# Why are Paramedics paid so little?



## crashh (Jun 14, 2012)

Why, with the advanced skill level, are paramedics paid so little?


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## STXmedic (Jun 14, 2012)

Because we're a dime a dozen. However, there are some extremely well paying companies out there. You just have to work to get them.


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## ffemt8978 (Jun 14, 2012)

Variety of reasons.

Skill sets are not hard to teach, education and knowledge is lacking, market saturation, Medicare/Medicaid reimbursement rates, FD's, vollies, and the list goes on.  Pick your poison for the week and it will be a correct answer.


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## JPINFV (Jun 14, 2012)

crashh said:


> Why, with the advanced skill level, are paramedics paid so little?



Because the barrier to entry is so low that Tyrion Lannister can use it for pull-ups. 

Because of the SUPPLY vs demand issue.

Because Medicare views EMS as a medical taxi service and EMS is fragmented to the point that no one can stand up and say, "No, we're better than taxi drivers." 

Because there's a sizable portion of EMS providers who are happy being medical taxi drivers, because being a medical professional is hard.


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## crashh (Jun 14, 2012)

I just finished my EMT (actually waiting on the results - it's been 4 weeks!).  I know i passed, just waiting for confirmation. 

Anyway, I am planning to go to nursing school.  Which will actually be a 3 year program, since I need some pre-requisites...so, pre-nursing into nursing.

Well, my company has just offered me, after some interest by myself, to pay for me to go to paramedic school.  This program is a 1 year school.  I would sign a contract to stay with my company for 3 years after completion of the course.  In that time I plan to do the pre-nursing>nursing.

I'm not thinking about doing the paramedic for the money ( we are a volunteer dept), but i feel the field trauma experience will be good for me.  My ultimate goal is to do travel nursing and eventually do national/international aide, so i thought the paramedic would help.

any thoughts?


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## crashh (Jun 14, 2012)

JPINFV said:


> Because the barrier to entry is so low that Tyrion Lannister can use it for pull-ups.



:rofl:


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## Christopher (Jun 15, 2012)

Who said Paramedics were paid so little?

Pay is commensurate with education, experience, and responsibility. 

If it takes 1500 hours to become a Paramedic (this includes EMT-B time) the barrier to entry is pretty low. Expect low pay for vocational positions. As an example of how low the barrier to entry is for a Paramedic, in North Carolina many folks going to school to become a hair dresser (_I may have just called them the EMS equivalent of an "Ambulance Driver", apologies in advance_) have longer educational requirements!

While we may know we have a large responsibility, as a profession we've not accepted that. This is most evident in that people still believe protocols are _The Word of God for the People of God_. Standing orders are merely a vehicle to shift responsibility onto medical directors. It also shows we're still technicians rather than clinicians.

My view is that paramedics are currently being paid slightly under their market value, but that this is consistent with almost all vocational positions in the US. Wages for these types of jobs has lagged, and I doubt we'll see anything different to come. Even as a software engineer for a Fortune 5 company, in our group we've not seen our wages track with those in "softer" positions such as management, HR, or finance/sourcing. Welcome to the world of being an Individual Contributor.

A reasonable starting wage for a certified paramedic should be 2-3 times the minimum wage multiplied by a cost-of-living adjustment for the given area. This represents the relative difficulty in obtaining a certification as a paramedic and the responsibility on the employee. (Interestingly enough the current mean wages in the US are around 2x the minimum wage.)

A reasonable starting wage for a licensed paramedic, with an AS or BS and an additional 1-2 years of paramedic school, should be 4-5 times the minimum wage multiplied by a cost-of-living adjustment for the given area. This represents the relative difficulty in obtaining the post-secondary education and the additional responsibilities associated with licensure.

Considering the potential harm we're able to cause as providers it is pretty crazy how little education we're given. Complaints about getting paid less are not terribly well founded.

Given that hair dressers and HVAC technicians (4,000 hours of experience prior to licensure*) spend more time in school and apprenticeship than your average Paramedic, your question should be: *"Why are Paramedics** so poorly educated?"*

_*I think the only program in the US that comes close to this is Seattle Medic One's paramedic program._
_**I'm included in this group._


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## NYMedic828 (Jun 15, 2012)

crashh said:


> I just finished my EMT (actually waiting on the results - it's been 4 weeks!).  I know i passed, just waiting for confirmation.
> 
> Anyway, I am planning to go to nursing school.  Which will actually be a 3 year program, since I need some pre-requisites...so, pre-nursing into nursing.
> 
> ...



They want you to be a medic to make THEM money. Work as an EMT, go to nursing school. Secure a better future for yourself.

If you are just finishing EMT, you probably haven't been with the company long enough to know you wanna work there for 4 more years.


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## sir.shocksalot (Jun 15, 2012)

Christopher said:


> Who said Paramedics were paid so little?
> 
> Pay is commensurate with education, experience, and responsibility.


Bravo! Every time I hear a paramedic complain about their wage (or EMT for that matter) I have a good laugh. 


Christopher said:


> If it takes 1500 hours to become a Paramedic (this includes EMT-B time) the barrier to entry is pretty low.


This is the problem, anyone, and I mean ANYONE can do my job. When all it takes to become a paramedic is an EMT card (aka. First-Aid for firefighters) and 4-6 months of your time, then employers are going to have serious reservations about paying you reasonable wages.

Many in EMS like to point fingers at nurses and say "Hey, I do all the same stuff they do, I should get paid as much!". If that is they case then it should be a simple task to get through nursing school... except that it isn't, most nursing programs require a year of A+P, chem, pathophys, basic english composition. Each class is one more filter so that only those with the drive to do well make it. In many places (there are always exceptions) there is absolutely no filter before paramedic school other than your EMT card.


Christopher said:


> Given that hair dressers and HVAC technicians (4,000 hours of experience prior to licensure*) spend more time in school and apprenticeship than your average Paramedic, your question should be: *"Why are Paramedics** so poorly educated?"*


I totally agree! I am not sure what it is that makes most EMS providers feel they are entitled to a higher wage simply because we have large responsibilities (relatively). Almost every worker on this planet thinks they deserve a higher wage, but few are willing to work hard to earn it. 

If the minimum for Paramedic certification was an AAS you would see and increase in wages as the number of people able to obtain an AAS would decrease the supply of Paramedics. This will never happen so long as EMS agencies are happy with the status quo and EMS providers remain too lazy to change it.

If paramedics weren't allowed to leave EMS I'm sure this career would be much better. As it stands the best paramedics we have go to nursing school or PA school or leave health care entirely, which leaves EMS in a sad state of talent-deprivation.


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## Tigger (Jun 15, 2012)

sir.shocksalot said:


> Many in EMS like to point fingers at nurses and say "Hey, I do all the same stuff they do, I should get paid as much!". If that is they case then it should be a simple task to get through nursing school... except that it isn't, most nursing programs require a year of A+P, chem, pathophys, basic english composition. Each class is one more filter so that only those with the drive to do well make it. In many places (there are always exceptions) there is absolutely no filter before paramedic school other than your EMT card.



And now cue the "I work on the streets, I don't need to take all of those college classes!" So few in EMS seem to understand that the point of taking these classes is to have a solid basis for trying to understand the human body. With this knowledge you can treat so many more patients efficiently and correctly. Just because you can practice as a paramedic without that knowledge does not mean you should, what happens when a patient fall between two pages of the protocol book?


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## JPINFV (Jun 15, 2012)

Tigger said:


> And now cue the "I work on the streets, I don't need to take all of those college classes!" So few in EMS seem to understand that the point of taking these classes is to have a solid basis for trying to understand the human body. With this knowledge you can treat so many more patients efficiently and correctly. Just because you can practice as a paramedic without that knowledge does not mean you should, what happens when a patient fall between two pages of the protocol book?








I throw up a little in my mouth every time I see that meme.


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## Tigger (Jun 15, 2012)

JPINFV said:


> I throw up a little in my mouth every time I see that meme.



Someone get me a bucket.


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## Amberlamps916 (Jun 15, 2012)

My grandparents, who were both general surgeons in Scotland, England, and Iran would laugh uncontrollably at that picture.


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## Akulahawk (Jun 15, 2012)

sir.shocksalot said:


> Many in EMS like to point fingers at nurses and say "Hey, I do all the same stuff they do, I should get paid as much!". If that is they case then it should be a simple task to get through nursing school... except that it isn't, most nursing programs require a year of A+P, chem, pathophys, basic English composition. Each class is one more filter so that only those with the drive to do well make it. In many places (there are always exceptions) there is absolutely no filter before paramedic school other than your EMT card.


There are LVN programs that teach a minimum of A&P and the like for the scientific background for their program and those "classes" may not be acceptable by other colleges for _their_ programs. This is not too much unlike some Paramedic programs that teach the minimum scientific stuff also. It's the "teach only what they need to pass" mentality. RN (thankfully) generally requires a much more rigorous set of coursework for entry to that program. So far, I have found that my education has been quite sufficient for understanding the nursing theory without having to crack the books much for that. 


sir.shocksalot said:


> If the minimum for Paramedic certification was an AAS you would see and increase in wages as the number of people able to obtain an AAS would decrease the supply of Paramedics. This will never happen so long as EMS agencies are happy with the status quo and EMS providers remain too lazy to change it.


Too true. I would completely support the AAS requirement, even if it was a general science AS degree with specific coursework for entry to a Paramedic program, though a ADP (Associate Degree in Paramedicine) would be more ideal, with similar prerequisites so that an ADP grad could transition to an ADN program or BSN program (or any other healthcare program) and meet most of the typical entry science requirements for those without too much difficulty. 


sir.shocksalot said:


> If paramedics weren't allowed to leave EMS I'm sure this career would be much better. As it stands the best paramedics we have go to nursing school or PA school or leave health care entirely, which leaves EMS in a sad state of talent-deprivation.





Tigger said:


> And now cue the "I work on the streets, I don't need to take all of those college classes!" So few in EMS seem to understand that the point of taking these classes is to have a solid basis for trying to understand the human body. With this knowledge you can treat so many more patients efficiently and correctly. Just because you can practice as a paramedic without that knowledge does not mean you should, what happens when a patient fall between two pages of the protocol book?


When the patient doesn't fit a given protocol, many would just say "call OLMC" and go from there... Of course, I prefer to call OLMC, advise what I've got and what I'd like to do. But that's just me... unfortunately...


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## DrParasite (Jun 16, 2012)

Respectfully disagreeing with almost everyone here, but WE don't give each other credit.

I can't speak for anyone else, but in my EMT class (in New York State and New Jersey, I took them both), there were people who didn't pass.  I know people who were in the paramedic program (in both NJ and NY), who didn't pass.  You know what?  not everyone can do this job, not everyone can pass the classes.  Yes, maybe our entrance prerequisites are too low (or non-existent), but like other educational programs, people who enroll do not always pass.

why are we paid so little?  well, to start, many EMS agencies are for-profit, so the lower they pay their paramedics, the more profit for the company.  we can also go with the idea that most EMS systems aren't tax funded (unlike fire and police) so they generate most of their revenue from what they make transporting people.  With medicare and medicaid abuse and declining returns, you have less money to spend on salaries.

And then there is the big one.  no, it's not supply and demand (although that does play a large role in many areas).  Paramedics are WILLING to work for those low wages.  EMTs are WILLING to work for lower wages.  if a paramedic will work for $12 an hour, why should any company pay more?  if an EMT will work for $9 an hour, why should any company pay more?

Education does come into play, but it all boils down to the simple fact that people are willing to work for those sucky wages.  and if they won't, employers will find some new hires who will.


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## EpiEMS (Jun 16, 2012)

There are ~200,000 EMTs, ~15,000 AEMT/EMT-Is, and ~60,000 medics (http://www.ems.gov/pdf/EMSWorkforceReport_June2008.pdf). You can fairly estimate that half of the workforce is volunteer (pg. 46 of the above cited report). These numbers are growing quite rapidly (http://www.bls.gov/ooh/Healthcare/EMTs-and-paramedics.htm).

Since the barriers to entry are quite low, you'd expect low wages. Considering the danger of the field and the (often?) odd hours, wages should be elevated. We observe, quite clearly, that wages are much lower for EMTs and medics than for similar fields (i.e. police, fire, RTs, RNs, etc.). 

"Supply and demand" expresses, on a larger level, why wages are where they are. People look for jobs and weigh the costs and benefits for one job over another, etc.
Simple as Econ 101.


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## jjesusfreak01 (Jun 17, 2012)

DrParasite said:


> I can't speak for anyone else, but in my EMT class (in New York State and New Jersey, I took them both), there were people who didn't pass.  I know people who were in the paramedic program (in both NJ and NY), who didn't pass.  You know what?  not everyone can do this job, not everyone can pass the classes.  Yes, maybe our entrance prerequisites are too low (or non-existent), but like other educational programs, people who enroll do not always pass.



