EMS Pay Sucks!! (Part 4) – We Control the Market

I read a short article in Entrepreneur Magazine (to which I subscribe) that had a story about a sign hanging in a shop somewhere that said this:

“Low Price. High Quality. Good Service.  – Pick two”

The saying goes that consumers can pick two of the above things that they feel are most important to them in their buying decisions. It also implies that businesses can focus and compete on two of the three, but they can’t do them all.

I agree with the sign. It shows in the fact that there are multiple outlets in the marketplace to purchase similar goods and services. If you’re price sensitive and don’t want the highest quality of furniture you buy from Ikea and assemble your purchase yourself. If you’re always after the best quality you go to a custom furniture builder who would be more than happy to deliver and install for the price you’re paying him. As always, if you as a consumer do not like what the merchant has for sale you “vote with your feet” and go somewhere else to spend your hard-earned money.

And that is how “the market” works. Businesses compete with one another for your patronage and this competition keeps their prices as low as the consumers are willing to pay for the level of quality they are willing to accept. People are willing to accept lesser quality products for lower cost as much as they are willing to pay more for better quality. Service and support plays a role in there too as nobody wants to get burned on a deal, product, or service. If your widget store has exactly the same quality of widgets for sale with the same service as the widget store across the street, people are going to buy the widgets at the lowest cost. Change any of the price/quality/service variables and the sales will follow where the consumer sees the best value. Of course I’ve oversimplified this a bit as the system we call “the free market” is infinitely nuanced in its simplicity, but this is indeed an EMS article. So don’t even get me started on that Adam Smith guy and his sleight of hand.

So why am I bringing forth this short little explanation of the free market? It’s because the ambulance industry is a service provider. Unfortunately (or fortunately if you prefer) we’re not entirely bent upon the whims of the marketplace due to the governmental regulations that set our price, control our service types, and dictate how we run our businesses. You probably know that Ambulance Services are “service providers” as they provide a service to our patients in exchange for fees paid for that service (ha!) and their tax revenues, but did you know that the Paramedics and EMTs are collectively a “service provider” for the ambulance industry itself?

Follow me here for a bit. If you separate out the collective “ambulance industry” from the collective EMTs and Paramedics making up the Profession of Paramedicine, you can see that there are two separate groups functioning in tandem. While we’ve always been inseparable and have been defined as one collective group, I suggest that we are really two entities. The Profession (Defined here as the Paramedics and EMTs together) and the ambulance industry (defined as the places we most usually work).The ambulance industry needs a service from the Profession in the form of us providing them with bodies to run their trucks, and we need them to employ us. If you were to take this thought further, we as members of the Profession compete with one another to provide our services to the various ambulance companies in the form of applying to and accepting positions with them under whatever conditions they set for us. They set the pay rates, benefits, shift schedules, etc and we paramedics compete with each other for the positions… usually accepting less compensation than we wished to receive as a condition of being employed.

Historically, our profession has competed on price as evidenced by the fact that our pay rates are much lower than we want to accept for our services. According to the above analogy, as we push our price lower either the quality of our education and skills or our level of service is going to suffer for it. One needs to look no further than their own paycheck to see that the pay is terrible. One also needs to look no further than their local “Medic Mill” school that exists solely to pump out EMTs and Paramedics with “a pulse and an EMT card” at the lowest possible cost with the absolute minimum level of education. We’ve become the Wal-Mart of ambulance staff, always rolling back our prices and lowering quality to encourage more and more demand.

If I have any liberty to speak to our profession I ask that today we all make the collective decision to compete on “High Quality” and “Good Service”, leaving “Low Price” behind. Frankly it hasn’t worked for our profession to provide our services for the low bid price. The subsequent drop in the quality of our education and services isn’t the best for our patients. We’ll always compete amongst each other to provide our services to the ambulance industry (I.E. apply for jobs) but if we all accept that we’re no longer competing on “Low Price”, we’ll all reap the benefits. Our patients will as well.

I suggest that we begin to “vote with our feet” more often in our quest for employment. If there are multiple ambulance services in your town, pick the one that offers the best pay and benefits and apply there for your employment. If and when you get hired, work like heck to make them the dominant ambulance company in the marketplace. Once the other competitors realize that the ambulance service with the best pay and benefits is gaining a competitive advantage, they’ll change… or be forced out of business. What you’ll begin to see is that the ambulance service that pays the best will begin to be able to “get what they pay for” from the profession in the fact that they will only hire the best qualified among us. Therefore we’ll begin to have to compete on quality and service to get hired for the best pay. We’ll no longer be competing on price alone. You’ll have to put more effort into the profession, but you’ll reap the rewards in terms of higher pay and benefits.

In addition, we need more Medicpreneurs. I’ve said before that the only way to make a lot of money in this game is to be the owner of a service. What’s to say that you can’t start your own ambulance company to put your boss out of business? Hire the best of your coworkers and pay them what they deserve. Do your best and work very hard every day. Soon enough, you’ll win if you can beat the market. You’ll be helping your profession and yourself as well.

