EMS Pay Sucks!! (part 3) – Who or What is at fault here!?

Welcome back to the ďLife Under the Lights Bar and GrilleĒ, your local dive bar filled with lousy food, tepid beer, bad ambiance, and great friends. Like any local Midwestern dive bar, itís a come-as-you-are-and-sit-on-down-and-hang-with-your-buds kinda place. A conversation has broken out on the topic of ďEMS Pay Sucks!! Letís DO something about it!!Ē and me, your local blogger has decided to write a series of posts explaining the issues as I see them.

So, if you havenít been here to read the last two, I suggest you go back and read them before you read this. If you donít, well then thatís your choice. Itís a pretty informal place we have here.

Part 1: ďEMS Pay Sucks!! Letís DO something about it!!Ē

Part 2: ďEMS Pay Sucks!! (Part 2) Ė Identifying the Problem

————————————————

In the last two parts here at the Life Under the Lights Bar and Grille, weíve established that the time for talking about the issues is over, and that all EMS people need to band together in an effort to affect the pay rates in our profession. Weíve also established that this is a very complex issue and it can pretty much be said that if this was going to be easy, that it would have been done already.†

If youíve read the comments that Iíve gotten on the other posts in this series, this is a hot issue with vastly different valid arguments that have been brought forth by people I respect. While I agree with a lot of what has been said, I would like to boil the issue down a bit further than it has been brought in the comments section and in the information that I have previously been exposed to. Basically itís like this: By examining other occupations that are well compensated for their skills, we can examine the position we find ourselves in with our profession.

I think that it works like this, Well Compensated Occupations have these things in common:

  1. There is a medium-to-high barrier to entry Ė Whether by education requirements, location, or the unpleasant nature of the work, there is a barrier to entering the occupation that requires work and/or an affinity for the location or work involved to get into the field. Not everyone can do it, the people that do it but cannot do it well easily fail out, and the people that can hang around to do the work are rewarded for it. Look at Dental Hygienists, teachers, and IT professionals.
  2. There has to be a perceived value in compensating the people in the field at a higher rate to achieve higher performance Ė Look at the salaries of professional athletes and CEOs. They create value intensively based upon their knowledge and talents and the better they are at doing what they do, the more value they create for their employers. Think of it, if you could raise profits in your company $5million per year, wouldnít that be worth an extra $1million per year in payroll?
  3. The Industry they work in turns significant revenue overall Ė You could be the most talented Ice Sculptor in the world, but if you couldnít find a market to sell your ice sculptures to before they melted, you wouldnít make any money at it. Nor would you if you were the executive chef at a greasy spoon. Sure, youíd have the same job title, ďSculptorĒ or ďExecutive ChefĒ, as a sculptor that worked with Marble and Gold, or an executive chef that worked at a very fancy restaurant in downtown New YorkÖ but since the places you worked for werenít making any money, you couldnít possibly be paid very much; Even if you were as highly educated and more talented than your counterparts at the fancy joints.

I think that overall, point number three above sets the tone for us. Our industry doesnít make much money, therefore, no matter how caring, compassionate, qualified, or talented we are, we wonít be making much for working in it. Itís pretty much that simple. Sure, some salaries are artificially inflated due to varying degrees support from governmentally levied taxes, subscriptions, or corporate support but if we were to stand solely on our current business model, the ďfee for serviceĒ model where we only get paid if we transport and most of our customers do not pay then weíd all be much poorer than we are now. In fact, most ambulance services would be out of business.

Iíve heard the argument that one form of EMS delivery or another is ďRuining it for the rest of usĒ with people in one camp bemoaning ďthe privatesĒ for being all about profit and not paying their employees due to the money grubbing nature of their owners, and people in another camp bemoaning ďThe Fire GuysĒ for holding the profession back and keeping educational standards low so that their fire guys donít have to get the advanced education that would be required of other well-compensated healthcare professions. People in almost every camp bemoan the volunteers saying ďIf they do it for free, how can we expect people to pay for us!?Ē

Well, while all of those arguments sound plausible enough and may hold some truth to them, theyíre crap when you really look at them. Should all restaurants be Governmentally based like the Fire Departments because then pay would be equal across the board? Right now people that work in Government cafeterias earn better money than those working in Flo and Ginoís Diner down on 5th St. Flo and Ginoís Diner is *ruining* the restaurant business, right? How about IT professionals? People that work doing advanced networking at IBM earn WAY more than the people that do networking at your local newspaper office. Does that mean that smaller operations, and not large companies are *ruining* the IT business? Waitresses that work in Casinos and at Hooters make way more than do waitresses that work at your local fancy chain restaurantÖ Is TGI Fridayís to blame?

Every business, governmental organization, or organization on Earth in one way or another, is a system that takes in money and other resources, does something to it, and then spits out something with perceived value to it. The military takes in vast amounts of money, manpower, and other resources and doesnít make a dime doing it. Its value is in protecting the interests of the society that funds it and therefore itís usually a governmental pursuit. Diamond mining takes a lot of resources and money to perform as well, but since diamonds are sold for huge profits, itís a pursuit of the private sector. I donít get much into politics on my blog, but I can say that personal experience has taught me that capitalism works and that government rarely does anything better, more efficiently, or faster than does the private sector. Government bodies, by definition, rarely are any good at staying within budget, let alone making a profit, and when they do try to make a profit, they fail spectacularlyÖ e.g. Fannie Mae and Freddie Mac. By definition, the Fire Service doesnít make a profit, and they have branched out into providing EMS in a lot of cases, solely to get a piece of the transport revenue to support their other operations. Private services, by definition, are doing the sameÖ Neither one is inherently evil.

And neither are volunteers. I work in rural areas and Iíve always lived in them. Heck, my hometown had more cows than people and yet I still needed someone to bring the ambulance whenever the†farm hand†got trampled on by Bessy. Rural areas have voluntary agencies where community members step up to the plate to provide services out of the humanity they have to their neighbors and also because of the fact that if they didnít do it, nobody would. Thatís not evil, itís just a reality of rural life. (There are benefits to the volunteer services that I will expound upon in a later article not in this series as well.) (Disclosure, Iím a volunteer paramedic and dang proud of it).