In my basic class I believe they told us to expect something like 60% attrition by the end of the class. Most of us stuck through it, which they said was very unusual. In my EMT-I class, only 75% of the class ended up passing the class final, though all those who passed the final passed the state test. What is the standard attrition rate for nursing school?


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## sir.shocksalot (Jun 17, 2012)

DrParasite said:


> I can't speak for anyone else, but in my EMT class (in New York State and New Jersey, I took them both), there were people who didn't pass.  I know people who were in the paramedic program (in both NJ and NY), who didn't pass.  You know what?  not everyone can do this job, not everyone can pass the classes.  Yes, maybe our entrance prerequisites are too low (or non-existent), but like other educational programs, people who enroll do not always pass.


Just because people do not pass EMT/Medic school does not mean that the course is difficult. There are a large number of reasons people do not do well in school; personal problems, lack of time to study, lack of drive to study, et cetera will cause someone to fail a course, this does not mean that the course is good at weeding out people that are incapable of doing the job.


DrParasite said:


> And then there is the big one.  no, it's not supply and demand (although that does play a large role in many areas).  Paramedics are WILLING to work for those low wages.  EMTs are WILLING to work for lower wages.  if a paramedic will work for $12 an hour, why should any company pay more?  if an EMT will work for $9 an hour, why should any company pay more?
> 
> Education does come into play, but it all boils down to the simple fact that people are willing to work for those sucky wages.  and if they won't, employers will find some new hires who will.


Actually your last paragraph highlights why wages are low... there is always someone else to do your job.

It is a fallacy that employees dictate wages. I personally detest working for $11/hr to $19/hr depending on the shift. However my choices are the wages I was offered and unemployment. I cannot walk into an employer and say "I am worth $24/hr and will work for no less", I will get laughed out of the office and over to the unemployment line. 

When looking at hiring paramedics 99.9% of companies simply say "Can s/he fulfill the job description?" and "Will s/he be a good fit for company culture?". The first question is answered by background checks, certification checks, and a physical ability test. The second question is usually answered by an interview. When pretty much every paramedic that applies meets the requirements it is hard to justify paying more because you offer nothing special to employers.

Contrast this with hiring in the IT/Computer software/Engineering world. Companies in this world instead ask "What skills/abilities/knowledge does this individual bring to the table that we can use here at Blahblah Industries?". These companies are looking for the best and the brightest who are creative and intelligent and will pay lots of money and benefits to recruit and retain these people. Thats why places like Google and Microsoft pay $100,000+/yr and have long paid vacations, at work nap times, on site childcare, on site healthcare, free cafeterias, and many more benefits. 

Now we will never see those benefits in EMS, ever really (Heck MD/DO don't even get those kinds of benefits). However as long as paramedic school is quick and easy to finish with minimal investment in school time, employers will have a glut of paramedics to choose from to fill holes in the schedule. And as long as EMS is a job where we drive patients to the hospital (or are viewed as such) then employers have no interest in hiring and retaining talented and dedicated healthcare providers.


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## sir.shocksalot (Jun 17, 2012)

jjesusfreak01 said:


> What is the standard attrition rate for nursing school?


This is a poor argument for wages. We know that physicians command a very high wage, yet less than 2% of students in medical school drop out for academic reasons. If we use the argument that high attrition should = high wages then we would expect to see attrition in medical school at a much higher rate.

In fact I would argue that high attrition is actually an indicator of poor instruction or poor screening of applicants to the program.



source for medical school graduation rates: https://www.aamc.org/download/102346/data/aibvol7no2.pdf


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## JPINFV (Jun 17, 2012)

sir.shocksalot said:


> source for medical school graduation rates: https://www.aamc.org/download/102346/data/aibvol7no2.pdf



That's what I was expecting. The general estimate is med school attrition rates is generally in the 10-15% range, but that counts attrition rates as "not graduated in your initial class" and not "not graduates at all." Of course that's a confounding variable when looking at a program that takes 4 years minimum vs a program that can be completed in less than a month for EMTs or less than a year for paramedics.


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## Hunter (Jun 17, 2012)

I hate to say this but I graduated with an AS in Emergency medical services and feel like it was a waste of time unless I decide to study something else. I an paid just like any other EMS professional/employee (depending on how you behave). A degree will do nothing else for my salary as far as a career as a pre hospital care provider.


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## crashh (Jun 17, 2012)

NYMedic828 said:


> They want you to be a medic to make THEM money. Work as an EMT, go to nursing school. Secure a better future for yourself.
> 
> If you are just finishing EMT, you probably haven't been with the company long enough to know you wanna work there for 4 more years.




I've been with the company for almost a year as a firefighter/ambulance driver.  I know i like the company, that's doesn't worry me at all.

I'm just wondering if it's a waste of time to do this or not


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## Christopher (Jun 18, 2012)

DrParasite said:


> Respectfully disagreeing with almost everyone here, but WE don't give each other credit.
> 
> I can't speak for anyone else, but in my EMT class (in New York State and New Jersey, I took them both), there were people who didn't pass.  I know people who were in the paramedic program (in both NJ and NY), who didn't pass.  You know what?  not everyone can do this job, not everyone can pass the classes.  Yes, maybe our entrance prerequisites are too low (or non-existent), but like other educational programs, people who enroll do not always pass.



As I saw in my EMT and paramedic classes, most folks washed out because they weren't ready for more schooling. By and large they figured they could skate on by to get out of some low paying job elsewhere and into the "exciting and expanding field of medicine."

The current EMT curriculum is not rocket surgery. I think you're fooling yourself by believing these folks failed because they, "just weren't cut out for EMS".



DrParasite said:


> why are we paid so little?  well, to start, many EMS agencies are for-profit, so the lower they pay their paramedics, the more profit for the company.  we can also go with the idea that most EMS systems aren't tax funded (unlike fire and police) so they generate most of their revenue from what they make transporting people.  With medicare and medicaid abuse and declining returns, you have less money to spend on salaries.



The job market is flooded with able bodies, call volumes are increasing, and the ROI (return on investment) is decreasing. Of course wages will slack.



DrParasite said:


> And then there is the big one.  no, it's not supply and demand (although that does play a large role in many areas).  Paramedics are WILLING to work for those low wages.  EMTs are WILLING to work for lower wages.  if a paramedic will work for $12 an hour, why should any company pay more?  if an EMT will work for $9 an hour, why should any company pay more?



Actually that is a supply/demand issue, just it's on the other side. But that's really just semantics and not salient to the discussion. There are Paramedics/EMTs willing to take that pay because it is fair based on the work they put into becoming an EMT or Paramedic. We wouldn't have excess labor if this weren't the case...



DrParasite said:


> Education does come into play, but it all boils down to the simple fact that people are willing to work for those sucky wages.  and if they won't, employers will find some new hires who will.



And how do you fix that problem? By raising the educational bar.


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## Christopher (Jun 18, 2012)

crashh said:


> I've been with the company for almost a year as a firefighter/ambulance driver.  I know i like the company, that's doesn't worry me at all.
> 
> I'm just wondering if it's a waste of time to do this or not



Paramedicine is a waste of time if you don't want to be a Paramedic. If you want to make money I'd get out of medicine.

If you want challenging work in a growing field, being a Paramedic can be one way to achieve that; but, expect to do it for little reward beyond the personal satisfaction that you enjoy your job.

You may find the easy way to balance making money and challenging work is to work multiple jobs. I've gone that route and wouldn't give it up. I'm also not human (_I'm an engineer_), so I can't say it'd work for you.


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## SliceOfLife (Jun 19, 2012)

Starting pay at my company is 17 per hour with a 48 hour schedule.  That's just under 46,000 a year for two days of work a week.  Not to bad for less than a year and a half of school.

That leaves time for a second job or OT.  I realize that it kinda sucks and it would be nice to work 40 hours 9-5 with weekends and holidays off but it is what is.


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## Level1pedstech (Jun 19, 2012)

crashh said:


> I've been with the company for almost a year as a firefighter/ambulance driver.  I know i like the company, that's doesn't worry me at all.
> 
> I'm just wondering if it's a waste of time to do this or not




Trust me with this advice because I have seen several people go the route Im going to recommend. They are doing what they love, are very happy and more importantly financialy secure.

Get your RN out of the way then do what you need to get your medic cert. With a nursing job you will have a schedule that better allows for you to pursue your outside interests. Your pay could be double if not more than what you would be able to make as a medic.

Also with the higher education your going to be a valuable asset to any agencies EMS operation paid or volunteer. You will be a better educated field provider and your ability to teach others will be greatly enhanced. Its a win all the way around.


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## Level1pedstech (Jun 19, 2012)

SliceOfLife said:


> Starting pay at my company is 17 per hour with a 48 hour schedule.  That's just under 46,000 a year for two days of work a week.  Not to bad for less than a year and a half of school.
> 
> That leaves time for a second job or OT.  I realize that it kinda sucks and it would be nice to work 40 hours 9-5 with weekends and holidays off but it is what is.



Thats an ok position but we all know the majority of employers are going to be paying in the 10.00-14.00 range for medics starting out. You can get your RN with just a little more time in school,be better educated and be making in most cases 20.00+ p/hr to start.

How about this for a good return on investment, 45K+ for one month of school. Trucking companies are in serious need of people that have clean driving records and decent backrounds. Its not the most glamorous of jobs but for people that are in need of work or cant find EMS work it pays almost twice what medics are making at the low to mid level pay rate.


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## BigBad (Jun 22, 2012)

i make great money.   Trick is finding where to make it.    Look for well a fluent towns and county's where the cost of living is slightly higher.   The majority of my coworkers commute to my ski town from the city.


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## Level1pedstech (Jun 22, 2012)

Great money to one person could mean poverty to another. When This topic comes up Im always careful to point out that there are some good paying jobs out there. However for the majority of you EMS is not going to provide the income needed to raise a family. 

A quick google search on how much annual income is required to support a family of four gave me a figure right at 69K. This is of course an average and many families get by on much less. According to the article this income level does not allow for a vacation,dinners out or extra money for your 401K.  

Based on the 69K figure if you plan to be the sole provider for your family your going to need an EMS job that is paying 33.00 per hour. How many of you know someone making that kind of money? 

Once again 69K for a family of four is an average but I believe its a good number to work with,its less than the 80K I like to use. Younger people need to be better informed before they drop a bundle of money and a year or more of thier time into training that in most cases will never give them the earning power required to raise a family.


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## DrParasite (Jun 23, 2012)

Christopher said:


> As I saw in my EMT and paramedic classes, most folks washed out because they weren't ready for more schooling. By and large they figured they could skate on by to get out of some low paying job elsewhere and into the "exciting and expanding field of medicine."
> 
> The current EMT curriculum is not rocket surgery. I think you're fooling yourself by believing these folks failed because they, "just weren't cut out for EMS".


most field aren't rocket surgery.  hell, rocket surgery isn't that hard, all you need is the proper tools to do surgery on rockets (a small welding torch, some eletronic gizmos, etc), and you are good to go.





Christopher said:


> The job market is flooded with able bodies, call volumes are increasing, and the ROI (return on investment) is decreasing. Of course wages will slack.


really?  because the market is flooded with lawyers, law schools are pump more out than their are jobs available.  and yet, lawyers still get paid pretty well, once they get a job.





Christopher said:


> Actually that is a supply/demand issue, just it's on the other side. But that's really just semantics and not salient to the discussion. There are Paramedics/EMTs willing to take that pay because it is fair based on the work they put into becoming an EMT or Paramedic. We wouldn't have excess labor if this weren't the case...And how do you fix that problem? By raising the educational bar.


if you make being a paramedic a PhD program, and people (new PhD grads) are accepting $9 an hour, than that's why wages are low.

BTW, my agency started EMTs at $18/hr.  my former employer started EMTs at $15.75.  for every 1 position, we have close to 100 applications, and of those, 50 -75 meet the qualification.  however, people aren't willing to work in a crappy city and do 12-20 911 jobs in 12 hours for less than $18 an hour.  And paramedics start higher than that.

Yes, it is supply and demand issue, but when people will accept $9, for an EMT job, that's why it's so low.  if no one in the EMS industry refused to work for less than $15 an hour, no hold outs, no newbies desperate for a job, if NO one would work for less, than wages would rise.


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## sir.shocksalot (Jun 23, 2012)

DrParasite said:


> most field aren't rocket surgery.  hell, rocket surgery isn't that hard, all you need is the proper tools to do surgery on rockets (a small welding torch, some eletronic gizmos, etc), and you are good to go.


