Request for ideas on a problem – Can we be paid enough already?

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.

  • totwtytr

    No, I don't see working in the ED as an option. First of all, the nurses won't stand for it. Unionized nurses will file grievances, non unionized ones will lobby the state to make it illegal. Nor would you actually want the job from the bits I've read about places that have done it.

    I've said it before in response to people who bemoan the “paramedic shortage”, but it bears repeating.

    There is NO PARAMEDIC SHORTAGE. There is a shortage of people who are paramedics who are willing to do a very difficult job for the poor pay, generally non existent benefits, crappy hours, physical and emotional stress, and difficult family/personal lives that being in EMS generally demands. That explains why people go to paramedic school, but leave the field one way or another in a relatively short period of time.

    If you really want to fix the problem, then unionize. The problem is that sometimes the fix is worse than the original problem.

  • mr618

    One of the big problems, though by no means the only problem, is the insurance industry. Their profit is based on income (premiums) minus expenses (reimbursements and other payments) minus overhead. As we have seen in the news, insurance companies have some huge overhead, in the forms of salaries and bonuses. Some insurance companies pay bonuses to employees for cancelling policies! (See, for instance, Gina Hamilton's piece in The Coastal Journal (Maine), “The Cost of a Public Option in Health Care”: http://www.coastaljournal.com/website/news/anal…)

    As long as the insurance industry has a disincentive to make payments — to patients, doctors, or EMS systems — the EMS world will continue to be underfunded, making reasonable salaries for paramedics impossible.

    Falling tax revenues and increasing mandated governmental expense (like school appropriations, etc) reduce the funding government has available, leading to layoffs, generally in the emergency services (“They only go out 4-5 times a day, why do we need them?”… instead of laying off a useless Deputy Assistant Commissioner In Charge of Counting Paperclips and Issuing Incomprehensible Memoranda). And there are really only two ways of increasing tax revenue: get people back to work, or raise tax rates (and institute new taxes).

    As for working in the ER, here in Maine our local hospital hires a relatively large number of moonlighting EMT-Is and Paramedics as ER Techs. The nurses don't mind; in fact, they love it. Increasing workloads, coupled with the national shortage of nurses, leaves a growing gap in service delivery. The Intermediates and Paramedics fill some of that gap and take some of the stress of the horrendously overworked nurses.

    It isn't an easy problem to solve, but perhaps the current EMS 2.0 debate might come up with some useful ideas.

  • http://www.firedaily.com Fire Daily

    Here, Chris.

    I was going to keep it all for myself, but turns out I have a horseshoe up my kiester. I won two more lotteries, one in the Philippines and one in Nigeria.

    No, No, No, please don't thank me..
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  • http://www.firedaily.com Fire Daily

    Here, Chris.

    I was going to keep it all for myself, but turns out I have a horseshoe up my kiester. I won two more lotteries, one in the Philippines and one in Nigeria.

    No, No, No, please don't thank me..
    —————————————————————————
    CONGRATULATIONS!!! YOU HAVE WON 750,000 Euro

    You have been awarded 750,000 euro in the SWISS LOTTO NETHERLANDS Satellite Software email lottery in which e-mail addresses are picked randomly by Software powered by the Internet through the worldwide website.

    Your email address was amongst those chosen this year for the SWISS LOTTO NETHERLANDS Satellite lottery. And this promotional program is proudly sponsored by the SWISS-LOTTO NETHERLANDS organization.

    Your email address attached to Ref Number 14, 17, 18, 435, 7, with Serial Number 1869-12 drew the Lucky Numbers 10, and consequently won the lottery in the “A” Category. You have therefore been approved for a lump sum pay out of 750,000 euro.

    Please note that your lucky winning number falls within our European booklet representative office. In View of this, your winning prize of 750,000 euro will be released to you by our accredited fiduciary agent located In the Netherlands. Our European accredited fiduciary agent will immediately commence the process to facilitate the remittance of your winning prize as soon as you contact them.

    This promotion takes place annually. For security reasons, you are advised to keep your winning details confidential till your claims is dully processed and your winning prize remitted to you in whatever manner you deem fit to claim your winning prize. This is part of our precautionary measure to avoid double claiming and unwarranted the abuse of this program by some unscrupulous elements.