A paramedic blogger who I really respect, TOTWTYTR (Who writes the blog ďToo Old to Work, Too Young to RetireĒ) offered the following comment on my post ďParamedics Providing Physicals? Decreasing Healthcare Costs and Improving Patient Care Ė EMS 2.0Ē

ďChris, you seem to be intent on finding more for paramedics to do. I’m not sure why, when there is a “shortage” of paramedics we need a heavier work load or “expanded scope”. We’re also likely intruding into someone else’s work space in the process.

Nor can I say that giving more for the same amount of money of benefit to the profession. In fact, I’d opine that it will have the opposite effect.Ē

His argument looks good too, when you donít share the same definition of a business as I do and you donít view EMS as a business, which it is. Remember my third point above, the one about industries that donít make any revenue being unable to compensate their employees at a reasonable rate. My idea in the above post, to have a paramedic provide your next annual physical, is another service that we can use to sell for a profit. The belief that we can survive solely on transport revenue has not panned out when most of our transport revenue is based upon dwindling government reimbursement through Medicare and Medicaid (and the looming universalization of healthcare) and the tax revenues we rely on from local governments is starting to be eaten away. We have to find new sources to generate revenue from. Weíve got to compete in the marketplace to either do old things better and/or cheaper or do new things before anyone else does them. Our profession is not insulated from capitalism just because we layer ourselves in compassion.

So to end this long rant, I think that we can go a long way towards solving our pay problem by turning our attention to the three points above.

First, educational standards must be universally standardized, universally raised, and must be owned by our professional governing body. While we should probably never make a Masterís degree the entry point to ambulance work, it shouldnít be a GED either. Probably some PE classes should be in there as well, or at least the ability to pass them. Go Get Educated!

Second, we have to educate the public about what it is that we do and why being good at it is important. If the public thinks that a volunteer service with a BLS response is adequate, then theyíve never laid there with a broken femur only to be bounced down a gravel road next to an EMT-Basic that canít give them a squirt of Morphine. Theyíve also never had their MI go into cardiogenic shock because the BLS volunteers couldnít give them correct medications to mitigate the damage. They have to be shown convincing evidence of these facts before they will, and someone has to be our cheerleaders. Honestly, Iíve never seen an ďEMS CheerleaderĒ or someone who was promoting the profession to the public, that hasnít been skewered by their peers. Maybe NBCís ďTraumaĒ wasnít the most accurate show in the worldÖ but neither was ďTop GunĒ and we loved that movie and wanted to be a fighter pilot after seeing it (last week, again). Be an EMS Cheerleader in your community!

Third, your EMS service needs to go do something to make itself money. Figure out what you can do to boost revenue, and do it. Try new things. There are a lot of business ventures that have a good synergy with EMS.. Perhaps you could sell those little ďIíve fallen and I canít get upĒ buttons and home-safety devices to the elderly in your community. Perhaps you could do home healthcare. Perhaps you could offer OSHA safety consulting to business and industry in your jurisdiction. All of these things are very much part of what we can, and probably will be doing in the future. Seek out New Ideas and Profitable Ventures!

I havenít figured out the title to the next post in this series, but Iíll be writing it tomorrow. Iíve loved the debates that have been popping up in the commentís section and Iím sorry that I havenít jumped in there much as of yet. Iím just trying to keep my ideas to the main posts, and then Iíll come back and debate when I get out what I want to say. You all have been creating some great energy and while weíre not going to agree on this, Iíll say it again ďPerfection is the Enemy of the Good EnoughĒ. Complete agreement is not necessary for us to act upon a consensus.

  • landfill624

    Don't you think that by trying to invest in the elderly more, we are merely trying to spread the wealth (or lack there of) even thinner? The idea of Home Health care is an excellent idea, but what about doing some sort of sports physical, or even getting into some sort of Cardiac/Stress testing. We can monitor EKG's, administer IV's, and we all know how to use a treadmill (or at least most of us.)

    You bring up the idea that we need to create revenue for ourselves, this is difficult because Emergency health care is like an insurance policy, everyone wants to have it and no one wants to pay for it. I think maybe the best way to eliminate the overhead is to minimize the “Corporate” influence. One business manager is enough, we don't need to have 2 or 3 sucking off the payroll teet, especially when it usually turns into a lemming race with more than 1 manager.

    As far as education, I thought Paramedic school was enough to get a higher wage, but apparently that year of school is only good for $4,000 more a year, who'd a thunk it!

  • http://twitter.com/firehat firehat

    I think your profitability point is dead wrong. In fact, I think that is part of what the problem with EMS pay scales in the first place. EMS, like fire and law enforcement, is NOT a business and should not be run like one. Businesses maximize efficiency whereas emergency services SHOULD maximize effectiveness in the 1%. Efficiency only maximizes effectiveness, say, 50-75% of the time. The prevalence of business models in EMS compared to fire and LE is part of the problem in the first place. My own agency furnishes a great example: we run out of engines maybe a few times a year. We run out of MICU's maybe a few times a week. But the EMS is not part of the fire department and is maximized for efficiency. The fire department, on the other hand, is maximized for effectiveness in the 1%.

  • Pingback: EMS Pay Sucks! Let’s do something about it | Life Under the Lights

  • Pingback: EMS Pay Sucks!! Part 2 – Identifying the problem | Life Under the Lights

  • landfill624

    Don't you think that by trying to invest in the elderly more, we are merely trying to spread the wealth (or lack there of) even thinner? The idea of Home Health care is an excellent idea, but what about doing some sort of sports physical, or even getting into some sort of Cardiac/Stress testing. We can monitor EKG's, administer IV's, and we all know how to use a treadmill (or at least most of us.)

    You bring up the idea that we need to create revenue for ourselves, this is difficult because Emergency health care is like an insurance policy, everyone wants to have it and no one wants to pay for it. I think maybe the best way to eliminate the overhead is to minimize the “Corporate” influence. One business manager is enough, we don't need to have 2 or 3 sucking off the payroll teet, especially when it usually turns into a lemming race with more than 1 manager.