I am not a rocket surgeon, but I do think rocket surgery is a lot more complicated than having tools to work on rockets. I haven't seen a rocket surgery program, but I imagine that it is similar to an engineering program, which all require in the first two years: Calculus 1-3, calculus-based physics 1-2, Chemistry, and assorted other mathematical classes that most people are quite incapable of intellectually grasping. I understand you were using a metaphor but I feel like you stretched it a little too far. It would be like saying my lab coat and scalpel make me a surgeon.


DrParasite said:


> because the market is flooded with lawyers, law schools are pump more out than their are jobs available.  and yet, lawyers still get paid pretty well, once they get a job.


Actually lawyer's pay is decreasing because of this. Lawyers are graduating in increasing numbers with increasing amounts of debt and are willing (more like required) to work for low wages just so they can make payments on school loans that are similar in size to medical school loans. While their pay is still high it is decreasing due to supply and demand. (source: http://www.abajournal.com/news/arti...ads_is_on_downward_shift_drop_is_largest_for/)



DrParasite said:


> BTW, my agency started EMTs at $18/hr.  my former employer started EMTs at $15.75.  for every 1 position, we have close to 100 applications, and of those, 50 -75 meet the qualification.  however, people aren't willing to work in a crappy city and do 12-20 911 jobs in 12 hours for less than $18 an hour.  And paramedics start higher than that.
> 
> Yes, it is supply and demand issue, but when people will accept $9, for an EMT job, that's why it's so low.  if no one in the EMS industry refused to work for less than $15 an hour, no hold outs, no newbies desperate for a job, if NO one would work for less, than wages would rise.


This will not and could not happen. If I could walk away from my job then I would, but I am not qualified to do much else. As a result I have to accept the wages I am offered or become homeless.

I don't know where you work and won't bother trying to postulate why your wages are so high. Fire departments have a similar thing going though, very high pay, very high number of applicants, very limited number of openings. The high pay of firefighters is largely a result of their union and limited numbers of people leaving the job. County/3rd service agencies also benefit from large numbers of applicants due to the "prestige" of a 911 job, these services also lose employees much slower than private agencies and they tend to pay their employees more because they aren't wasting money on training new employees all the time.

Pay is a 100% supply and demand issue. The only times this doesn't come into effect is when a union is involved. As long as we keep luring people in with promises of adrenaline and life saving for as little as 2 months of school, wages are going to continue to be crappy. Due to the fragmented nature of EMS I don't really see this situation changing any time soon.


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## crashh (Jun 24, 2012)

Level1pedstech said:


> Great money to one person could mean poverty to another. When This topic comes up Im always careful to point out that there are some good paying jobs out there. However for the majority of you EMS is not going to provide the income needed to raise a family.
> 
> A quick google search on how much annual income is required to support a family of four gave me a figure right at 69K. This is of course an average and many families get by on much less. According to the article this income level does not allow for a vacation,dinners out or extra money for your 401K.
> 
> ...



good lord, 69K?  I raised 2 kids on MUCH less than that.


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## Level1pedstech (Jun 24, 2012)

crashh said:


> good lord, 69K?  I raised 2 kids on MUCH less than that.



Many others have as well,its really all about location. Like any other "average" you have to consider all the factors in order to get to the number thats right for you. Right behind location is lifestyle,things like toys and a couple of vacations each year require a larger income. Its like the old saying " theres a difference in living and living well".

My household income has been well above that 69K figure for at least the last ten years and has never been below it for the last seventeen thanks to my former teamster job. Even now my non union job pays well above that but I can tell you its tight on one income here in So Cal. Many families with two incomes live on less here as well as in other places but its not easy especially in the more popular areas.


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## Keka (Jun 24, 2012)

Again, where are the strong EMS unions? Fire and police have solid unions, and thus don't get screwed into low wages. Fire and police in my town can make 60k plus easy (usually more), and my town by no means has a high cost of living.  We're having a fire department merger next month, and nothing got done without the approval of their air tight union representation.  Maybe I'm ignorant because I'm new to this, but I don't understand it.


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## EpiEMS (Jun 24, 2012)

Keka said:


> Again, where are the strong EMS unions? Fire and police have solid unions, and thus don't get screwed into low wages.



Fire and police are almost always (if not always) delivered by government. EMS is not necessarily a government service - it's often private companies. Public employees are more likely to be unionized. Why, I couldn't say. But maybe it's because of the place that EMS occupies in between healthcare and public safety?


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## Level1pedstech (Jun 24, 2012)

EpiEMS said:


> Fire and police are almost always (if not always) delivered by government. EMS is not necessarily a government service - it's often private companies. Public employees are more likely to be unionized. Why, I couldn't say. But maybe it's because of the place that EMS occupies in between healthcare and public safety?



With the exception of right to work (for less) states anyone can ask for union representation and become organized. Now the question is will the employer be receptive and enter into talks with your union reps and enter into a contract. As long as you have reasonable demands and dont shoot for the moon you probably have a decent shot. Many people are ignorant to the fact that employers can also benefit from a contract if they put reasonable requests on the table. Its all about the back and forth. Even in right to work states its possible to organize but you will need power.

One thing that will work against any effort to organize will be the large number of chumps that will work for less than liveable wages. There are alot of people looking for work right now and unions are falling out of favor with the general public. Best thing anyone who is interested can do is call your union of choice and ask to speak to an organizer,they could answer any questions you have and advise you on how to get started.

When I first started with the teamsters in Portland,OR I thought only truck drivers were teamsters. The IBT represents people from every line of work from drivers to cops to plant workers. Without a doubt they would be my first call.

I left the union to work for the company that the unions consider thier number one target to organize. My seventeen years with the teamsters were fine and I have a decent pension waiting down the line. My new employer treats me better and offers a better work environment. Do I need union representation with my current employer,no but I did not personaly need it at my old employer either. The union was there at contract time and thats what justified my 50.00 per month in dues.


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## crashh (Jun 25, 2012)

Level1pedstech said:


> Many others have as well,its really all about location. Like any other "average" you have to consider all the factors in order to get to the number thats right for you. Right behind location is lifestyle,things like toys and a couple of vacations each year require a larger income. Its like the old saying " theres a difference in living and living well".
> 
> My household income has been well above that 69K figure for at least the last ten years and has never been below it for the last seventeen thanks to my former teamster job. Even now my non union job pays well above that but I can tell you its tight on one income here in So Cal. Many families with two incomes live on less here as well as in other places but its not easy especially in the more popular areas.



I disagree  with the living/living well.  It's not how much you make really but how much you choose to take on to sink all your money into.  Or what kind of standard of living you think you have to have.   A good share of the population has no idea how much of a  slave they are to what they own.  Just my .02 of course


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## BigBad (Jun 25, 2012)

Level1pedstech said:


> Great money to one person could mean poverty to another. When This topic comes up Im always careful to point out that there are some good paying jobs out there. However for the majority of you EMS is not going to provide the income needed to raise a family.



Unless you find your niche specializing in teaching or emergency management or CQI you would be a fool to think you can find a street paramedic job paying 69K a year.    That is only possible with Fire and it would take years to make that working up from 50-55k.   69k is even a stretch for nurses without graduate education.  Maybe my director makes that, Maybe.  


With that being said, I cleared 70K last year because of overtime.


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## Level1pedstech (Jun 25, 2012)

crashh said:


> I disagree  with the living/living well.  It's not how much you make really but how much you choose to take on to sink all your money into.  Or what kind of standard of living you think you have to have.   A good share of the population has no idea how much of a  slave they are to what they own.  Just my .02 of course



The living/living well is of course a matter of opinion but at the end of the day most people would probably choose to have the "living well" money even if they choose to just get by.


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## Level1pedstech (Jun 25, 2012)

BigBad said:


> Unless you find your niche specializing in teaching or emergency management or CQI you would be a fool to think you can find a street paramedic job paying 69K a year.    That is only possible with Fire and it would take years to make that working up from 50-55k.   69k is even a stretch for nurses without graduate education.  Maybe my director makes that, Maybe.
> 
> 
> With that being said, I cleared 70K last year because of overtime.



Overtime is great but setting long term goals that depend on it is not so good. Not that your doing that but many do and then get into trouble becuse they thought it would always be there.  Besides in twenty years many of the people who are working the killer overtime now will look back and say "I would rather have had the time". Even if your not funding lifestyle and instead are banking cash theres another old saying "you cant take it with you when you go".


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## crashh (Jun 25, 2012)

Level1pedstech said:


> The living/living well is of course a matter of opinion but at the end of the day most people would probably choose to have the "living well" money even if they choose to just get by.



you misunderstand me.  The "just get by" money isn't that if you are living w/in your means.


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## Level1pedstech (Jun 25, 2012)

crashh said:


> you misunderstand me.  The "just get by" money isn't that if you are living w/in your means.



Roger that.


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## STXmedic (Jun 25, 2012)

80k with very minimal overtime. It can indeed be done, you've just got to look and be willing to travel. And as was mentioned above, you may have to bite the bullet and go Fire/Medic to really pull in the good money.


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## Level1pedstech (Jun 26, 2012)

PoeticInjustice said:


> 80k with very minimal overtime. It can indeed be done, you've just got to look and be willing to travel. And as was mentioned above, you may have to bite the bullet and go Fire/Medic to really pull in the good money.



The key word here is "willing". How many times have you seen people that get all worked up at the thought of having to make even a small commute. We all know that the most successful people in any line of work are the ones that do the unconventional things. Long commutes,taking work where your gone from home during your work week and cross country moves are all things that the less motivated wont consider.

For almost ten years I commuted 3 hours roundtrip and did it six days most weeks. Thats probably a bit extreme for most but many people do long commutes. Twice I have packed up and moved over 1000 miles. Truth is many people are just not willing to make the sacrifices needed to get to the top of thier game.

As far as FF/PM goes its not as easy as it was five years ago but there is still a big advantage for fire applicants that have a medic cert. If you remember there was a time when guys were getting medic certs because it was almost a sure bet you would get a fire job. We ended up with a bunch of crappy medics in the fire service and that trend for the most part died a welcome death. Now its back to where if you want a job that pays a livable wage with excellent benefits and dont mind fire you can with some effort land a FF/PM job. If your young you make a killing on overtime when you can and your out in 25 years with a nice retirement and your still young enough to enjoy the fruits of your labor.

Of course there are many medics that will have nothing to do with fire and because of that they will most likely never hit that 80K + which is thier choice. With the economy on its back in most parts of the country most departments are under hiring freezes and many are cutting positions. There are little areas that seem to be immune to this and despite the economy they are still hiring. Over on firehouse.com there is a thread about West Covina,CA Fire and the fact that they just hired 8 people.  West Covina has five fire stations,taking on 8 people is huge. They are an example of whats available to those that are "willing" to put in the effort.


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## nocoderob (Jun 27, 2012)

Pay will vary with location. I work in the bay area of N. California and with minimal OT 100k+ is easy to do.


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## dsw163 (Jun 27, 2012)

I just don't get it. Why people in EMS hate the concept of higher education? I've had this discussion about low wages at work many times and when I mentioned "we should all have a degree before going to medic school", someone would say "Why do we need a degree?", "A degree not going to make you a better medic!". And most of these people often complain about our salary. How much do they expect to make working a technician-level job? How are we supposed to gain respect from our peers and public trust?

This is same mentality that give EMS a bad name. Other medical professions see us as "people who can barely finish high school trying to play doctors"

Correct me if I'm wrong. It takes a B.S. or at least an A.S. to become an entry level paramedic in UK, Australia, Germany... and I'm pretty sure it takes post-grad education, ie M.S., to be a critical care medic in OZ.

How do these following statements sound? 
"Hi, I'm Joe the EMT! I barely graduated high school with a GED and I went to EMT class for 150 hours! Please let me treat your unresponsive baby."
or
"Hi, I'm Pete the Paramedic! I also got my GED. I'm going to give these meds, which I know very little about, to sedate your wife here and shove this tube down her throat. Trust me, I was trained for 11 months!"

Ok.... I'm done ranting. SOrry


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## Hunter (Jun 27, 2012)

I have to correct my earlier post, my  AS in EMS might facilitate bfe moving out of state without having to take my NREMT-P


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## crashh (Jul 3, 2012)

for my first 3 years, i'll be working volunteer as a Paramedic.  It's part of my contract w/my company ..and in return they are paying for my classes & books!  

I guess I'll find out when I get out there what it's like,...alot of research to do tho!


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## Handsome Robb (Jul 3, 2012)

crashh said:


> for my first 3 years, i'll be working volunteer as a Paramedic.  It's part of my contract w/my company ..and in return they are paying for my classes & books!
> 
> I guess I'll find out when I get out there what it's like,...alot of research to do tho!



Wait really? My company pays for school and pays you're hourly wage during school, clinical and internship hours with a 5 year contract as a paid paramedic for them after school and options to break the contract with a pro-rated rate for school if you do. 

