Maybe You Don’t Deserve More Money – A Guest Post

My new ambulance partners don’t really take me seriously the first time they witness me do this. They don’t really think I’m sincere, I guess. Neither do the new people who I stop in the hallway and thank, and I mean sincerely thank, for doing their part to save the lives of my patients and prevent the suffering of countless others. These people labor in obscurity for the most part, performing a thankless job that is every bit as lifesaving as the jobs of the world’s top physicians. They work around the clock, are paid peanuts, and rarely get the prestige they have rightfully earned and thoroughly deserve. These people perform tasks that are absolutely vital for society to function and live comfortably. They’re the very epitome of who Mike Rowe was talking about when he describes a “Dirty Job” as “The Jobs that Make Civilized Society Possible for the Rest of Us.”

When I hear the contemporary debate about whether or not fast food workers deserve a raise to $15.00 per hour, I think about these people. I think about how vital their job is and about how it needs to be performed very well by motivated people. Literally, the lives of you and your loved ones depends on the skill, motivation, talent, and morale of these people each and every time you or they get sick or injured enough to require a hospital.

And if you don’t know it yet, I’m talking about hospital cleaning staff, the Environmental Services workers who keep out medical areas clean, sanitary, and functional. Make no mistake, the cleaning techs save more lives than the doctors do. Each time they kill a germ, remove gross contamination, or sanitize a surface they prevent a potentially devastating infection in some future patient that may chance to enter the area they have cleaned. They do a hard job that requires training, technical skill, motivation, and tireless attention to detail.

And I’ll bet that each and every one of the people reading this piece has walked by one of these lifesavers and haven’t even given them a second thought.

Don’t think I’m serious? Take a look at this article from Scientific American: “Clean Sweep: Hospitals Bring Janitors to the Front Lines of Infection Control.” They’re serious too.

My mother always used to tell me that “a hospital is no place for sick people” and I’ve read the CDC curtly describe a hospital as a box where they stick sick people in with a bunch of circulating germs and hope that nobody gets any sicker. Environmental services techs make possible the small miracle that not everyone dies from secondary infections, even though Healthcare Acquired Infections (HAIs) kill around 98,000 patients per year.

So when you read the guest post that follows what I’ve written above, you should keep in mind that there are plenty of people who save more lives in one shift than you do in a month, who labor in obscurity for no money. You might also agree that if we had any sense we’d take EMS Week and rename it in honor of the hospital cleaning tech. They’re heroes by anyone’s definition.

What follows is a guest post written by a friend of mine and a blog reader. His name is Brian, but in order to insulate him from some of the flames that might follow, I’m not going to state his last name. These words are his. They’re sharp, they’re to the point, and they’re uncomfortably true. I’ll lead you into them, then leave you to them. Try to catch the point of what he’s saying and react using intellect, not emotion. After all we’re not really the biggest underpaid lifesavers around. Don’t get mad, get better.

Take it Brian: (The links and notes in blue are mine)


Maybe you don’t deserve more money.

American EMTs are the fast food workers of the health care industry. They are easily trained and easily replaced workers who are also easily paid a low wage. I go out of my way to tell students and new EMTs that “Being an EMT is not a career. It is a great starting point, but not a good end point.”

The EMTs currently demanding more money need to be brought down to earth a bit. You are not highly skilled; if we are being honest here you are little more than a taxi driver with a first aid and CPR card. You are not heroes. You may save the occasional life but it is because you were there, not because you were highly trained. Anyone with a CPR card and first aid training can do almost your entire job. In some areas the police and members of the public can administer medications that you are not allowed to. And even if you were truly the heroes you believe yourselves to be, so what?

Where is being a hero tied to any specific form of monetary compensation? Do you see any other group of medical providers saying the reason they deserve more money is because they save lives? (See Above)

When anyone with a 10th grade level education and 14 free days can become an EMT the value of being an EMT is so diluted it is nearly nonexistent. The supply of EMTs is greater than the demand. EMT is never going to be a high paying job when there are services out there that can find an unlimited supply of labor sporting both a pulse and a patch. That is just simple economics. Being a paramedic you stand a slightly better chance of being paid more. You have some skills, some knowledge and some education, but without any kind of an industry wide degree requirement we will never advance above the level of the blue collar worker.