    As far as education, I thought Paramedic school was enough to get a higher wage, but apparently that year of school is only good for $4,000 more a year, who'd a thunk it!

  • http://twitter.com/firehat firehat

    I think your profitability point is dead wrong. In fact, I think that is part of what the problem with EMS pay scales in the first place. EMS, like fire and law enforcement, is NOT a business and should not be run like one. Businesses maximize efficiency whereas emergency services SHOULD maximize effectiveness in the 1%. Efficiency only maximizes effectiveness, say, 50-75% of the time. The prevalence of business models in EMS compared to fire and LE is part of the problem in the first place. My own agency furnishes a great example: we run out of engines maybe a few times a year. We run out of MICU's maybe a few times a week. But the EMS is not part of the fire department and is maximized for efficiency. The fire department, on the other hand, is maximized for effectiveness in the 1%.

  • http://thehappymedic.com the Happy Medic

    I too have to side with EMS being more of an insurance policy as opposed to a business. By your example the military could be better run by private industry, yet recent examples show the opposite. Excessive waste and lowered standards, but a high salary didn't stop private companies from profiting while still relying on the rank and file soldiers to handle most of the work.

    EMS needs too be provided regardless of the ability to pay. Take that away and Medics aren't pressured to transport everyone to generate a bill or to CYA. With all the little fiefdoms wiped away, we all provide the same service for the same reason, the best interest of the patient, not the corporation (or mom and pop) running the Ambulances.
    Remove the need to make a profit and we can focus on improving our standards, raising the education level and competing to make a place for ourselves at the table. Until then we're the only ones at the Public Safety table trying to make a buck on the backs of our people.
    Government agencies that run poorly are the direct result of bad management. Here are dynamite fire departments led by dynamite folks as there are Cities and municipalities who were well managed and are weathering the economic downturn.
    Your Fanny and Freddie example is another good one.

    Our pay, as a profession, sucks because we are directly tied to dwindling profitability in the private market.

    I believe it should be a public safety agency similar to, but not necessarily within, the Fire or Police Department, road repair and other vital services.

    Keep up the conversation CK!

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

    Chris- I'm enjoying your posts immensely- as usual! I agree with your well-formed thoughts and suggestions. My comments here only serve to better define the debate, and they come from the government-run services.

    First- It seems to be a difficult proposition to attempt to tell an EMS newbie to go get educated. Those that can are already doing so, with many new employees entering the market with a 2- or 4-year degree already in hand. Those who don't have the paper yet also don't have much of a financial incentive to go any further. The pay will still suck for them after all their educational efforts. Also, while universal standards make all the sense in the world, the reality is there are a number of Kings who want specific control over their kingdoms, and would joust fiercely to protect their control. Not impossible, but quite a battle for sure!

    Secondly, no matter how many cheerleaders you put in front of your tax-paying public, they still won't part with their hard-earned cash. If they won't pony up for their children's education and they know they can dial 911 and get an ambulance, they will continue to vote NO behind the polling curtain every time.

    Thirdly, government-run agencies are not in it for a profit. Their “profit” would come from offering the public the “best-acceptable” service at the best available price- hence your wages have a ceiling. One thing an EMS service CAN do is to become more “community-friendly”- increasing their positive involvement publicly with active participation in community events. This may make the customer more accepting of giving more bucks at election time. But, whilst that puts money into the local coffers, the budgeteers still need to make the decision to direct the new-found moneys to up your pay- if they do, their “profit” is not gained. It's a Catch-22-22.

    Finally, Chris, and with all the love one blogger can publicly admit to another without getting all phobic, I'll ask the same Devil's Advocate-type question you had posed earlier this year when I posted about staffing cuts (which I would argue is even worse than working for less-than-we-oughtta-get pay):

    ——————————————
    ” So what's the solution other than saying “Don't cut our budget!!” and calling them names?

    Sure, I agree with you that staffing cuts hurt. I know the reasons why they hurt. I also know that tax revenues are way down and the cuts have to come from somewhere.

    I'm again playing the Devil's Advocate here, but the question must be answered. What's your other option?”
    —————————————————

    In both posts, the arguments make sense. The passion is there. The money is not.

    The money is not.

    The money is not.

    Until the taxpayer is looser with the purse strings, the hard fact is that the money simply is not there.

    Thanks for the discussion, keep the ball rolling, my friend!

  • Paul

    I agree with many of the points in the post as well as some of the points in the comments. My views differ is that I see EMS, Fire and Law Enforcement all as “businesses”. All have a product (health, safety, security, etc), all have customers (or, as a certain medic like to call them, clients), all have stakeholders, all have expenses and all have revenue. Where I see the ďbusiness modelĒ coming into EMS isnít so much to turn a profit. Itís that an industry we can certainly do more to implement best practices, standardize practices, adapt quicker, work more efficiently, identify/track risks or issues and implement strong QC and QA programs. We can do a better job of eliminating waste, improving productivity, reducing inefficiencies, implementing technology and a whole other host of ďbusiness improvement processes.Ē Now in the interest of full disclosure I have to point out that my thinking has been colored by working for a number of years in academic biomedical research and the biotechnology sector. Along the way I was fortunate to be able to advance my education and now tend to look at thing through the lens of my MS and MBA.

    I came to Fire/EMS (per diem and volunteer) in my mid-20ís and saw how much was being done in my service that could be improved, how mentalities and cultures (civilians and firefighters) worked so much against the department I joined. The department culture (and that of many others) was ďUSĒ (firemen) against ďThemĒ (taxpayers). Meanwhile, the private ambulance I worked for part-time (in my state all ďprivatesĒ are little more than glorified taxiís) exemplified how anyone with a license and a pulse could be technically in EMS (be they EMT-B, EMT-C or EMT-P) but do nothing but dialysis runs and transfers. Meanwhile since only the fire departments do real 911.around here there was no way to improve the lot of the crews on an ambulance. Why pay someone as a professional when the obviously donít look, act or conduct themselves as one? By the way ďambulanceĒ around is here is a semi-dirty word (volunteer is even worse in many quarters) because it refers to a private service. REAL EMS happens in a Rescue.