I'm not on that scholarship but it's available to employees.


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## BigBad (Jul 3, 2012)

dsw163 said:


> I just don't get it. Why people in EMS hate the concept of higher education? I've had this discussion about low wages at work many times and when I mentioned "we should all have a degree before going to medic school", someone would say "Why do we need a degree?", "A degree not going to make you a better medic!". And most of these people often complain about our salary. How much do they expect to make working a technician-level job? How are we supposed to gain respect from our peers and public trust?
> 
> This is same mentality that give EMS a bad name. Other medical professions see us as "people who can barely finish high school trying to play doctors"
> 
> ...




The only "degree" I've heard about in paramedicine is an associates.   I got my associates because I already had a BS in liberal arts prior to going to get my EMT-P.   The only difference in a AS and a certificate was a semester of school including math, english, computer class and maybe another elective.   All those credits transferred over.   I wouldn't consider that "higher" education.   But my BS in liberal arts made me more marketable and helped me get my dream job.

That being said, my education is only beginning.  I plan to become fluent in Spanish and continue learning emergency medicine daily.


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## KnightVision (Jul 3, 2012)

A friend asked me what an EMT starts at, told her around $13. Her response was shock, couldn't believe the pay compared to the "what" EMS is called to do. Mainly speaking 911 or first on the scene. Seems Joe Public may have a poor perception on average wages as related to expectations of quality care. Not sure if she was troubled or sad as she walked away.


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## crashh (Jul 3, 2012)

NVRob said:


> Wait really? My company pays for school and pays you're hourly wage during school, clinical and internship hours with a 5 year contract as a paid paramedic for them after school and options to break the contract with a pro-rated rate for school if you do.
> 
> I'm not on that scholarship but it's available to employees.



I work for a volunteer company.  we have 3 ALS in our company already (1 paramedic and 2 cc's)  but they can always use another, especially one that isn't a captain or officer and is available at different times.


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## Shishkabob (Jul 3, 2012)

BigBad said:


> The only "degree" I've heard about in paramedicine is an associates.



There are BS in EMS programs.


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## legion1202 (Jul 3, 2012)

I just want to make like 50k a year with good benefits. If I can do that working 2 24hs shifts with a chance of a nap that be great.. At 17 an HR times 48(including OT) 46k a year. Making 46k a year at 21 is perfect.. Making 46k a year at 30 with a family well that's tight. I make 42k a year now working M-F. I hate my job!!

Making 46k a Year doing what I love for the most part..  And only working 2 shifts a week. Is not a bad gigg.. If you want more money change jobs.. I dunno...

i`m moving my family to a different state for a better shot.. As a medic in S. Fl i`d making 25k a year.. Its all fire/ems here.. they make 50k a year and hardly run fire calls. There Just not hiring now.. So what the hell.. throwing my dice and seeing what Boston has to offer =) Maybe one day i`ll work for Boston ems..


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## TransportJockey (Jul 3, 2012)

Linuss said:


> There are BS in EMS programs.



Yep. UNM School of Medicine has one


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## Hockey (Jul 3, 2012)

I make $36 a hour as a road medic in the US, in Michigan.  Where do you guys all work? lol


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## Anjel (Jul 3, 2012)

Hockey said:


> I make $36 a hour as a road medic in the US, in Michigan.  Where do you guys all work? lol



Rightttt and I make $20 as a basic.


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## NYMedic828 (Jul 3, 2012)

Why is that so hard to believe?

One hospital here in NYC pays per diem $37.50 an hour.

I make $30 an hour sitting in a flycar of a volunteer firehouse.

$32 an hour roughly top pay FDNY EMS medic.

$23 as an EMT. Top pay


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## Level1pedstech (Jul 3, 2012)

dsw163 said:


> I just don't get it. Why people in EMS hate the concept of higher education? I've had this discussion about low wages at work many times and when I mentioned "we should all have a degree before going to medic school", someone would say "Why do we need a degree?", "A degree not going to make you a better medic!". And most of these people often complain about our salary. How much do they expect to make working a technician-level job? How are we supposed to gain respect from our peers and public trust?
> 
> This is same mentality that give EMS a bad name. Other medical professions see us as "people who can barely finish high school trying to play doctors"
> 
> ...




Most all of us here are for higher education some want to go way over board but they tend to fall into the young and dumb category. Those of us who are veterans of EMS and think clearly know that except for a few very rare cases the return on investment is lousy. If your in the position to spend a few years in school and come out only to find jobs where your making 13.00 to 15.00 p/hr if you can even find one then get after it.

With ten plus years in the field and six in the ER I can honestly tell you that your statements are a little "goofy" to say the least. Im trying to be kind so dont get me wrong but you are either really young or really green and are spending way to much time dribbling off your reume on scene. The care giver of that baby could give a rats butt about your "higher education" all they want is for you to make things better. Same goes for the patient your geting ready to tube,all the family wants are positive results and a happy ending.

Really the very best way to go is to bypass EMS all together and aim for somthing higher like RN,PA or even MD. You can always work as a medic or basic while your in school. After you have recieved your education and are making a decent living you can go back and be in the position to make positive contributions to pre hospital EMS.


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## Level1pedstech (Jul 3, 2012)

NYMedic828 said:


> Why is that so hard to believe?
> 
> One hospital here in NYC pays per diem $37.50 an hour.
> 
> ...



Everyone knows there is "gravy" to be found in EMS  but your talking about a very small percentage of available jobs.

Someone must have some numbers that show the national average hourly pay for basics and medics (non fire). My guess is 10.00 and 15.00 in that order which is no where near the gravy level


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## Level1pedstech (Jul 3, 2012)

Hockey said:


> I make $36 a hour as a road medic in the US, in Michigan.  Where do you guys all work? lol



Very interesting,money sounds good but lets get the big picture. There are many things in life that pay big money but is it really a "gravy gig" or us it one of those pain in the butt jobs where they have to pay that in order to get people to work. An example would be truck drivers making 100k+ in the North Dakota oil and gas fields. Great money and if you make it more than a few months your probably good to go but its a god awful job most of the time. Here are a few things I would want to know.

Hours per week.
Benefits.
Long term job security,would you pull a mortgage thinking you could retire there.
Working conditions.
Turn over rate,big money and high turnover equals red flags.


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## STXmedic (Jul 3, 2012)

Level1pedstech said:


> Hours per week.
> Benefits.
> Long term job security,would you pull a mortgage thinking you could retire there.
> Working conditions.
> Turn over rate,big money and high turnover equals red flags.



Hours: 24/72
Benefits: Full benefits, including full healthcare, vision, dental, life, CMEs. Also one of the lowest costs of living in the country.
Security: You have to commit murder to get fired from here.
Conditions: One (very) big family. Every now and then there's a troll that likes to pull rank, but they're few and far between.
Turn over: People leave when they retire. That's about it.

Don't be so skeptical. The "gravy trains" are out there. You just have to be willing to move around and work to get them. If you stay locked to your current location, you considerably limit yourself. There are several on here that are actively looking at some of the best gigs in the country. Those guys have a much better shot at making it to one of your mythical "gravy trains." N7s already done this. He seems to be enjoying it pretty well. Just mention Delaware and watch him go on and on about his awesome gig that he had to move literally across the country for.


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## Level1pedstech (Jul 3, 2012)

PoeticInjustice said:


> Hours: 24/72
> Benefits: Full benefits, including full healthcare, vision, dental, life, CMEs. Also one of the lowest costs of living in the country.
> Security: You have to commit murder to get fired from here.
> Conditions: One (very) big family. Every now and then there's a troll that likes to pull rank, but they're few and far between.
> ...



No skepticism here I always point out that there are some good jobs out there but they are the exception not the rule. These jobs also tend to be in areas with very high costs of living which means a commute or a second job to make ends meet. Once again this is not always the case but alot of times it is. In real money 25p/hr in NY city is equal to 11 p/hr in Mule Lick Texas. The majority of jobs in pre hospital EMS do not I repeat do not pay a liveable family wage you can point out the few that do but what about the 90% that dont ?


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## STXmedic (Jul 3, 2012)

Don't hate on Mule lick! That's right down the road from me!  :rofl: 

I definitely agree that there are considerably more poor-paying EMS jobs than there are well-paying. Thus the need to move and advance yourself to get one of the well-paying ones.


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## Anjel (Jul 3, 2012)

NYMedic828 said:


> Why is that so hard to believe?
> 
> One hospital here in NYC pays per diem $37.50 an hour.
> 
> ...



Because I make $9 and he makes roughly around $13-14.


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## Level1pedstech (Jul 3, 2012)

PoeticInjustice said:


> Don't hate on Mule lick! That's right down the road from me!  :rofl:
> 
> I definitely agree that there are considerably more poor-paying EMS jobs than there are well-paying. Thus the need to move and advance yourself to get one of the well-paying ones.



I would live in Mule Lick or just about anywhere else in the lone star state. Texas has got it going on and its economy and the number of oeople headed that way is only going to grow. 

We have transportation offices all over the state but I am thinking Plainview. After moving from WA to CA I might have to drag my wife and kids kicking and screaming out of Cali but since I make all the money they will make the move.


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## DrParasite (Jul 3, 2012)

Anjel1030 said:


> Rightttt and I make $20 as a basic.


I'm working on that... I only make 19 an hour as a basic, but with a $2 night differential, I make a decent living.  full time Paramedics start at 25 or so, and I think per diems start at $31.

True, our guys work their asses off, but if you live in Mule Lick and do only 2 calls a shift, you probably won't make as much as someone who is doing 10-16 calls.

Not only that, but if you work for-profit, you will almost always make less than a non-profit or tax payer funded employee.  

And with all jobs, if you don't like the salary, either move to an area where the pay is better, work for a better agency, find a new career, or get educated and move up in the ranks.

oh, and i'm looking at a side job (because I want it, not because I need it), and they are going to pay me $16 an hour.  maybe it's just some places value EMTs more?


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## VFlutter (Jul 3, 2012)

As a new grad BSN RN I will be making around $25 an hour so it sounds like a lot of you guys have it pretty good. In comparison an emt basic around here is ~$10 / hr


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## Level1pedstech (Jul 3, 2012)

ChaseZ33 said:


> As a new grad BSN RN I will be making around $25 an hour so it sounds like a lot of you guys have it pretty good. In comparison an emt basic around here is ~$10 / hr



Good job on getting thru your program you have a secure future ahead of you and the opportunities are going to be many. Just to use as an example could you tell us how much time you have invested in your education to this point. We understand every student is different and the time they take can vary depending on thier situation.


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## VFlutter (Jul 3, 2012)

Level1pedstech said:


> Good job on getting thru your program you have a secure future ahead of you and the opportunities are going to be many. Just to use as an example could you tell us how much time you have invested in your education to this point. We understand every student is different and the time they take can vary depending on thier situation.



Thanks, I am not quite done yet I graduate in December. Most of my friends graduated in May. When I am all done it will end up being about 4 years, which is pretty standard. 2 years (4 semesters with summers off) of pre nursing classes and then 2 years (5 semesters year round) of actual nursing school. 

I think it really depends on your region and particular school. For my prerequisites I took anatomy and physiology (2 separate classes), med school microbiology, nutrition, bio, chem, multiple human development classes, algebra, medical terminology, English I and II,  and enough humanities to end up with two minors (psychology and Philosphy) while having to maintain to 3.5 to be competitive for admission. Oh and I got my EMT-B while doing that. I am not saying this is typical because I know a lot of other schools that require much less.

Here are the prerequisites for the paramedic program at the university that I attended. 

COURSE PREREQUISITES/REQUIREMENTS: Applicants must:
1. Be 18 years of age.
2. Have a high school diploma or G.E.D.
3. Be currently licensed as an Emergency Medical Technician (EMT) by the State of Missouri.
4. Have three professional letters of recommendation from individuals that are familiar with the
applicants EMS background, work experience or personal attributes. These individuals must not
be related to the applicant.
5. Have current certification in AHA Healthcare Provider CPR.
6. Have current health care insurance.
7. Have current medical liability insurance. 1million/3million
8. Be of good mental and physical health and able to lift and carry 100 to 150 lbs.
9. Be a U.S. Citizen or have a legal right to work in the U.S.
10. Have a valid email address and regular access to a computer
11. Have an up-to-date criminal background check from the Missouri State Highway Patrol, the Office
of the Inspector General, the Caregiver Background Screening, and the Employee Disqualification
Listing.
12. Background check through Validity Screening at student expense contact EMS Education office
for details.



Not to get into a huge debate but about Nurse vs paramedic but you can see there is a huge difference. Maybe that is why nurses are expected to be paid more. Also the paramedic program is around $5000. My education cost me over $45,000 :wacko:. Again that was my choice to go to certain schools but the initial investment in time and money in education is huge.


