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:
ďLow Price. High Quality. Good Service. †Ė Pick twoĒ
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 canít 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 youíre price sensitive and donít want the highest quality of furniture you buy from Ikea and assemble your purchase yourself. If youíre 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 youíre paying him. As always, if you as a consumer do not like what the merchant has for sale you ďvote with your feetĒ and go somewhere else to spend your hard-earned money.
And that is how ďthe marketĒ 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 Iíve oversimplified this a bit as the system we call ďthe free marketĒ is infinitely nuanced in its simplicity, but this is indeed an EMS article. So donít 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? Itís because the ambulance industry is a service provider. Unfortunately (or fortunately if you prefer) weíre 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 ďservice providersĒ 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 ďservice providerĒ for the ambulance industry itself?
Follow me here for a bit. If you separate out the collective ďambulance industryĒ 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 weíve 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 positionsÖ 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 ďMedic MillĒ school that exists solely to pump out EMTs and Paramedics with ďa pulse and an EMT cardĒ at the lowest possible cost with the absolute minimum level of education. Weíve 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 ďHigh QualityĒ and ďGood ServiceĒ, leaving ďLow PriceĒ behind. Frankly it hasnít worked for our profession to provide our services for the low bid price. The subsequent drop in the quality of our education and services isnít the best for our patients. Weíll always compete amongst each other to provide our services to the ambulance industry (I.E. apply for jobs) but if we all accept that weíre no longer competing on ďLow PriceĒ, weíll all reap the benefits. Our patients will as well.
I suggest that we begin to ďvote with our feetĒ 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, theyíll changeÖ or be forced out of business. What youíll begin to see is that the ambulance service that pays the best will begin to be able to ďget what they pay forĒ from the profession in the fact that they will only hire the best qualified among us. Therefore weíll begin to have to compete on quality and service to get hired for the best pay. Weíll no longer be competing on price alone. Youíll have to put more effort into the profession, but youíll reap the rewards in terms of higher pay and benefits.
In addition, we need more Medicpreneurs. Iíve said before that the only way to make a lot of money in this game is to be the owner of a service. Whatís to say that you canít 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, youíll win if you can beat the market. Youíll 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 weíve got to collectively become aware of our power and our duty to control the playing field. We havenít won yet, letís 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 folksÖ We just have to realize the power we have together.
Low Price. High Quality. Good Service Ė Which two do you pick?