    I agree that barriers to entry need to be raised, I came in with a decent amount of life and career experience but many of the 18 year olds fresh from EMT did little more than drive code 3 as fast as possible to ANYTHING. We need to change cultures to be seen as valuable as fire and police and as educated and professional as a nurse, PA or (dare I say) MD. I disagree that we have to be a municipal service like public works. Why? Those services are cost centers, not revenue centers and as soon as the tax dollars dry up so does everything else. I would prefer to see EMS run as a professional service under a ďquasi-publicĒ entity/joint municipal-private venture (we have a few here that actually work well). Put some checks and balances on the corporate aspect (too much profit driven is bad) as well as the public side (too much cronyism and political sway is also bad). I see nothing wrong with trying to maximize revenue provided that patient care isnít compromised. ďBusiness, revenue and profitĒ are not bad words and if weíre successful, professionals weíll get paid as such.

    Another issue that I see around here is the ďimageĒ problem. Too many services here do a terrible job of managing public perception. The fire departments get paid damn well (when you include OT) for the most part, yet many carry a sense of entitlement that irks the taxpayers, the ďprivatesĒ look like a 3 ring circus and many of the volunteer companies are their own worst enemies. I recently moved and ended up changing departments. Recently I was promoted to Rescue Lt and have at once begun working on building my departments ďbrandĒ with the public we serve. Little things like have a better appearance, a better job of communicating with patient (or clients), using our service name/crew member names, doing more outreach, etc. have done a lot to bolster our image in the public eye. On more than on occasion weíve been told by the patient/patient family ďThank God itís Rescue 1 not those other clowns in the townĒ, heck the cops even have an unofficial policy: if they get shot they will drive or drag themselves to our district to ensure WE are the ones working them up. Applying good business principles makes perfectly good sense in EMS and would go a long way to getting us where we need to be.

  • firemed4

    While I do agree to a point with the arguments made in this article I think you left something out… The salaries of athletes and CEOs are mentioned here but what isn't is the fact that those people are few and far between. It is much more difficult finding a Brett Favre in the world than it is fingding a paramedic or especially an EMT. When I worked for a private EMS provider both my coworkers and myself knew one thing above all, we were expendable. I am by no means saying we weren't valuable but the fact remains that for every one EMT they could fire they had 10 coming out of school waiting to take that place. Thats the reality, there are too many of us and we are too disorganized to become a true force for change.

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

    Chris- I'm enjoying your posts immensely- as usual! I agree with your well-formed thoughts and suggestions. My comments here only serve to better define the debate, and they come from the government-run services.

    First- It seems to be a difficult proposition to attempt to tell an EMS newbie to go get educated. Those that can are already doing so, with many new employees entering the market with a 2- or 4-year degree already in hand. Those who don't have the paper yet also don't have much of a financial incentive to go any further. The pay will still suck for them after all their educational efforts. Also, while universal standards make all the sense in the world, the reality is there are a number of Kings who want specific control over their kingdoms, and would joust fiercely to protect their control. Not impossible, but quite a battle for sure!

    Secondly, no matter how many cheerleaders you put in front of your tax-paying public, they still won't part with their hard-earned cash. If they won't pony up for their children's education and they know they can dial 911 and get an ambulance, they will continue to vote NO behind the polling curtain every time.

    Thirdly, government-run agencies are not in it for a profit. Their “profit” would come from offering the public the “best-acceptable” service at the best available price- hence your wages have a ceiling. One thing an EMS service CAN do is to become more “community-friendly”- increasing their positive involvement publicly with active participation in community events. This may make the customer more accepting of giving more bucks at election time. But, whilst that puts money into the local coffers, the budgeteers still need to make the decision to direct the new-found moneys to up your pay- if they do, their “profit” is not gained. It's a Catch-22-22.

    Finally, Chris, and with all the love one blogger can publicly admit to another without getting all phobic, I'll ask the same Devil's Advocate-type question you had posed earlier this year when I posted about staffing cuts (which I would argue is even worse than working for less-than-we-oughtta-get pay):

    ——————————————
    ” So what's the solution other than saying “Don't cut our budget!!” and calling them names?

    Sure, I agree with you that staffing cuts hurt. I know the reasons why they hurt. I also know that tax revenues are way down and the cuts have to come from somewhere.

    I'm again playing the Devil's Advocate here, but the question must be answered. What's your other option?”
    —————————————————

    In both posts, the arguments make sense. The passion is there. The money is not.

    The money is not.

    The money is not.

    Until the taxpayer is looser with the purse strings, the hard fact is that the money simply is not there.

    Thanks for the discussion, keep the ball rolling, my friend!

  • Paul

    I agree with many of the points in the post as well as some of the points in the comments. My views differ is that I see EMS, Fire and Law Enforcement all as “businesses”. All have a product (health, safety, security, etc), all have customers (or, as a certain medic like to call them, clients), all have stakeholders, all have expenses and all have revenue. Where I see the ďbusiness modelĒ coming into EMS isnít so much to turn a profit. Itís that an industry we can certainly do more to implement best practices, standardize practices, adapt quicker, work more efficiently, identify/track risks or issues and implement strong QC and QA programs. We can do a better job of eliminating waste, improving productivity, reducing inefficiencies, implementing technology and a whole other host of ďbusiness improvement processes.Ē Now in the interest of full disclosure I have to point out that my thinking has been colored by working for a number of years in academic biomedical research and the biotechnology sector. Along the way I was fortunate to be able to advance my education and now tend to look at thing through the lens of my MS and MBA.

    I came to Fire/EMS (per diem and volunteer) in my mid-20ís and saw how much was being done in my service that could be improved, how mentalities and cultures (civilians and firefighters) worked so much against the department I joined. The department culture (and that of many others) was ďUSĒ (firemen) against ďThemĒ (taxpayers). Meanwhile, the private ambulance I worked for part-time (in my state all ďprivatesĒ are little more than glorified taxiís) exemplified how anyone with a license and a pulse could be technically in EMS (be they EMT-B, EMT-C or EMT-P) but do nothing but dialysis runs and transfers. Meanwhile since only the fire departments do real 911.around here there was no way to improve the lot of the crews on an ambulance. Why pay someone as a professional when the obviously donít look, act or conduct themselves as one? By the way ďambulanceĒ around is here is a semi-dirty word (volunteer is even worse in many quarters) because it refers to a private service. REAL EMS happens in a Rescue.