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## JPINFV (Jul 3, 2012)

ChaseZ33 said:


> med school microbiology



Which medical school did you take micro at?


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## VFlutter (Jul 3, 2012)

JPINFV said:


> Which medical school did you take micro at?



University of Missouri - Columbia (Mizzou). I was on of the lucky few who did not get a spot in the Nursing school track so I was given the option of waiting until next year and being a semester behind or taking the medical school track (since it was a higher level class it would count as credit) . I chose the latter. Horrible decision, it took every thing I had to pass that class.


Edit: Sorry that sounds misleading, it would be better described as pre-med micro not med school micro. I should have worded that differently. It was a much more advanced and thorough class than most of the ones designed for pre-nursing.


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## JPINFV (Jul 3, 2012)

Umm, University of Missouri School of Medicine doesn't offer a "microbiology" course as they use a pure problem based learning curriculum.

http://medicine.missouri.edu/education/uploads/Preclerkship-Curriculum-At-a-Glance1.pdf

http://medicine.missouri.edu/education/pbl.html

It sounds like you took a pre-med course, which is in no ways a "med school microbiology" course.


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## VFlutter (Jul 3, 2012)

JPINFV said:


> Medical school track? When I hear of tracks, I think of undergrad, not medical school. Were your fellow students premeds or medical students?



I edited my post. It was undergraduate pre med class not medical school. Sorry for the confusion. I was not trying to portray it as medical school I should have said pre med. I understand it is totally different

The class was held in the actual medical school, that counts right? Haha


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## Level1pedstech (Jul 4, 2012)

ChaseZ33 said:


> Thanks, I am not quite done yet I graduate in December. Most of my friends graduated in May. When I am all done it will end up being about 4 years, which is pretty standard. 2 years (4 semesters with summers off) of pre nursing classes and then 2 years (5 semesters year round) of actual nursing school.
> 
> I think it really depends on your region and particular school. For my prerequisites I took anatomy and physiology (2 separate classes), med school microbiology, nutrition, bio, chem, multiple human development classes, algebra, medical terminology, English I and II,  and enough humanities to end up with two minors (psychology and Philosphy) while having to maintain to 3.5 to be competitive for admission. Oh and I got my EMT-B while doing that. I am not saying this is typical because I know a lot of other schools that require much less.
> 
> ...



Thanks for taking the time to lay it out for us. The medic program I was looking at in WA was closer to 10k plus pre reqs. When people start droaning on about increasing the level of education for paramedics I like to question the return on investment. We are all for advancing education but there has to be a benefit at the end of the line. 

No doubt there is a very huge difference between the two both in education and in the money you can expect to earn over your life time. You will be starting at 25.00 p/hr but have the ability to make much more as you gain experience and discover opportunities that you find interesting. I have worked with CC RN's in the ER that were well above 50.00 p/hr with all the little extras added in. They worked 3 12's and have plenty of time off to enjoy life.

Some people want medics to have your education or more but they know MOST medics will never see north of 25.00 p/hr in thier life time. Some may fall into a higher paying gig but I would think 25.00 p/hr is the ceiling for most medics. More than a few medics I know are working second jobs to make ends meet which does not allow much time to enjoy life.

There are those that believe that better educated "professional" providers can demand better pay. Ask them where the money and jobs will come from and they all have to step back and face the cold hard facts. EMS is not set up to provide two RN's on every rig. It stuggles along in most systems with a basic and a medic who togeather might make 25.00 p/hr.


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## JPINFV (Jul 4, 2012)

Level1pedstech said:


> There are those that believe that better educated "professional" providers can demand better pay. Ask them where the money and jobs will come from and they all have to step back and face the cold hard facts. EMS is not set up to provide two RN's on every rig. It stuggles along in most systems with a basic and a medic who togeather might make 25.00 p/hr.



As long as paramedics are seen as medical technician taxi drivers, then they're over educated and properly paid for what they do. If paramedics want to do something else than medical taxi work while following a cookbookocol, then the current education isn't nearly enough. The problem is that you can't be expected to do non-taxi non-cookbookocol work and THEN get more education. You have to have the education to justify the additional work, and subsequent reimbursement. 


What I find interesting is the attitude of, "Well, things aren't working. We're struggling to get by because insurance views us as nothing more than a taxi (hence only being reimbursed when we transport). However, even though it's a failing system, we can't change anything on our end because it's too expensive for us. Pay us more, allow us to do more, and then we'll get the education to do it properly. After all, what could go wrong when we do things we aren't educated to do?" 

[insert story of DCFD leaving a chest pain patient at home because they thought a pulmonary embolism was GERD]


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## crashh (Jul 4, 2012)

wow.


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## JPINFV (Jul 4, 2012)

crashh said:


> wow.




Seeing no quote, I'm assuming this was in response to me. 

Do I sense a bit a biwilderment about how blunt my post was?

True or false, Medicare is the largest reimburse for EMS?

True or false, Medicare only pays EMS for transports?

True or false, taxis are the stereotypical occupation when it comes to moving humans from point A to point B as an on demand service?

I'm not saying anyone has to like it, just that it has to be recognized. Hopefully EMS providers will eventually get "as mad as hell and we're not gonna take it anymore." However there's simply too much apathy and "look at the cool toys" mentality right now.


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## usalsfyre (Jul 4, 2012)

crashh said:


> wow.



JP is right. It's one of those uncomfortable truths you come to realize once you move past the "cool toys" stage.


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## JPINFV (Jul 4, 2012)

I just looked over my post. 

True or false, i spell good todey?


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## Hunter (Jul 4, 2012)

Important question where do you guys with the gravy train jobs live, and what department do you work for.


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## STXmedic (Jul 4, 2012)

Hunter said:


> Important question where do you guys with the gravy train jobs live, and what department do you work for.



Do some hunting around (pardon my pun). They're spread all over the place.

I will say that there seem to be quite a few top-notch systems in Texas 

Just know that many of these systems are very difficult to get on to. You'll need to really make yourself stand out.


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## crashh (Jul 4, 2012)

sorry should have quoted....it was to pedstech's post about what he needed to go to para school...

i don't have to have letters of req...although i would have gladly supplied them.  I don't have to have medical insurance (which i don't)..they take care of that while i'm on school business....i don't have med liability...or any background checks

but the rest is all the same


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## Hunter (Jul 4, 2012)

PoeticInjustice said:


> Do some hunting around (pardon my pun). They're spread all over the place.
> 
> I will say that there seem to be quite a few top-notch systems in Texas
> 
> Just know that many of these systems are very difficult to get on to. You'll need to really make yourself stand out.



Well I'm in florida, definitely willing to move, I have been looking around, ofcourse a name of a department/company would always be appreciated.


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## DrParasite (Jul 4, 2012)

Hunter said:


> Important question where do you guys with the gravy train jobs live, and what department do you work for.


I don't reveal what agency I work for, but I will say that I live in New Jersey, and work in the NY Metro Area (in the NJ part).

If you want to know more, PM me and I can tell you some of the higher paying places near me


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## Level1pedstech (Jul 5, 2012)

crashh said:


> sorry should have quoted....it was to pedstech's post about what he needed to go to para school...
> 
> i don't have to have letters of req...although i would have gladly supplied them.  I don't have to have medical insurance (which i don't)..they take care of that while i'm on school business....i don't have med liability...or any background checks
> 
> but the rest is all the same



Actually I was quoting ChaseZ33. It can get a bit confusing aound here.


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## Level1pedstech (Jul 5, 2012)

JPINFV said:


> As long as paramedics are seen as medical technician taxi drivers, then they're over educated and properly paid for what they do. If paramedics want to do something else than medical taxi work while following a cookbookocol, then the current education isn't nearly enough. The problem is that you can't be expected to do non-taxi non-cookbookocol work and THEN get more education. You have to have the education to justify the additional work, and subsequent reimbursement.
> 
> 
> What I find interesting is the attitude of, "Well, things aren't working. We're struggling to get by because insurance views us as nothing more than a taxi (hence only being reimbursed when we transport). However, even though it's a failing system, we can't change anything on our end because it's too expensive for us. Pay us more, allow us to do more, and then we'll get the education to do it properly. After all, what could go wrong when we do things we aren't educated to do?"
> ...




Some time ago I think we all came to a conclusion on what level of training would make the ideal 911 providers. If memory serves me right it was a PA and an RN working together. To me and I think most of you this would be ideal of course both would have to have specific training in pre hospital emergency medicine.

Having never been involved in the actual budgeting of staff for a 911 agency  I can only throw out numbers off the top of my head. We do have some community members who have been in that position and maybe they could jump in and offer more precise numbers. In order to staff a crew consisting of a PA and an RN I would think it would be more than triple the cost of what it takes to run a basic and a medic. 

One option could be to only staff a certain number of cars at that level with the remaining maybe being units staffed by a cc medic and a traditional medic eliminating basics all together. BLS could be covered by fire either paid or volunteer as it is now in many places. Once again we are faced with the problem of where would the extra money come from and what about the areas that really have no extra revenue for such an expensive venture.

Maybe looking at it from the angle of what percentage of all calls placed to 911 require traditional ALS. Once again Im working with rough numbers but I think it an 80/20 split in most areas. A far as the medi taxi (non emergent) end of the business goes I think they would work it out with the funding currently available. Im not real sure what the profit margin is for the dialysis and IFT ends of the business but perhaps they should be seperated fom 911.


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## NomexMedic (Jul 5, 2012)

crashh said:


> Why, with the advanced skill level, are paramedics paid so little?


Very simple.  Until paramedics can learn to work together to demand higher wages from their employers for their skillset, then we are doomed to fail.  Everyone is afraid of the word union, but it's worked for the nurses and the firefighters and it should work for us.


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## JakeEMTP (Jul 5, 2012)

NomexMedic said:


> Very simple.  Until paramedics can learn to work together to demand higher wages from their employers for their skillset, then we are doomed to fail.  Everyone is afraid of the word union, but it's worked for the nurses and the firefighters and it should work for us.



For nurses the employers have also now said you must have a BSN (4 year degree) before your application is considered regardless of the minimum entry standard.

Fore Firefighters they must also have a Paramedic cert in addition to their FF training and certs thus attempting to keep up with two very different professions. The union in turn will back them for also providing EMS but will  see that the Paramedic cert does not get so demanding it interferes with the fire side. For this reason also the Paramedic cert has remained the same for the past 40 plus years.


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## VFlutter (Jul 5, 2012)

NomexMedic said:


> Very simple.  Until paramedics can learn to work together to demand higher wages from their employers for their skillset, then we are doomed to fail.  Everyone is afraid of the word union, but it's worked for the nurses and the firefighters and it should work for us.



That is the problem, paramedics are in no position to demand higher wages. Every other healthcare profession continues to move forward and raise their standards of education on their own accord. Nurses are now requiring bachelors, RT need bachelors and some masters. OT/PT now need their masters and doctorates to practice. I know you can say the current pay does not justify getting a higher degree but you can not demand higher pay without it. The education must come first. Its how most professions work. 

Just like nurses over the years from diploma to AD to BSN. Many nurses were getting BSNs when they first came out but did not see any increase in pay for the profession until years after. Now Nurse Practitioners are going through this, in the next few years all NPs will need a doctorate in order to practice (phasing out MSN programs in the next 5 years). Do you think their pay will increase now that they require more education? Probably not right away. 

So is being a paramedic a job or a profession? Or more specifically is it really a medical profession?

"A profession is a vocation founded upon specialized high educational training, the purpose of which is to supply objective counsel and service to others, for a direct and definite compensation, wholly apart from expectation of other business gain"

"A profession has been further defined as: "a special type of occupation...(possessing) corporate solidarity...prolonged specialized training in a body of abstract knowledge, and a collectivity or service orientation"


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## NomexMedic (Jul 5, 2012)

ChaseZ33 said:


> That is the problem, paramedics are in no position to demand higher wages. Every other healthcare profession continues to move forward and raise their standards of education on their own accord. Nurses are now requiring bachelors, RT need bachelors and some masters. OT/PT now need their masters and doctorates to practice. I know you can say the current pay does not justify getting a higher degree but you can not demand higher pay without it. The education must come first. Its how most professions work.
> 
> Just like nurses over the years from diploma to AD to BSN. Many nurses were getting BSNs when they first came out but did not see any increase in pay for the profession until years after. Now Nurse Practitioners are going through this, in the next few years all NPs will need a doctorate in order to practice (phasing out MSN programs in the next 5 years). Do you think their pay will increase now that they require more education? Probably not right away.
> 
> ...


Wow...  Just wow.  This is what we have to deal with?  Nursing students who are of the belief they are higher than a Paramedic.  Look, it's a profession.  I have continuing education, and a college degree.  As of the next two years, it becomes a mandatory degree program to take your NREMT and the majority of programs in the nation now are through an accredited college requiring an Associate's degree.