When we begin to see the collective power that we wield as a profession in the marketplace we can begin to change the marketplace to fit our wishes. If we want EMS 2.0 to go ahead and get here already we’ve got to collectively become aware of our power and our duty to control the playing field. We haven’t won yet, let’s change the rules so we do. We owe it to our families, our patients, and everyone who depends on us. Wake Up EMS. We control the game here folks… We just have to realize the power we have together.

Low Price. High Quality. Good Service – Which two do you pick?

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  • http://firecritic.com Fire Critic

    You suggest starting an ambulance company, giving better service than others and paying medics more than others.

    The biggest problem I see with this is the fact that ambulance choice seems to be picked largely on price…i.e. the cheapest after medicare picks up some of the bill.

    In order to pay the medics more then wouldn't you have to charge more….conversely working against the profitable bottom line ambulance company down the street.

  • http://firecritic.com Fire Critic

    You suggest starting an ambulance company, giving better service than others and paying medics more than others.

    The biggest problem I see with this is the fact that ambulance choice seems to be picked largely on price…i.e. the cheapest after medicare picks up some of the bill.

    In order to pay the medics more then wouldn't you have to charge more….conversely working against the profitable bottom line ambulance company down the street.

  • SC

    Good post, but you assume that money will lead to a better quality of service. It is well proven that money is really only a good motivator for a few months for an employee. So unless your service is willing to constantly be throwing money at its employees, it's not going to entirely be a great long term solution.

    I think the big motivator for a long successful EMS career, is more working conditions (equipment, protocols, and physical buildings) and the type of calls the service runs. This is really why Fire based EMS and EMS as a third service tends to be the “premiere” place to be employed. Typically non-profit driven pay scales, good benefits, good equipment, kick ass schedules and most importantly, more “exciting” calls. Your previous post laid out the benefits and the detractions from the two services above. I strongly believe that profit as a motivator tends to kill the patient care, versus who your employer is. After all a Private EMS company is a business that HAS TO make a profit to survive and that in turn compromises the ability to care for a patient “at any cost”. I think a non-profit, but for specifically government based (Fire or Third Service, and my conservative side cringes at the thought) tend to be able to eat the cost of more aggressive and costly protocols and procedures. After all we’re saving lives here and you can’t put a price on that, or at least that’s what our tax marketing campaigns say.

    The solution is not to push for a new company to hire good employees and pay them well. The solution is to push for ALL EMS providers to better the profession and let the market see the need for a better value add service. I'm sorry to say, but EMS needs to be a degreed field for both Basics and Medics. Greater Education, drives a greater service, drives a better pay scale. Throw in ALOT of public education (ala “I'm not just an ambulance driver”) and MAYBE you'll see an improvement in the field. We've got a LONG way to go.

    The thing you really have right in this post is really obscured by the “other data”… That WE as EMS providers, regardless of what type of service you work for, have the power to change and push this field to where WE think it needs to be. I’m just finding your blog now, and reading some of the other posts you have, I just may need to add this to my regular blog reading, keep up the good work!

    Sincerely,
    A Happy Degreed FF/Medic :)

  • SC

    Good post, but you assume that money will lead to a better quality of service. It is well proven that money is really only a good motivator for a few months for an employee. So unless your service is willing to constantly be throwing money at its employees, it's not going to entirely be a great long term solution.

    I think the big motivator for a long successful EMS career, is more working conditions (equipment, protocols, and physical buildings) and the type of calls the service runs. This is really why Fire based EMS and EMS as a third service tends to be the “premiere” place to be employed. Typically non-profit driven pay scales, good benefits, good equipment, kick ass schedules and most importantly, more “exciting” calls. Your previous post laid out the benefits and the detractions from the two services above. I strongly believe that profit as a motivator tends to kill the patient care, versus who your employer is. After all a Private EMS company is a business that HAS TO make a profit to survive and that in turn compromises the ability to care for a patient “at any cost”. I think a non-profit, but for specifically government based (Fire or Third Service, and my conservative side cringes at the thought) tend to be able to eat the cost of more aggressive and costly protocols and procedures. After all we’re saving lives here and you can’t put a price on that, or at least that’s what our tax marketing campaigns say.

    The solution is not to push for a new company to hire good employees and pay them well. The solution is to push for ALL EMS providers to better the profession and let the market see the need for a better value add service. I'm sorry to say, but EMS needs to be a degreed field for both Basics and Medics. Greater Education, drives a greater service, drives a better pay scale. Throw in ALOT of public education (ala “I'm not just an ambulance driver”) and MAYBE you'll see an improvement in the field. We've got a LONG way to go.

    The thing you really have right in this post is really obscured by the “other data”… That WE as EMS providers, regardless of what type of service you work for, have the power to change and push this field to where WE think it needs to be. I’m just finding your blog now, and reading some of the other posts you have, I just may need to add this to my regular blog reading, keep up the good work!

    Sincerely,
    A Happy Degreed FF/Medic :)

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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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