    I agree that barriers to entry need to be raised, I came in with a decent amount of life and career experience but many of the 18 year olds fresh from EMT did little more than drive code 3 as fast as possible to ANYTHING. We need to change cultures to be seen as valuable as fire and police and as educated and professional as a nurse, PA or (dare I say) MD. I disagree that we have to be a municipal service like public works. Why? Those services are cost centers, not revenue centers and as soon as the tax dollars dry up so does everything else. I would prefer to see EMS run as a professional service under a ďquasi-publicĒ entity/joint municipal-private venture (we have a few here that actually work well). Put some checks and balances on the corporate aspect (too much profit driven is bad) as well as the public side (too much cronyism and political sway is also bad). I see nothing wrong with trying to maximize revenue provided that patient care isnít compromised. ďBusiness, revenue and profitĒ are not bad words and if weíre successful, professionals weíll get paid as such.

    Another issue that I see around here is the ďimageĒ problem. Too many services here do a terrible job of managing public perception. The fire departments get paid damn well (when you include OT) for the most part, yet many carry a sense of entitlement that irks the taxpayers, the ďprivatesĒ look like a 3 ring circus and many of the volunteer companies are their own worst enemies. I recently moved and ended up changing departments. Recently I was promoted to Rescue Lt and have at once begun working on building my departments ďbrandĒ with the public we serve. Little things like have a better appearance, a better job of communicating with patient (or clients), using our service name/crew member names, doing more outreach, etc. have done a lot to bolster our image in the public eye. On more than on occasion weíve been told by the patient/patient family ďThank God itís Rescue 1 not those other clowns in the townĒ, heck the cops even have an unofficial policy: if they get shot they will drive or drag themselves to our district to ensure WE are the ones working them up. Applying good business principles makes perfectly good sense in EMS and would go a long way to getting us where we need to be.

  • firemed4

    While I do agree to a point with the arguments made in this article I think you left something out… The salaries of athletes and CEOs are mentioned here but what isn't is the fact that those people are few and far between. It is much more difficult finding a Brett Favre in the world than it is fingding a paramedic or especially an EMT. When I worked for a private EMS provider both my coworkers and myself knew one thing above all, we were expendable. I am by no means saying we weren't valuable but the fact remains that for every one EMT they could fire they had 10 coming out of school waiting to take that place. Thats the reality, there are too many of us and we are too disorganized to become a true force for change.

  • http://www.firegeezer.com Mike "FossilMedic" Ward

    Hey Chris, we need to explore “Seek out New Ideas and Profitable Ventures!”

    The movement to Scope of Practice may provide opportunities … opportunities that Physician Assistants and Nurse Practicioners may also be looking at.

    Happy New Year!

  • http://www.firegeezer.com Mike "FossilMedic" Ward

    Hey Chris, we need to explore “Seek out New Ideas and Profitable Ventures!”

    The movement to Scope of Practice may provide opportunities … opportunities that Physician Assistants and Nurse Practicioners may also be looking at.

    Happy New Year!

  • Ambulance_Driver

    [Disclosure: I work for a for-profit EMS agency that runs interfacility transfers and owns the 911 contract for most of its service area. Every company I've ever worked for has been the same.]

    That said, I believe the ideal model for EMS is a third-service, taxpayer subsidized system, separate from police and fire. They should also bill private insurance, Medicare and Medicaid for their services, when applicable.

    This doesn't necessarily mean they should be profitable, but they should do whatever it takes to lessen their dependence on taxpayer subsidies, while still providing quality care and good wages for their medics.

    But part of the problem IS the volunteers, and not just in the abstract, “Why buy the cow when you can get the milk for free?” argument.

    I'm not bashing volunteers. I teach a lot of them, and I've been one myself. But whenever CMS calculates a new Medicare fee schedule (and usually Medicaid reimbursement is tied proportionally to Medicare), they do so by averaging the cost of providing EMS services around the country.

    When well over half of EMS care in this country is provided by volunteers, that really drags down the average, resulting in a far smaller revenue pool for paying personnel.

    Heck, it took several years of Medicare reimbursing at only 70% of actual cost before relief legislation could be passed to make the fee schedule a little less of a colossal money-loser for providers.

    And you can bet that, when the next revision comes around, they will use the same formula.

    I appreciate the dedication and altruism of volunteers, but the cynical realist in me says that if a community wants EMS, they'd better be willing to pay for it. As long as we continue to provide our services for free, those services are not going to be valued.

  • http://www.nottrainedbutwetryhard.blogspot.com FireCap5

    Well folks, its time for me, a lowly EMT-B to weigh in.

    I say lowly, because I work in a private fire based system performing EMS duties for a third party private ambulance.

    They provide the rig and the Medic, my company provides the EMT-B for the rig.

    I volunteer in one of the premier ALS systems in my state. 5 time winners of ALS Provider of the Year. All the local VFD's and Career FD's have EMT-B and First Responders on staff and respond to calls in their jurisdiction, establishing BLS care quickly and then assisting the ALS Ambulance crew upon their arrival.

    Education is key.

    Educate yourself AND those you serve. I don't mean wait until you want something or are facing budget cuts. I mean every dang day of the week. Participate in local events, talk to people while you are there, don't just sit in the rig. Be your own advocate!

    Educate yourself so that when your views are challenged you are ready to rebutt with facts and knowledge, not emotion. It is WAY easier to get emotional than stay rational. If you go over to emotion, the argument is lost.

    Where is EMS's Billy G, Branigan, Dunn, Brunacini?? Where are the nationallly recognized voices? It is all Doctors at hospitals and an isolated Medic here or there speaking out and up.

    Volunteers do hurt the overall goal. They are held up everytime more pay is asked for. They are not to blame though. Stop bashing them. Without their services, countless numbers of Americans would lie bleeding to death on our rural highways and in their homes. There is NO WAY that those rural areas they serve are going to pony up the money for a paid service, and if they did it would only serve to drag wages lower on the average.