Until we demand higher wages, people aren't going to pay $15,000 to become paramedic when they can walk into Jiffy Lube off the street and make more money changing oil.  People with your mindset are exactly what's wrong with the profession.


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## legion1202 (Jul 5, 2012)

I really don't understand what the deal is. if your making 17 bucks an hour  with two 24hr shifts and 8 ours of OT ur making 45k a year. If your running the full 24 hrs then yes that sucks.. But around where I live these guys are making 49k a year working 2-3 shifts a week. 102 shifts a year and sleep 10-8hrs a day.

Even working for a private company I`ve seen this is possible haha. Nurses get paid good money but i`d get sick of having to be at the same location for 12 hrs a day. This is why i do not want a office job. The only way i`d become a nurse is if I get hurt/old or I want to be on a Bird.

The only down side of working private is that you do not get all the city or state pensions. Which in FL that going away or will be going away as states can not afford it. A lot of private companies do however provide 401k and if its a big enough company your health Plans are better then most normal jiffy lubes. 

AMR down here pays 9$ a hour for emts... How can anyone afford to live off that. Problem is.. 2-3 years ago you could work at amr for 9 bucks an hr because chances are in 5-8mos u would be picked up. Or it was good to work there p/t while going through fire or medic school like I did.


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## STXmedic (Jul 5, 2012)

NomexMedic said:


> Very simple.  Until paramedics can learn to work together to demand higher wages from their employers for their skillset, then we are doomed to fail.  Everyone is afraid of the word union, but it's worked for the nurses and the firefighters and it should work for us.



What skill set? Being able to put in an IV and blindly give a few medications because the magic protocol book says so? 

What do we have to offer that allows us to beg for higher compensation? 

Does EMS need a union? Sure. But having a union doesn't mean you automatically get better pay and benefits. You can't expect more without giving more in return.

The nursing analogy was used earlier. Nurses have an incredibly strong union. And nursing pay has dramatically increased over the last 40 years. My mother-in-law was a diploma nurse during this time. Nursing has gone from a diploma nurse (this is not an ADN) as the standard, to a BSN as the up and coming standard. How has EMS improved in the last 40 years? Oh, wait... We can call heart alerts now... The amount of self-worth EMTs and Paramedics have is mind-boggling.

Maybe once we start advancing ourselves, we can advance our pay. Unfortunately, I don't see this happening any time in the near future. That's one of the reasons I, along with many other very competent providers, will be advancing to a different field that can compensate and advance itself. Sad, but reality.


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## VFlutter (Jul 5, 2012)

NomexMedic said:


> Wow...  Just wow.  This is what we have to deal with?  Nursing students who are of the belief they are higher than a Paramedic.  Look, it's a profession.  I have continuing education, and a college degree.  As of the next two years, it becomes a mandatory degree program to take your NREMT and the majority of programs in the nation now are through an accredited college requiring an Associate's degree.
> 
> Until we demand higher wages, people aren't going to pay $15,000 to become paramedic when they can walk into Jiffy Lube off the street and make more money changing oil.  People with your mindset are exactly what's wrong with the profession.



I never said anything about nurses being better that a paramedic. The topic is why paramedics are paid so little, specifically compared to other medical careers. Me being a nursing student has nothing to do with that. I am just trying to point out that the nursing profession had similar problem
In the past 

It's just my opinion. Take it for what it's worth. However I don't see anyone paying more for a job with the hopes that they will eventually get more education to justify it. It's something that has to happen internally within the profession.


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## VFlutter (Jul 5, 2012)

NomexMedic said:


> Until we demand higher wages, people aren't going to pay $15,000 to become paramedic when they can walk into Jiffy Lube off the street and make more money changing oil.  People with your mindset are exactly what's wrong with the profession.



No I think people with your mindset are exactly what is wrong with the profession.


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## atropine (Jul 5, 2012)

I know about 200 medics that make over 100k a year, thats not low.


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## VFlutter (Jul 5, 2012)

atropine said:


> I know about 200 medics that make over 100k a year, thats not low.



But is that with a fire department? I know paramedic/FF around
here start off at $70k.


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## STXmedic (Jul 5, 2012)

It is when you live in Cali...

LA City fire if I'm not mistaken?


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## atropine (Jul 5, 2012)

yeah it's fire, the past four years I have not made less than 120k, but Iam going probably call it quits in another year or so.


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## VFlutter (Jul 5, 2012)

atropine said:


> yeah it's fire, the past four years I have not made less than 120k, but Iam going probably call it quits in another year or so.



I think fire based pay scales should be taken with a grain of salt or just left out of the debate. There is such a huge difference in pay between non fire and fire, plus there are way fewer jobs. 


Ya I know a few RNs that work as VA travel nurse and make over $100k a year but that doesn't really have much to do with the average pay of a nurse at a hospital where a vast majority of the jobs are.


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## Hunter (Jul 5, 2012)

ChaseZ33 said:


> No I think people with your mindset are exactly what is wrong with the profession.











ChaseZ33 said:


> I never said anything about nurses being better that a paramedic. The topic is why paramedics are paid so little, specifically compared to other medical careers. Me being a nursing student has nothing to do with that. I am just trying to point out that the nursing profession had similar problem
> In the past
> 
> It's just my opinion. Take it for what it's worth. However I don't see anyone paying more for a job with the hopes that they will eventually get more education to justify it. It's something that has to happen internally within the profession.



You're both half right and half wrong. We do need to demand higher pay, the only way to do that is by making ourselves more valuable, and you so that by making it harder to get an Emt\paramedic licensure by raising education.


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## JakeEMTP (Jul 5, 2012)

NomexMedic said:


> Wow...  Just wow.  This is what we have to deal with?  Nursing students who are of the belief they are higher than a Paramedic.  Look, it's a profession.  I have continuing education, and a college degree.  *
> 
> *Until we demand higher wages, people aren't going to pay $15,000 to become paramedic when they can walk into Jiffy Lube off the street and make more money changing oil.  People with your mindset are exactly what's wrong with the profession.



Please provide the information that the NREMT is making a 2 year degree mandatory.  In fact, some states are fighting the accreditation part and may go back to giving their own state test. Also, nothing says that a votech or private trade school can not become accredited. 

What is your degree in? 

As far as the union stuff, per the national statistics, only 19% of the nurses belong to a union.  Right now 50% of the RNs in the US have a BSN. By 2020 the goal is to be 80% with BSN degrees.

Over 62% of the fire fighters are union and probably more than half are Paramedics. The other 38% are volunteer firefighters. Chances are any Paramedic who works for a city or county will belong to a union which also raises the number higher. There are also several private companies which have union representation.  So there is a large union presence in EMS.  According to the stats only 20% of the Paramedics hold any type of degree and it may be in something else like nursing, fire science or accounting.  

For your Jiffy Lube comment, make sure you know something about a profession before you try to cut it down. You made an assumption they are grease monkeys without an education. The Jiffy Lube Technicians are ASE Certified which makes the NREMT exams look like a cake walk. Many Technicians will be graduates of votech program which could be 24 months including a college degree. There are different tests. After passing at least one exam and providing proof of two years of relevant work experience, the test-taker becomes ASE certified.  Doesn't exactly sound like some of the zero to hero Paramedic programs which are now in existence. To remain certified, ASE-certified professionals must be retested every five years. Imagine if you had to retake the NREMT every 5 years in addition to getting CEs.


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## Tigger (Jul 5, 2012)

ChaseZ33 said:


> That is the problem, paramedics are in no position to demand higher wages. Every other healthcare profession continues to move forward and raise their standards of education on their own accord. Nurses are now requiring bachelors, RT need bachelors and some masters. OT/PT now need their masters and doctorates to practice. I know you can say the current pay does not justify getting a higher degree but you can not demand higher pay without it. The education must come first. Its how most professions work.
> 
> Just like nurses over the years from diploma to AD to BSN. Many nurses were getting BSNs when they first came out but did not see any increase in pay for the profession until years after. Now Nurse Practitioners are going through this, in the next few years all NPs will need a doctorate in order to practice (phasing out MSN programs in the next 5 years). Do you think their pay will increase now that they require more education? Probably not right away.
> 
> ...



I could not agree more with this post. Look at the countries where paramedics are respected and paid well and you'll find that they're education is far and away superior to that of the US model.

So many are quick to bemoan comparisons between nursing and EMS, and I agree that it's fairly apple to oranges. A paramedic and nurse have fundamentally different roles, and fundamentally different skills. To me, it just seems backwards that even the best paramedic programs only take a year or so (plus prereqs), yet their scope of practice is far larger than that of nursing.


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## JakeEMTP (Jul 5, 2012)

ChaseZ33 said:


> I think fire based pay scales should be taken with a grain of salt or just left out of the debate. There is such a huge difference in pay between non fire and fire, plus there are way fewer jobs.
> 
> 
> Ya I know a few RNs that work as VA travel nurse and make over $100k a year but that doesn't really have much to do with the average pay of a nurse at a hospital where a vast majority of the jobs are.



Fire is required to be proficent in 2 vastly different skill sets. Anyone who does this should be paid more. Also, I would say Fire service Paramedics make up a signicant number so they can not be ignored.

It is easy for RNs to make over $100k if they live in NY, CA or MA. Just like the areas Atropine lives in, $75K is probably considered at the poverty level. But, for EMTs, in those areas they are mass produced in 3 week mills. Everybody in that part of the country is an EMT from movie stars, rock stars to the person serving you your Big Mac.


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## VFlutter (Jul 5, 2012)

JakeEMTP said:


> Fire is required to be proficent in 2 vastly different skill sets. Anyone who does this should be paid more. Also, I would say Fire service Paramedics make up a signicant number so they can not be ignored.



I agree, I did not mean that they should
Be ignored. However saying paramedics are paid great because a medic/FF and make $100k a year is not really an argument because as you said they are paid for doing two jobs. Just talking about the statistics if you added all the medics and medic/FF together and averaged out their salaries it would be misleading since the average would be much higher.


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## Shishkabob (Jul 5, 2012)

JakeEMTP said:


> Fire is required to be proficent in 2 vastly different skill sets.



I think we need to clearly define "proficient"... because you and I apparently have 2 different views on that.


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## JakeEMTP (Jul 5, 2012)

ChaseZ33 said:


> I agree, I did not mean that they should
> Be ignored. However saying paramedics are paid great because a medic/FF and make $100k a year is not really an argument because as you said they are paid for doing two jobs. Just talking about the statistics if you added all the medics and medic/FF together and averaged out their salaries it would be misleading since the average would be much higher.



If the FF/Paramedic was in TN, they might make $50k while the private Paramedics might make $40k - $45k

In some of the areas like where Atropine is or in the SF Bay area, the FF Paramedic may make $100k and the private $75k - $85k. RNs in the area do most of the CCTs so it is difficult to get a good comparison across the board because of the cost of living and the make up of the state's EMS and ALS transport services.

In other states Paramedics might also do CCT transport with private companies and be paid a little more but with basically the same base Paramedic education.


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## atropine (Jul 5, 2012)

In other states Paramedics might also do CCT transport with private companies and be paid a little more but with basically the same base Paramedic education.[/QUOTE]

That's right in Tulsa when I worked for EMSA they gave you a little extra to operate med pumps, there were no RN rigs like they have here in Cali, but because of the weather you couldn't pay me enough to live in the midwest, I'd rather be homless in sunny Cali anyday of the week.


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## crashh (Jul 5, 2012)

my next step after medic is nursing school...should I be thinking about a bachelors?


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## STXmedic (Jul 5, 2012)

Yes. If you have the ability to go BScN, do it.


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## VFlutter (Jul 5, 2012)

crashh said:


> my next step after medic is nursing school...should I be thinking about a bachelors?



Yes, most hospitals will only hire BSN new grads now


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## NomexMedic (Jul 5, 2012)

PoeticInjustice said:


> What skill set? Being able to put in an IV and blindly give a few medications because the magic protocol book says so?
> 
> What do we have to offer that allows us to beg for higher compensation?


I apologize good sir.  I didn't realize you were from a state where Paramedics operate out of a cook book and aren't allowed to think for themselves.  Over here in Tennessee, we actually practice and are good at what we do.  Maybe you should try it sometime.



ChaseZ33 said:


> I never said anything about nurses being better that a paramedic. The topic is why paramedics are paid so little, specifically compared to other medical careers. Me being a nursing student has nothing to do with that. I am just trying to point out that the nursing profession had similar problem
> In the past
> 
> It's just my opinion. Take it for what it's worth. However I don't see anyone paying more for a job with the hopes that they will eventually get more education to justify it. It's something that has to happen internally within the profession.