Recently fast food workers pushed for their wages to be $15.00 / hour.  Ask yourself do you think fast food workers should be paid that much?  I would say absolutely not. It is an entry level job and requires little to no education or training to perform the job. It is not a learned profession. It is not a skilled profession. If we want to have a talk about raising the minimum wage to keep up with inflation, that is a different discussion all together. Stating EMS should be paid more just because fast food workers got a raise is never going to get you a raise. (Link provided below)

I see people saying that they paid “x” amount of dollars to get their initial training. The fact that you had to pay money to go to EMT school is no guarantee that you will be paid well. (Another Link below) Hopefully you realized this before you invested money in paying tuition. In economics this is known as return on investment. Did you do the math before you entered the field? Most well-paying professions require a substantial amount of money be spent on education prior to entering them. $900 is nothing compared to the cost of initial education in almost any other field.

EMT school is not a Herculean feat of academia. EMTs need to realize that compared to any other medical profession, with the exception of CNAs, EMTs do not even hold a candle to the amount of training required by other medical professions for an entry level position. 202 hours is the equivalent of one or two college classes. It is nowhere even close to an associate’s degree. 24 hours in clinical rotations is a laughable amount. You went and rode on the ambulance or hung out at the ER for a few hours.  In most states a nail salon tech, cosmetologist and a barber have five to ten times the educational requirements than an EMT. (In Illinois, a barber must have 1500 hours of class and an internship before sitting for the test)

The final barrier to entry for being an EMT is a test that can be passed in 70 questions and as little as 20 minutes. Filling out an application at McDonalds takes longer than the NREMT test.

If any one of the EMS protesters in San Diego had a sign that said something along the lines of “I went and got a college degree and took a critical care course and become an FTO and submitted best practice driven revisions of protocols! I deserve a raise” I would say you are gosh darn right you do.

Sadly that was not the case.

The health care market is changing. Spending is being scrutinized more. I predict in the next few years you will see every health care service being forced to validate their existence. Even the exalted fire service is starting to be questioned, why do we need 7 people and a fire truck on a medical call? But I digress, that is an entirely different post.

Prove it to me that you deserve a raise, not with some hyperbole about saving lives but about patient based outcomes you affect, health care dollars you are saving, how you are improving patient’s quality of life, etc. You do not deserve a raise due to some over blown sense of self-esteem courtesy of Mr. Rogers, your parents, and your T-ball coach saying you are special. If you want more money you are going to need to argue for it with facts, with data, and with logic. Just because you envision yourself as some lifesaving hero that is invaluable to your community does not make it so.

While members of the community may tell you that you are invaluable, ask them to put their money where their mouth is, tell them to say it with their tax dollars.

When you decide that you’re invaluable, prove it by investing in yourself through education and development.

That’s the only way our profession is ever going to get ahead.


Thanks Brian. Hopefully we get some people out there who listen. We need people to get mad, but not at you. You didn’t create the situation you describe. You’re simply pointing out some uncomfortable truths that we need to work through as an industry and a profession. We’ll never get ahead by decrying the status quo without doing the work that is necessary to fix it.


I think that this guy may have helped Brian prove his point...

I think that this guy may have helped Brian prove his point…

  • Well said. It makes me rethink my coaching role as an EMT instructor.

    • We need awesome EMT instructors who help awesome people achieve awesome success with EMS at all levels. We just need to let them know that their state or national registry test is the floor, not the ceiling, and then coach them to launch towards the sky.

      • Agreed – I’ll just have to find the balance between full-on, lifesaver vision casting and don’t waste your time going into EMS. 😉 “I know there’s a balance, ‘cuz I see it when I swing past.” (Mellencamp, 1984)

  • Mike Smertka

    This is absolutely brilliant. Well done.

  • Ken Wilson

    I hope you do not work in the health profession. Is it all about dollars to you? have you ever scraped somebody up off the side of the road and brought them to an emergency room still alive?The next time you have crushing chest pain, an allergic reaction, or major trauma, do me a favor and stay out of my hospital.

    • I never reply to these… but with you Sir, I am very curious. What part are you angry at, specifically

  • Scott Bennett

    A long reply written while on standby. tl;dr version: Basics, and for that matter paramedics, are poorly paid because there is little, if any, economic incentive to pay them more.