    Stand Alone EMS services can and do work. The one I volly with works very well, they bill Medicare and Medicade as well as insurance companies. They field 6 ALS ambulances 24-7, with 22 fire departments supporting the mission by decreasing response times.

    Fire Based works too! In many areas, the FD has the facilities in place to forward deploy ALS units to population centers, and even to rural clusters. The old mentality of firefighters that I hate EMS is slowly dying out as these guys retire or quit. THere is no shartage of replacements for them either. The quality and professionalism of fire based EMS is every bit as good as anywhere.

    There is no one answer that fits all for what type of provider system is best, anymore than there is one way to establish an airway in a patient! STOP THE BICKERING AND WORK TOGETHER!!

    This is the same problem the Fire Service as a whole has.

    We will never bring wages up until we speak with one voice and get the people to understand what we do and why.

    Get 'em on our side!

  • http://www.nottrainedbutwetryhard.blogspot.com FireCap5

    Well folks, its time for me, a lowly EMT-B to weigh in.

    I say lowly, because I work in a private fire based system performing EMS duties for a third party private ambulance.

    They provide the rig and the Medic, my company provides the EMT-B for the rig.

    I volunteer in one of the premier ALS systems in my state. 5 time winners of ALS Provider of the Year. All the local VFD's and Career FD's have EMT-B and First Responders on staff and respond to calls in their jurisdiction, establishing BLS care quickly and then assisting the ALS Ambulance crew upon their arrival.

    Education is key.

    Educate yourself AND those you serve. I don't mean wait until you want something or are facing budget cuts. I mean every dang day of the week. Participate in local events, talk to people while you are there, don't just sit in the rig. Be your own advocate!

    Educate yourself so that when your views are challenged you are ready to rebutt with facts and knowledge, not emotion. It is WAY easier to get emotional than stay rational. If you go over to emotion, the argument is lost.

    Where is EMS's Billy G, Branigan, Dunn, Brunacini?? Where are the nationallly recognized voices? It is all Doctors at hospitals and an isolated Medic here or there speaking out and up.

    Volunteers do hurt the overall goal. They are held up everytime more pay is asked for. They are not to blame though. Stop bashing them. Without their services, countless numbers of Americans would lie bleeding to death on our rural highways and in their homes. There is NO WAY that those rural areas they serve are going to pony up the money for a paid service, and if they did it would only serve to drag wages lower on the average.

    Stand Alone EMS services can and do work. The one I volly with works very well, they bill Medicare and Medicade as well as insurance companies. They field 6 ALS ambulances 24-7, with 22 fire departments supporting the mission by decreasing response times.

    Fire Based works too! In many areas, the FD has the facilities in place to forward deploy ALS units to population centers, and even to rural clusters. The old mentality of firefighters that I hate EMS is slowly dying out as these guys retire or quit. THere is no shartage of replacements for them either. The quality and professionalism of fire based EMS is every bit as good as anywhere.

    There is no one answer that fits all for what type of provider system is best, anymore than there is one way to establish an airway in a patient! STOP THE BICKERING AND WORK TOGETHER!!

    This is the same problem the Fire Service as a whole has.

    We will never bring wages up until we speak with one voice and get the people to understand what we do and why.

    Get 'em on our side!

  • http://www.nottrainedbutwetryhard.blogspot.com FireCap5

    Well folks, its time for me, a lowly EMT-B to weigh in.

    I say lowly, because I work in a private fire based system performing EMS duties for a third party private ambulance.

    They provide the rig and the Medic, my company provides the EMT-B for the rig.

    I volunteer in one of the premier ALS systems in my state. 5 time winners of ALS Provider of the Year. All the local VFD's and Career FD's have EMT-B and First Responders on staff and respond to calls in their jurisdiction, establishing BLS care quickly and then assisting the ALS Ambulance crew upon their arrival.

    Education is key.

    Educate yourself AND those you serve. I don't mean wait until you want something or are facing budget cuts. I mean every dang day of the week. Participate in local events, talk to people while you are there, don't just sit in the rig. Be your own advocate!

    Educate yourself so that when your views are challenged you are ready to rebutt with facts and knowledge, not emotion. It is WAY easier to get emotional than stay rational. If you go over to emotion, the argument is lost.

    Where is EMS's Billy G, Branigan, Dunn, Brunacini?? Where are the nationallly recognized voices? It is all Doctors at hospitals and an isolated Medic here or there speaking out and up.

    Volunteers do hurt the overall goal. They are held up everytime more pay is asked for. They are not to blame though. Stop bashing them. Without their services, countless numbers of Americans would lie bleeding to death on our rural highways and in their homes. There is NO WAY that those rural areas they serve are going to pony up the money for a paid service, and if they did it would only serve to drag wages lower on the average.

    Stand Alone EMS services can and do work. The one I volly with works very well, they bill Medicare and Medicade as well as insurance companies. They field 6 ALS ambulances 24-7, with 22 fire departments supporting the mission by decreasing response times.

    Fire Based works too! In many areas, the FD has the facilities in place to forward deploy ALS units to population centers, and even to rural clusters. The old mentality of firefighters that I hate EMS is slowly dying out as these guys retire or quit. THere is no shartage of replacements for them either. The quality and professionalism of fire based EMS is every bit as good as anywhere.

    There is no one answer that fits all for what type of provider system is best, anymore than there is one way to establish an airway in a patient! STOP THE BICKERING AND WORK TOGETHER!!

    This is the same problem the Fire Service as a whole has.

    We will never bring wages up until we speak with one voice and get the people to understand what we do and why.

    Get 'em on our side!

  • Ambulance_Driver

    [Disclosure: I work for a for-profit EMS agency that runs interfacility transfers and owns the 911 contract for most of its service area. Every company I've ever worked for has been the same.]

    That said, I believe the ideal model for EMS is a third-service, taxpayer subsidized system, separate from police and fire. They should also bill private insurance, Medicare and Medicaid for their services, when applicable.

    This doesn't necessarily mean they should be profitable, but they should do whatever it takes to lessen their dependence on taxpayer subsidies, while still providing quality care and good wages for their medics.

