of an issue in order for there to be a magic fix to the entire situation. If there were, I think that despite the political forces at work, someone would have put it into place by now. I will say that the ďFee For ServiceĒ model of ambulance revenue is failing. You know, the one where we only intake revenue if we transport and the volume of transports is supposed to be able to pay for everything. Well, what if youíre in a small town that cannot support a high volume of transports like I am? Or what if youíre in a big city like The Happy Medic (follow @CoEMS on Twitter!) and a high percentage of your patients can not or will not pay you for your services?
The fix, in my opinion, to find new revenue sources for EMS. If you look at professions with the highest salaries, theyíre the ones where the people earning those salaries earn large amounts of revenue for the company. Say someone in sales whose salary is commission-based and is dependent on making large sales, or large amounts of small sales, or an athlete who not only fills the stands but also earns tons of money from licensed products. EMS people donít do that, for the most part our patients cannot afford what we charge them and arenít using their disposable income to pay our salaries. Weíve got two sources, Secondary payers (Medicare/Medicaid/insurance) whose revenue depend on NOT paying as much as possible, and tax revenue. Yes, there are some that rely solely on one or the other, but most services that Iíve seen rely on both.
So what do we do? As Iíve said, I donít have the answer and Iím pretty much winging this post from this point on. I donít know. Iíve thought about adding home care services, having EMTs and Paramedics staff a community health-care clinic, and even working a 2nd job while on-duty (really, Iíve picked up an application from the local McDonalds to see if I could park the ambulance out back and flip burgers for a while in between calls Ė Iím only half-way joking about that) to increase the revenue potential for me personally.
Hey, maybe thatís the answer. Could we get the local ERs to let us staff them as techs whilst on duty? The local clinics? Dialysis facilities?
No, probably notÖ
Help. I canít finish this because I donít have a good idea. Maybe I will later, because Iím thinking of this issue pretty hard lately. I need EMS to pay better. You probably do too. Letís work this out.