Sorry if I came off crude to you, however it the mentality that is portrayed agitates me very much and it's all over this industry.  This, along with the general laziness of most in our field is why we are held back so badly and why we can't advance.  Everyone wants something for nothing.


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## STXmedic (Jul 5, 2012)

NomexMedic said:


> I apologize good sir.  I didn't realize you were from a state where Paramedics operate out of a cook book and aren't allowed to think for themselves.  Over here in Tennessee, we actually practice and are good at what we do.  Maybe you should try it sometime.



LOL! Oh the irony. Texas is actually one of the most progressive states for EMS. Thanks to medical directors in our state having the ability to set their own non-state regulated protocols, there are MANY systems here (mine included) that are allowed a tremendous amount of free reign. Almost too much. We're not bound by a half-*** Tennessee Statewide Guideline.


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## JakeEMTP (Jul 5, 2012)

NomexMedic said:


> I apologize good sir.  I didn't realize you were from a state where Paramedics operate out of a cook book and aren't allowed to think for themselves.  Over here in Tennessee, we actually practice and are good at what we do.  Maybe you should try it sometime.



The protocols of TN don't look any different except for telling you exactly how to transport a patient like giving you permission to transport in a non emergency mode if the condition of the patient warrants it. In fact, your protocols explains everything out in the most minute detail to not leave anything out or to guess. You must also call Med Control for ANY deviation of the standing orders or protocols. Your state also allows for FDs to have their own Paramedic schools and break away from the colleges. 



NomexMedic said:


> Sorry if I came off crude to you, however it the mentality that is portrayed agitates me very much and it's all over this industry.  This, along with the general laziness of most in our field is why we are held back so badly and why we can't advance.  Everyone wants something for nothing.



Having a union do all the talking for you is the easy way out. Getting an education is alittle harder. Having a union fight to keep the education standards low so you don't have to extend yourself learning is the lazy way.


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## JakeEMTP (Jul 5, 2012)

PoeticInjustice said:


> LOL! Oh the irony. Texas is actually one of the most progressive states for EMS. Thanks to medical directors in our state having the ability to set their own non-state regulated protocols, there are MANY systems here (mine included) that are allowed a tremendous amount of free reign. Almost too much. We're not bound by a half-*** Tennessee Statewide Guideline.



Yet, Texas only requires just over 600 hours of training for its Paramedics. I think TX was the poster child for how not to do RSI.

None of the states in the US have much to brag about. If any company wants to raise the bar to be more picky about who they hire like nursing has, they can always fight it through a union or scaring the agency into believing using the education card is discrimination.


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## STXmedic (Jul 5, 2012)

Thus the "almost too much"


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## Shishkabob (Jul 5, 2012)

JakeEMTP said:


> Yet, Texas only requires just over 600 hours of training for its Paramedics. I think TX was the poster child for how not to do RSI.



Minimum != average.
Minimum != the norm.
Minimum != the expected.


Infact, I can't point to a single program in the state that does the minimum.  One infamous one comes close, but still exceeds it, and even then I know a portion of people from there won't get hired by any of the more progressive agencies without actually proving knowledge.


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## Tigger (Jul 5, 2012)

crashh said:


> my next step after medic is nursing school...should I be thinking about a bachelors?



And maybe possibly think about getting a BSN first, it'll make getting your medic a snap I'd think. That's my plan at least, I'm shooting for PA or eventually ending up as a CEN, and from there I wouldn't mind be backing on the ambulance part time if possible.


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## epipusher (Jul 5, 2012)

Puppy mill type programs.


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## JPINFV (Jul 5, 2012)

Linuss said:


> Minimum != average.
> Minimum != the norm.
> Minimum != the expected.



For EMS... yes. How often is the standard people are held to is the bare minimum in thought, and anyone who acts different is the "dangerous" one. Somehow I doubt that Texas is any different from other states in that regard.


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## atropine (Jul 5, 2012)

In a couple of our last academies, we had recruits from Medstar, bunch of them relocated from Texas to southern Cali, wonder why? I don't think education hours and protocols where the reason.


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## usalsfyre (Jul 6, 2012)

atropine said:


> In a couple of our last academies, we had recruits from Medstar, bunch of them relocated from Texas to southern Cali, wonder why? I don't think education hours and protocols where the reason.



Funny, I sat in on a MedStar academy a couple months ago and there were at least three from So Cali in there. Perhaps they're just hanging out till they hit the fire loto?


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## NomexMedic (Jul 6, 2012)

JPINFV said:


> For EMS... yes. How often is the standard people are held to is the bare minimum in thought, and anyone who acts different is the "dangerous" one. Somehow I doubt that Texas is any different from other states in that regard.


Oh it's different alright...  Almost special.  All my ex's live there after all! :rofl:


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## BillyNightNurse (Jul 27, 2012)

*Career Change*

I am a nurse and considering what I think would be a more exciting career in EMS.  I am in my late 30's.  Is that too old?  I still have tons of energy.


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## Christopher (Jul 27, 2012)

BillyNightNurse said:


> I am a nurse and considering what I think would be a more exciting career in EMS.  I am in my late 30's.  Is that too old?  I still have tons of energy.



I've got volly's in their 60's at my department.

Provided you can lift and move, hear, and see Ok, age is not a limiting factor.


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## crashh (Jul 29, 2012)

Billy, I'm 42 and just going to Paramedic shool...and nursing school next year if all works out ok.  My bf is 48 and he's a nursing student.  it's never too late!


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## NYMedic828 (Jul 29, 2012)

Christopher said:


> I've got volly's in their 60's at my department.
> 
> Provided you can lift and move, hear, and see Ok, age is not a limiting factor.



We have vollies in their 70s....


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## VirginiaEMT (Jul 29, 2012)

crashh said:


> Why, with the advanced skill level, are paramedics paid so little?



The same reason that airline pilots are paid so little. Airline owners know that pilots LOVE to fly and are willing to sacrifice just about everything to be able to do it, so they know they will do it for little pay. EMS agencies know that medics are willing to do it for little pay because of their love for it and they would rather work for $15 an hour doing what they love verses making $20 an hour at a factory or such.


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## Veneficus (Jul 29, 2012)

Level1pedstech said:


> Some time ago I think we all came to a conclusion on what level of training would make the ideal 911 providers. If memory serves me right it was a PA and an RN working together. To me and I think most of you this would be ideal of course both would have to have specific training in pre hospital emergency medicine.
> 
> Having never been involved in the actual budgeting of staff for a 911 agency  I can only throw out numbers off the top of my head. We do have some community members who have been in that position and maybe they could jump in and offer more precise numbers. In order to staff a crew consisting of a PA and an RN I would think it would be more than triple the cost of what it takes to run a basic and a medic.
> 
> ...



Actually, if it were up to me, I would ditch the PA. It is a useless position anyway.

Recently I had the opportunity to work with a prehospital RN. Basically I would call it an RN with some paramedic training and undoubtably it is more than adequete. Even for treat and refer or treat and release.


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## Veneficus (Jul 29, 2012)

*I have too much time this weekend.*



NomexMedic said:


> Wow...  Just wow.  This is what we have to deal with?  Nursing students who are of the belief they are higher than a Paramedic.  Look, it's a profession.  I have continuing education, and a college degree.  As of the next two years, it becomes a mandatory degree program to take your NREMT and the majority of programs in the nation now are through an accredited college requiring an Associate's degree.



I am going to have to respectfully disagree on this one. 

It is a vocation. It will continue to be a vocation until 2 things come to pass.
1. Higher education is mandatory.
2. It is a unique body of knowledge that is so expansive that it cannot be a cert added on to a fire cert.

Just because a degree comes from a college doesn't mean it is a valuable education. 

I have taught for an institution that to meet this degree requirement for NREMT, they pay a fee to a community college to be "a remote campus" that isn't in the state and doesn't even boarders the state. (infact it is more than 3 states away)

Second, the ole national fire academy and all of the online "fire science" stuff I have seen over the years is basically filling out a highschool level workbook and in the later case, because fire academy doesn't actually grant credit, you have to beg for it to be recognized by a real institution, isn't undergrad university level education by any length of the imagination. Even the fire officer books are so simple they don't even require opening to pass the exams because it is intuitive. 

There is a host of ways medic mills are getting around the "degree" requirement. Especially in states that don't require a national registry cert. (Like Ohio where registry is based.) In fact it would take me pages to describe how EMS training institutes are getting "around" this requirement. But it all comes down to throwing enough money at the right benefactor.

There is also the matter of language. There is a difference in requiring a "degree" and requiring the teaching to be done at an "accredited" institution. So you can still take your paramedic class at the local CC, never get a degree and still meet the criteria to take registry.

I even know of 1 instance of a program accredited through a medical school that stopped paying that school because they were making "unreasonable demands" (a program director with a college degree)on the EMS institution and got a local community college to offer them "remote capus" accreditation for less money. (Not exactly professional pride there)

The only legitimacy anyone I personally know will give registry is that it is a testing agency. In fact, if you have an Ohio card instead of national registry, the CE requirements are double for Ohio comparitively. 

If you are looking for the defenders of the true faith in EMS, it is certainly not National Registry.  They put on a really great dog and pony show though.



NomexMedic said:


> Until we demand higher wages, people aren't going to pay $15,000 to become paramedic when they can walk into Jiffy Lube off the street and make more money changing oil.  People with your mindset are exactly what's wrong with the profession.



I am always interested to hear why/that I am a discredit to anything I choose to get/stay involved in.


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## Veneficus (Jul 29, 2012)

JakeEMTP said:


> Chances are any Paramedic who works for a city or county will belong to a union which also raises the number higher..



If I could just add my support to this?

Most firefighters are municiple employees.

There are relatively very few others in any healthcare discipline that actually work for a government entity and not a private orgaization. (Really wealthy NPOs included)

It should not be overlooked there is a climate of unrest in the US about what public workers earn. 

In both Wisconsin and Ohio, public safety workers (Police, EMS, and fire) largely supported a political party that was targeting "overpaid government workers."

Ask them how that worked out for them.


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## emtCstock (Jul 29, 2012)

Being an EMT-b, I don't make much, I knew that going into the field. I always have people telling me, "why don't you do something that pays better". I however see it as I love to do this, when i'm on a unit working, it doesn't even seem like work for me, so whatever money I do get from it is an added bonus.


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## VirginiaEMT (Jul 30, 2012)

emtCstock said:


> Being an EMT-b, I don't make much, I knew that going into the field. I always have people telling me, "why don't you do something that pays better". I however see it as I love to do this, when i'm on a unit working, it doesn't even seem like work for me, so whatever money I do get from it is an added bonus.



This is exactly why pay is so low.. I would say a large portion of us, including me, feel this way so why would they pay more if we are willing to do it for free.


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## Level1pedstech (Jul 30, 2012)

Veneficus said:


> Actually, if it were up to me, I would ditch the PA. It is a useless position anyway.
> 
> Recently I had the opportunity to work with a prehospital RN. Basically I would call it an RN with some paramedic training and undoubtably it is more than adequete. Even for treat and refer or treat and release.



Your thoughts on PA's suprises me. Maybe it was a WA/OR thing but in my level one you couldnt swing a bag of saline without hitting a PA. For years my personal providers have been PA's. Yes I know they work under the supervision of an MD but patients dont always know that.

My observations have been that PA's tend to be young and some what "new school". Being more receptive to patients needs and more willing to work outside the box. My new provider here in CA is a young some what new MD,very bright but pretty much by the book. We talk and I can tell he has spent alot of time away from us regular folk. To me having a provider that able to communicate well with patients is as important as a first class education.

What is your reason for wanting to ditch PA's?


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## Veneficus (Jul 30, 2012)

Level1pedstech said:


> Your thoughts on PA's suprises me. Maybe it was a WA/OR thing but in my level one you couldnt swing a bag of saline without hitting a PA. For years my personal providers have been PA's. Yes I know they work under the supervision of an MD but patients dont always know that.
> 
> My observations have been that PA's tend to be young and some what "new school". Being more receptive to patients needs and more willing to work outside the box. My new provider here in CA is a young some what new MD,very bright but pretty much by the book. We talk and I can tell he has spent alot of time away from us regular folk. To me having a provider that able to communicate well with patients is as important as a first class education.
> 
> What is your reason for wanting to ditch PA's?



I have never encountered one who wasn't arrogant beyond thier ability.

I have determined they are people who want to play doctor without the dedication. I have heard all the excuses, why get loans, takes too much time to go to med school, want time with family, you name it.

They are basically glorified medics who can't function without their slightly expanded cookbook which they claim is practicing medicine.


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## NYMedic828 (Jul 30, 2012)

Veneficus said:


> I have never encountered one who wasn't arrogant beyond thier ability.
> 
> I have determined they are people who want to play doctor without the dedication. I have heard all the excuses, why get loans, takes too much time to go to med school, want time with family, you name it.
> 
> They are basically glorified medics who can't function without their slightly expanded cookbook which they claim is practicing medicine.