    But part of the problem IS the volunteers, and not just in the abstract, “Why buy the cow when you can get the milk for free?” argument.

    I'm not bashing volunteers. I teach a lot of them, and I've been one myself. But whenever CMS calculates a new Medicare fee schedule (and usually Medicaid reimbursement is tied proportionally to Medicare), they do so by averaging the cost of providing EMS services around the country.

    When well over half of EMS care in this country is provided by volunteers, that really drags down the average, resulting in a far smaller revenue pool for paying personnel.

    Heck, it took several years of Medicare reimbursing at only 70% of actual cost before relief legislation could be passed to make the fee schedule a little less of a colossal money-loser for providers.

    And you can bet that, when the next revision comes around, they will use the same formula.

    I appreciate the dedication and altruism of volunteers, but the cynical realist in me says that if a community wants EMS, they'd better be willing to pay for it. As long as we continue to provide our services for free, those services are not going to be valued.

  • http://www.nottrainedbutwetryhard.blogspot.com FireCap5

    Well folks, its time for me, a lowly EMT-B to weigh in.

    I say lowly, because I work in a private fire based system performing EMS duties for a third party private ambulance.

    They provide the rig and the Medic, my company provides the EMT-B for the rig.

    I volunteer in one of the premier ALS systems in my state. 5 time winners of ALS Provider of the Year. All the local VFD's and Career FD's have EMT-B and First Responders on staff and respond to calls in their jurisdiction, establishing BLS care quickly and then assisting the ALS Ambulance crew upon their arrival.

    Education is key.

    Educate yourself AND those you serve. I don't mean wait until you want something or are facing budget cuts. I mean every dang day of the week. Participate in local events, talk to people while you are there, don't just sit in the rig. Be your own advocate!

    Educate yourself so that when your views are challenged you are ready to rebutt with facts and knowledge, not emotion. It is WAY easier to get emotional than stay rational. If you go over to emotion, the argument is lost.

    Where is EMS's Billy G, Branigan, Dunn, Brunacini?? Where are the nationallly recognized voices? It is all Doctors at hospitals and an isolated Medic here or there speaking out and up.

    Volunteers do hurt the overall goal. They are held up everytime more pay is asked for. They are not to blame though. Stop bashing them. Without their services, countless numbers of Americans would lie bleeding to death on our rural highways and in their homes. There is NO WAY that those rural areas they serve are going to pony up the money for a paid service, and if they did it would only serve to drag wages lower on the average.

    Stand Alone EMS services can and do work. The one I volly with works very well, they bill Medicare and Medicade as well as insurance companies. They field 6 ALS ambulances 24-7, with 22 fire departments supporting the mission by decreasing response times.

    Fire Based works too! In many areas, the FD has the facilities in place to forward deploy ALS units to population centers, and even to rural clusters. The old mentality of firefighters that I hate EMS is slowly dying out as these guys retire or quit. THere is no shartage of replacements for them either. The quality and professionalism of fire based EMS is every bit as good as anywhere.

    There is no one answer that fits all for what type of provider system is best, anymore than there is one way to establish an airway in a patient! STOP THE BICKERING AND WORK TOGETHER!!

    This is the same problem the Fire Service as a whole has.

    We will never bring wages up until we speak with one voice and get the people to understand what we do and why.

    Get 'em on our side!