    To file for your claim, please contact our fiduciary agent:

    Mr. John Smith
    Email: fakeremitdept@aol.nl
    Tel: +31-64-799-4455
    Fax: +31-84-799-4701

    Provide him with the informationís as stated below:

    (1) Name:
    (2) Address:
    (3) Marital:
    (4) Age:
    (5) Sex:
    (6) Nationality:
    (7) Country of Residence:
    (8) Occupation:
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    (10)Fax Number:
    (11)Draw Lucky Number:
    (12) Ref Number:
    (13) Serial Number:

    These details facilitate the due process and the release of your winnings prize, to avoid unnecessary delays and complications in the processing of your winning prize. Always remember to quote your Reference, serial and Lucky Numbers in all your correspondences with your designated fiduciary agent.

    Congratulations once more from all members and staff of this program and Thank you for being part of our 2009 promotional program.
    Sincerely,

    Mr. Kenneth Gram
    Online Games Director
    SWISS LOTTO NETHERLANDS
    Dijkstraat 40
    4322 AA, Scharendijke,
    Netherlands.
    .

  • http://www.firedaily.com Fire Daily

    Here, Chris.

    I was going to keep it all for myself, but turns out I have a horseshoe up my kiester. I won two more lotteries, one in the Philippines and one in Nigeria.

    No, No, No, please don't thank me..
    —————————————————————————
    CONGRATULATIONS!!! YOU HAVE WON 750,000 Euro

    You have been awarded 750,000 euro in the SWISS LOTTO NETHERLANDS Satellite Software email lottery in which e-mail addresses are picked randomly by Software powered by the Internet through the worldwide website.

    Your email address was amongst those chosen this year for the SWISS LOTTO NETHERLANDS Satellite lottery. And this promotional program is proudly sponsored by the SWISS-LOTTO NETHERLANDS organization.

    Your email address attached to Ref Number 14, 17, 18, 435, 7, with Serial Number 1869-12 drew the Lucky Numbers 10, and consequently won the lottery in the “A” Category. You have therefore been approved for a lump sum pay out of 750,000 euro.

    Please note that your lucky winning number falls within our European booklet representative office. In View of this, your winning prize of 750,000 euro will be released to you by our accredited fiduciary agent located In the Netherlands. Our European accredited fiduciary agent will immediately commence the process to facilitate the remittance of your winning prize as soon as you contact them.

    This promotion takes place annually. For security reasons, you are advised to keep your winning details confidential till your claims is dully processed and your winning prize remitted to you in whatever manner you deem fit to claim your winning prize. This is part of our precautionary measure to avoid double claiming and unwarranted the abuse of this program by some unscrupulous elements.

    To file for your claim, please contact our fiduciary agent:

    Mr. John Smith
    Email: fakeremitdept@aol.nl
    Tel: +31-64-799-4455
    Fax: +31-84-799-4701

    Provide him with the informationís as stated below:

    (1) Name:
    (2) Address:
    (3) Marital:
    (4) Age:
    (5) Sex:
    (6) Nationality:
    (7) Country of Residence:
    (8) Occupation:
    (9) Telephone Number:
    (10)Fax Number:
    (11)Draw Lucky Number:
    (12) Ref Number:
    (13) Serial Number:

    These details facilitate the due process and the release of your winnings prize, to avoid unnecessary delays and complications in the processing of your winning prize. Always remember to quote your Reference, serial and Lucky Numbers in all your correspondences with your designated fiduciary agent.

    Congratulations once more from all members and staff of this program and Thank you for being part of our 2009 promotional program.
    Sincerely,

    Mr. Kenneth Gram
    Online Games Director
    SWISS LOTTO NETHERLANDS
    Dijkstraat 40
    4322 AA, Scharendijke,
    Netherlands.
    .

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Chris Kaiser aka "Ckemtp"

I am a paramedic trying to advance the idea that the Emergency Medical Services can be made into the profession that we all want it, need it, and know it deserves to be.

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  • Comments
    mr618
    Welcome to the Club
    Well said, Chris. We can't save everybody, but the ones we don't save tend to stick around a lot longer than the ones we do save.
    2014-10-18 14:40:00
    Steel City Medic
    Welcome to the Club
    Particularly appropriate for me this week. Thanks.
    2014-09-23 21:46:00
    DiverMedic
    Welcome to the Club
    Very well done, Chris.
    2014-09-17 22:15:00
    DiverMedic
    My Blogroll
    One of these days you'll figure out where my blog is... :)
    2014-09-17 22:11:00
    emtterri123
    Six Tricks You Can Use Today to Improve Your EMS Narrative Report
    The first and best way to get people reading you to think that you are an idiot is to pepper your writing with spelling and grammatical errors. It makes you look dumb. - Me thinks this should have been restructured as it does not flow and caused me to reread it several times. lol :)
    2014-09-17 08:27:00

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