    It’s my general belief that “deserve a raise” is a phrase with little practical meaning. Nearly no one in this country is paid based on what they deserve, whatever that means. People are paid what they are worth in economic terms, or at least what their employer believes that are worth. We are paid what everyone gets paid: the amount that our employer could, or believes they could, hire someone minimally competent to replace us.

    What is an EMT, even a great one, worth in economic terms? What is the economic value of a great EMS system? What is the economic impact of an EMT who really knows what they are doing vs an EMT who barely scraped by the laughably easy NREMT and doesn’t care to learn much more? Phrased another way, how much money would it cost your employer if they replaced a great EMT with one who barely meets the minimum requirements of a patch and a pulse? My guess is: not much. If the cost was higher, services would be going to great lenghts to identify and retain those providers. I’m not aware of any service doing so.

    What is the economic impact of a service which boasts progressive protocols, exceptional medical direction, strenuous continuing education requirements, and providers who comport themselves as professionals vs, say, DCFEMS? Again, my assumption is that there’s not much difference, based on observations of EMS services. If it paid to be better, most services would be better.

    A journalist and economist I read frequently is fond of saying “The price is the price is the price”. Economically inefficient pricing, for anything, may exist in the sort term, but sooner or later, emphasis on the sooner, the market forces a price adjustment. The price of labor in EMS is low because our education is not particularly time consuming, difficult, or expensive, and the value of exceptional labor is minimal. Therefore it is both easy and cheap to replace us.

    This is not to say that EMT-Basics are societally unimportant. But don’t expect labor market economics to be impacted by that fact. If you want to spend your working life as a Basic, go for it. But understand that unless educational requirements are exponentially increased, you’re going to spend your career making peanuts. If you decide to go on to become a Paramedic, understand that you’re probably not going to make much more. There simply isn’t enough economic incentive to force your wage higher.

    Scott Bennett, EMT-B

  • mr618

    Spoken like a true medic, who views EMTs as nothing more than servants. Medics are always screaming for more pay… why are you entitled if we’re not? 1300 hours of training is nothing compared to 7-10 years of formal education, plus residencies, internships, specialty-board examinations etc. By the time you paragods get to crash scenes here in Maine, we have the patient extricated, boarded-and-collared if warranted (or not, if the patient clears the spinal rule-out protocol), fully packaged. We help you get the patient on the stretcher, we lift him into the rig, you spend a few minutes starting an IV and then you drive off to the ER, where you use our PCRs to tell the doctor what’s happening. We have two medics in the area who view us as allied professionals, who are willing to teach us and share their experience; the rest of them are like you: “we doan nee’ no steenkin’ basics.” You paragods can visit Louisiana or Frisco or someplace that doesn’t need us “lowly” basics; we’ll stay here and deal with the petty shit you can’t be bothered with, like car crashes and cardiac arrests and childbirth and so on.

    Bennett, a lot of us don’t have the option of going beyond basic… we work for volunteer squads, and have full-time (non-medical) days jobs, and we don’t have the money or time for more advanced classes (up here, Advanced classes are something like $3 grand and paragod is $10k… most of us don’t have that kind of cash). Our services usually don’t have that kind of money, either; we’re generally private, not-for-profit corporations subsisting on local donations, not tax dollars like you big-city dudes.

    Kaiser’s the only one making sense for those of us in rural areas… but “awesome EMT” instructors are hard to find (or build) if Maine has ONE I/T class every 2-3 years. The spots in those classes are generally completely filled by medics before they consider us peons. We don’t have the option of travelling out of state for the classes sponsored by the Borg, either (which have incredibly high fail rates here, anyway).

    BTW: I *KNOW* I’ve made a difference: as a First Aid instructor, 3 of my students became RNs’, five went to medic school (when I lived in Michigan), two became flight medics, and one is completing med school, aiming for a career in emergency medicine. Oh, and I have four CPR saves (survival to discharge, minimal deficit afterwards), delivered four babies, and I have comforted hundreds of people who needed just a little TLC.

    So, do I derserve more money? According to you, no. That’s fine, I didn’t really go into this FOR the money. I went into EMS to help people. Perhaps that’s the biggest difference between basics and medics?