background image Blogger Img

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.
Categories
  • 2009 (2)
  • 911 (4)
  • 911 fail (20)
  • accident (4)
  • ACLS (3)
  • Administration & Leadership (85)
  • aed (2)
  • AHA (3)
  • Als (9)
  • ALS Intercept (14)
  • Ambulance (90)
  • Ambulance cleaning (4)
  • Ambulance Driver (6)
  • ambulance humor (20)
  • Ambulance maintenance (4)
  • ambulance report (3)
  • American Heart Association (3)
  • amulance (1)
  • appreciation (13)
  • attack (2)
  • bad calls (5)
  • Bed pan (1)
  • Bed pans (1)
  • bedpan (1)
  • bernoulli (1)
  • blog (5)
  • blogger (4)
  • blogosphere (3)
  • boy scouts (1)
  • camaraderie (2)
  • Case law (2)
  • cat puke (1)
  • cats (1)
  • CCC (5)
  • CCR (7)
  • CDC (1)
  • change (20)
  • chart (1)
  • CISD (3)
  • ckemtp (14)
  • ckemtp rants (29)
  • cnn fail (1)
  • code-3 (2)
  • comfort (1)
  • Command & Leadership (54)
  • cool pics of thunderstorm (1)
  • courtesy (2)
  • cpr (10)
  • cpr fail (4)
  • cpr save (4)
  • crisis (6)
  • dave barry (2)
  • dextrocardia (1)
  • disaster (2)
  • disinfection (4)
  • Dispatch & Communications (2)
  • DNR (5)
  • Do Not Resuscitate Order (5)
  • domestic violence (1)
  • Dr. Bledsoe (1)
  • drive fast (2)
  • duty boots (2)
  • Economics (17)
  • edemse (28)
  • EKG (10)
  • Emergency Communications (5)
  • Emergency Medical Services (189)
  • Emergency Nurse (11)
  • Emergency room (11)
  • Emergency Room Nurse (5)
  • emotions (17)
  • EMS (250)
  • ems 2.0 (67)
  • EMS Blog (19)
  • EMS Blog Carnival (3)
  • EMS blogosphere (11)
  • ems boots (1)
  • EMS Conference (4)
  • EMS Dispatch (3)
  • ems education (54)
  • EMS ethics (54)
  • ems garage (2)
  • EMS Health & Safety (69)
  • EMS Humor (41)
  • EMS Management (52)
  • EMS Motivation (21)
  • EMS motivational posters (1)
  • ems narrative (7)
  • EMS narrative report (6)
  • ems pants (1)
  • EMS paramedics (25)
  • ems patient care report (6)
  • EMS pay sucks (7)
  • ems pcr (1)
  • EMS pep talk (21)
  • EMS practice (8)
  • EMS protocol project (1)
  • EMS protocols (12)
  • EMS rant (27)
  • ems report (3)
  • EMS safety (10)
  • ems salary (8)
  • ems scenario (9)
  • ems scenario based education (12)
  • EMS system (9)
  • EMS Topics (237)
  • EMS training (58)
  • ems uniforms (1)
  • EMS week (10)
  • EMS Week 2009 (2)
  • ems week 2010 (8)
  • EMT (73)
  • emt narrative (3)
  • EMT-Intermediate (6)
  • EMT-Paramedic Specialist (5)
  • ER (8)
  • ET Intubation (3)
  • Ethics (27)
  • everyday ems ethics (29)
  • explosion video (1)
  • extrication (1)
  • ez-io (2)
  • FEMA (2)
  • fire (13)
  • fire boots (2)
  • Fire department (38)
  • fire department taser training (1)
  • Fire Dispatch (1)
  • Fire Prevention & Education (4)
  • Fire Rescue Topics (96)
  • fire truck (1)
  • Firefighter (21)
  • Firefighter Safety & Health (20)
  • firefighter Tazed (1)
  • Firefighting Operations (4)
  • Fires (2)
  • first call (1)
  • first day of school (1)
  • first responder (2)
  • friendly (1)
  • Funding & Staffing (15)
  • funny (8)
  • grumblemedics (6)
  • Happy Medic (2)
  • harry reid (1)
  • HazMat (1)
  • hospital (5)
  • humor (14)
  • hurricane (1)
  • idph (3)
  • illinois (4)
  • In the Line of Duty (13)
  • infection control (5)
  • information (1)
  • inside the mind of a paramedic (16)
  • intraosseous (3)
  • Introduction (1)
  • intubation (3)
  • IO (3)
  • Iowa (4)
  • Iowa EMS (4)
  • ireland (1)
  • Irish EMS (1)
  • IV (3)
  • jaws of life (1)
  • kindergarten (1)
  • kneeling (1)
  • las vegas review journal (1)
  • Letter (2)
  • letter to the editor (4)
  • lights and sirens (2)
  • Line of Duty (12)
  • link (3)
  • MABAS (1)
  • Magnum boots (2)
  • magnum elite equipment (2)
  • mainstream media sucks (3)
  • Major Incidents (3)
  • Management (10)
  • Mass Casualty Incident (1)
  • medical ethics (19)
  • medicblog999 (7)
  • mental illness (2)
  • mental imagery (6)
  • Mission Lifeline (1)
  • Music (1)
  • narrative (4)
  • narrative report (3)
  • new perspective (16)
  • News (23)
  • newspaper (3)
  • NOAA (1)
  • northern illinois (3)
  • nursing home (2)
  • obama (1)
  • odansetron (2)
  • Paramedic (195)
  • paramedic education (74)
  • paramedic narrative (7)
  • paramedic pants (1)
  • paramedic salary (11)
  • Patient Assessment (7)
  • patient care (37)
  • Patient Handovers (3)
  • Patient Management (77)
  • pcr (2)
  • pediatric cardiology (2)
  • physician (10)
  • politics (36)
  • potential (14)
  • PR (5)
  • pride (15)
  • profession (27)
  • professionalism (32)
  • Protocol development (5)
  • psychology (6)
  • Public relations (14)
  • puke (2)
  • rant (7)
  • relationships (2)
  • renaisance (1)
  • rescue (1)
  • rescuing providence (1)
  • RN (3)
  • Rockford (1)
  • roll-over (1)
  • run sheet (2)
  • rural ems (3)
  • sadness (6)
  • safety (4)
  • salary (7)
  • sanitize (3)
  • save (3)
  • scenario (13)
  • scenario based training (15)
  • school bus (1)
  • Scope of Practice (4)
  • severe storm pictures (2)
  • sherman frederick (1)
  • shift length (2)
  • show tunes (1)
  • SitRep (1)
  • Skilled Nursing Facility (2)
  • SMG (7)
  • SMO (7)
  • soap (4)
  • soap charting (3)
  • socialized medicine (4)
  • southern wisconsin (4)
  • Special Operations (1)
  • STEMI (8)
  • stories (11)
  • swine flu (2)
  • Taser (1)
  • tattoo (1)
  • tattoo humor (1)
  • Technology & Communications (9)
  • technology-communications-ems-topics (10)
  • thank you (3)
  • The EMT Spot (2)
  • The Handover (3)
  • The Shine Factor (2)
  • thom dick (1)
  • thunderstorm (1)
  • train derailment (1)
  • train explosion (1)
  • Training (16)
  • Training & Development (49)
  • training-fire-rescue-topics (19)
  • Transfer of Care (1)
  • UK Child custody (1)
  • UK medic attacked (1)
  • UK paramedics (5)
  • Uncategorized (230)
  • united kingdom (4)
  • universal healthcare (5)
  • us (2)
  • US economy (11)
  • Vehicle Operation & Ambulances (3)
  • Vehicle Operations & Apparatus (1)
  • Videos (3)
  • volunteer fire department (9)
  • volunteer firefighter (6)
  • wall cloud (1)
  • Week (1)
  • whattaya do (4)
  • when god made paramedics (1)
  • wisconsin (3)
  • wolf parkinson white (1)
  • wpw (1)
  • wpw syndrome (1)
  • Your Happy Medic (5)
  • zofran (1)
  • Comments
    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
    –ź–Ľ–Ķ–ļ—Ā–Ķ–Ļ –†—É–ļ–ł–Ĺ
    So You Think You Can EKG?
    78% accuracy... and I'm not even a medical student, only a blog reader...
    2014-07-12 18:12:00
    Another One Bites the Dust (Part 2) | Medic15
    The Five Second Rule – Six Ways you can Reduce Pauses in Compressions and Save More Lives with CPR
    […] 5,7,9 http://www.lifeunderthelights.com/2014/03/24/the-five-second-rule-six-ways-you-can-reduce-pauses-in-… […]
    2014-07-09 18:39:31

    Care to Search the Blog?

    FireEMS Blogs eNewsletter

    Sign-up to receive our free monthly eNewsletter

    LATEST EMS NEWS

    HOT FORUM DISCUSSIONS