My sort of uncle (they arent married) is a recently retired pediatrician who practiced for around 40 years. We were all out at lunch the other day and he asked me how my career was going and whatnot and I expressed my interest to him to return to school for nursing or PA once I was promoted to firefighter.

His immediate response was he does not like what has happened with PA usage and feels it is a blatant abuse of a broken system. He told me how he has sent patients to see a specialist such as an otolaryngologist and he was disgusted when he found out the patient never even saw the doctors face, but rather his PA.

Many places now are hiring one doctor for an army of PAs. Essentially, a medical director with paramedics beneath him. (I was told it basically is a loophole in having to pay malpractice insurance for a bunch of doctors)

The result of the conversation was go for nursing, work my way up to NP when I can.


In my eyes, the benefit of having a body of doctors is that you end up with a larger combined brain to establish treatment plans/goals for the more complicated patients. Certainly a PA has medical knowledge just as anyone in the medical field does, but at their own level. A doctor does not go for school for 8 years and then another few of residency for nothing.


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## Veneficus (Jul 30, 2012)

NYMedic828 said:


> My sort of uncle (they arent married) is a recently retired pediatrician who practiced for around 40 years. We were all out at lunch the other day and he asked me how my career was going and whatnot and I expressed my interest to him to return to school for nursing or PA once I was promoted to firefighter.
> 
> His immediate response was he does not like what has happened with PA usage and feels it is a blatant abuse of a broken system. He told me how he has sent patients to see a specialist such as an otolaryngologist and he was disgusted when he found out the patient never even saw the doctors face, but rather his PA.
> 
> ...



What is worse is when a hospital has you seen by a PA, the doctor comes in to see you and you are billed for both.

In my experience they are the ultimate cookbook medicine. 

If you don't fit into their protocol, they will treat you the same anyway until it doesn't work.


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## DrParasite (Jul 30, 2012)

NYMedic828 said:


> The result of the conversation was go for nursing, work my way up to NP when I can.


oddly enough, when I discussed PA vs NP with a doctor friend of mine, he told me there were pretty much the same jobs, except the PAs were trained by the boys, while the NPs were trained by the girls.  His words not mine, but the PAs are trained to think as doctors were taught, while NPs were trained to think as nurses were taught.  in the end, they were very similar.

Just something to keep in mind.


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## Sublime (Jul 31, 2012)

NYMedic828 said:


> The result of the conversation was go for nursing, work my way up to NP when I can.



At least in the hospital I work at in Texas... NP's and PA's function in the exact same manner, just with different letters on their badge. I don't know much about how their training compares, but from what I've seen they seem to have a pretty comparable knowledge base.

I know NP is soon going to become a Doctorates degree, that will be interesting.



			
				Veneficus said:
			
		

> I have never encountered one who wasn't arrogant beyond thier ability.
> 
> I have determined they are people who want to play doctor without the dedication. I have heard all the excuses, why get loans, takes too much time to go to med school, want time with family, you name it.
> 
> They are basically glorified medics who can't function without their slightly expanded cookbook which they claim is practicing medicine.



I don't see anything wrong with someone who has been in the medical field as a paramedic or nurse and wants to progress in their career, so they decide to go to PA / NP school. For many people who have already spent years in school and established themselves in a career, it is not possible to go to med school.   

This is how it seems to be for most people I talk to. Obviously all NP's start out as nurses, but I know PA's who started out as medics also. By the time some people decide being a physician or practitioner is what they really want, med school is not possible. 

I think some individuals choose to be cook book providers because its easy... be it a medic, PA or even MD. I don't believe its fair to say all PA's are this way (though I've worked with some who fit your description).


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## Veneficus (Jul 31, 2012)

Sublime said:


> I don't see anything wrong with someone who has been in the medical field as a paramedic or nurse and wants to progress in their career, so they decide to go to PA / NP school. For many people who have already spent years in school and established themselves in a career, it is not possible to go to med school.
> 
> This is how it seems to be for most people I talk to. Obviously all NP's start out as nurses, but I know PA's who started out as medics also. By the time some people decide being a physician or practitioner is what they really want, med school is not possible.



Are you really suggesting that people who don't have what it takes to be a doctor should get to play doctor because they want to?


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## NorCalEMTechB (Aug 1, 2012)

*Just my 2 cents*

I read through only a couple responses as to why are paramedics (and let's add EMTs, too) paid so little. While it is unfortunate as to why we are paid so little, I disagree with a lot of what people are saying. Yes, education and experience are going to dictate pay scales...higher education, higher pay. But look at Fire Departments. Look at Police Departments. They are paid very well (over here in the Bay Area pay upwards of 100k to start in the nicer areas, maybe 70k on the low end, all with great benefits and pensions). These public safety positions do not require high education such as nursing and higher medical positions like MD. So why do they get paid higher? Because of the danger of the job. FD and PD are community essentials that all people can agree that they need to have. Why not include ambulance? 

It does suck that anyone and everyone can get their EMT/EMT-P and is ultimately the reason why the pay is so low. Everyone wants to be a firefighter and we are continuously told "go get your medic and you'll get a fire job" so now medics are easy to come by so FDs and places higher medics as EMTs to pay lower and to be able to use them for later if and when they need medics. It's just such a messed up system and time right now. Very discouraging. Other than my ramble, I still disagree that Paramedics should not be paid a similar salary to RNs. Two similar but very different occupations. Obviously a paramedic is a more dangerous job with higher risks out in the field, and have to make quicker, higher stress decisions than RNs/PAs do. Honestly, what more does an RN do for the patient (life-saving) that a Paramedic can't legally do? I agree RN/PA makes the population a lot smaller by requiring more schooling and more prereqs in a competitive field just to get into a program. It is truly scary the people who are paramedics. I think it's time for paramedic schools to get a lot tougher and weed people out before they kill someone and scare their partners on a daily basis. 

No disrespect to ANY medical profession. I am just saying Paramedics deserve a lot higher pay so they can at least make a quality career out of it. Why would you other medical professionals (i.e. RN, PA, MD) who have had their say on here believe Paramedics shouldn't get paid higher? Our pay has nothing to do with your pay. I am scared that Paramedic positions will soon be the new EMT and pay dirt cheap and offer no career option (not that I believe anyone could make a great career out of being an EMT). Just giving my two cents...I have been striving towards the fire service since I was 15. I have earned an AS and a BS degree and have 5 years field experience. I have never made more than $20/hr base pay. Try to live off that in the Bay Area...lol


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## Veneficus (Aug 1, 2012)

NorCalEMTechB said:


> No disrespect to ANY medical profession. I am just saying Paramedics deserve a lot higher pay so they can at least make a quality career out of it. Why would you other medical professionals (i.e. RN, PA, MD) who have had their say on here believe Paramedics shouldn't get paid higher? Our pay has nothing to do with your pay. I am scared that Paramedic positions will soon be the new EMT and pay dirt cheap and offer no career option (not that I believe anyone could make a great career out of being an EMT). Just giving my two cents...I have been striving towards the fire service since I was 15. I have earned an AS and a BS degree and have 5 years field experience. I have never made more than $20/hr base pay. Try to live off that in the Bay Area...lol



I have detailed extensively over the years what paramedics have to do to increase their value and demand higher wages.

The long and short of it is as it stands paramedics may feel they are worth more, but everyone feels they should be paid more.

US paramedics have not done what is required in every modern society, which is increase the level of education, in order to get a raise.

As it stands, US society sees them as ambulance drivers. Who are pad accordingly. (Don't believe me, call medicare and ask them what they pay EMS for.)

(it is transport, not treatment. Otherwise you would be able to bill for treat and release or treat and refuse)


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## NYMedic828 (Aug 1, 2012)

I can't remember the last time I had to make a truly high stress decision in EMS, that's a poor argument to compare to RN level.

As far as a cop or firefighter, they don't get paid more because their job is more dangerous. You don't see it as often because it isn't as prestigious but look how many construction workers are injured and killed a year. That doesn't get them higher pay.

The difference between a paramedics and fireman/cops is that fireman and cops are their own entity. In a large portion of the country, EMT/paramedic is considered a supplement to firefighter/LEO. The standard of education is considered so low, that we actually consider it an add on to other professions.

Fireman are good at putting out fires.
Police are good at enforcing the law (usually)
I can't say the same for EMS. Not by a long shot.

The people who do have that ambition to reach beyond the boundaries of the educational standard of EMS often move on with their lives. The doctor above me is a prime example. I myself have NO desire to stay at this level the rest of my life and am planning every day how to move away from it.

EMS is honestly a dying system in the US. If we don't re-work it on a government level, it will cease to exist at some point. (atleast the way we know it)


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## NorCalEMTechB (Aug 1, 2012)

Veneficus said:


> I have detailed extensively over the years what paramedics have to do to increase their value and demand higher wages.
> 
> The long and short of it is as it stands paramedics may feel they are worth more, but everyone feels they should be paid more.
> 
> ...



I am not sure I completely see what you are saying. But I agree they need to make paramedic a more desirable and educational job. Few places make a Paramedic Associates Degree (I can only think of Foothill College in Palo Alto) and I know there is a 4 year university in Washington that offers a Bachelor's Degree in Paramedicine which is I am sure brings a lot of value to the job there in Washington state. People do see EMS as ambulance drivers...including docs and nurses! EMS obviously respects MDs and RNs, why not vice versa?



NYMedic828 said:


> I can't remember the last time I had to make a truly high stress decision in EMS, that's a poor argument to compare to RN level.
> 
> As far as a cop or firefighter, they don't get paid more because their job is more dangerous. You don't see it as often because it isn't as prestigious but look how many construction workers are injured and killed a year. That doesn't get them higher pay.
> 
> ...



I totally agree, NYMedic828. I did not mean to say PD and FD only get paid a generous salary and pension because of risk entirely, but that does have a significant effect. And I could not agree any more that there are too many EMS people who have no ambition and no drive to move on. For me, I have always wanted to be a firefighter, and being a paramedic is turning into the norm to get into fire. With that, brings a bunch of D-bag EMTs and Paramedics who overflow the system and equates to low pay from a high supply of EMS personnel. A high turnover rate makes it even easier for ambulance companies to pay medics dirt. I do have ambition and drive to get out of this field and get with a City FD as a Fire medic, but so do thousands of others (literally, took Richmond, Ca FD test a few weeks ago had thousands of applicants for 8 positions...took FDNY's test and who knows how many 10's of thousands were there). So, ultimately, I do not think it's the problem of desire to stay as an EMT or medic for life, I don't think many lifers are 100% content with being on a box for life. It's more the harsh reality of the economy and everyone wanting to be Fire or whatever else that uses EMT and Medic as a stepping stone. I myself have been an EMT for 3 years on a transport ambulance, 2 years on a small county FD engine. So obviously it's a stepping stone job but I think it should have a better option of a career, since THERE ARE people who make risking their life and being physically and mentally demanding on their body a career. It's more frustrating than anything to see anyone and everyone get into this field. Supply and demand issue. Definitely low quality medics and EMTs resulting. As I said prior, paramedics need to have a degree option, and standards and schools/programs need to be more strict to who they pass and give the opportunity to take their NREMT-P...I personally know wayyyy tooooo many horrible and scary techs and medics


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## Veneficus (Aug 1, 2012)

NorCalEMTechB said:


> People do see EMS as ambulance drivers...including docs and nurses! EMS obviously respects MDs and RNs, why not vice versa?



US paramedics do not have enough education.


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## VFlutter (Aug 1, 2012)

Veneficus said:


> US paramedics do not have enough education.



Also I think that a lot of medical professionals, especially outside of the ER, do not really understand what paramedics actually do. They can not tell you the difference between a basic and a paramedic. The only contact some nurses get with EMS may be when they pick up a patient from the floor and take them back to the nursing home. They never see any real patient care. So to them, all they see are ambulance drivers. 

Kind of a side comment. I was trying to explain the difference between an EMT and paramedic to a nursing classmate and I made the comment that paramedics can intubate. and her response was "Wow, how long do you have to go to school to do that?" She was shocked to find out how little you are actually required to do. With all of the invasive procedures paramedics are allowed to do there is a general expectation that they have a substantial amount of education and training. Without the education, we just look like cookbook technicians who can only follow an algorithm and have no understand of why we are doing it.


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## Level1pedstech (Aug 2, 2012)

Veneficus said:


> US paramedics do not have enough education.



Like it or not they actually do for the way the system is currently set up. Replacing or adding additional education is not something that sits high on the list of things to do for most people.

What would happen to the people that get displaced because they are not able to advance their education due to cost or available time. Wait I know we can have another grand government program sold to us with the promise of EMS jobs for everyone. What about those that think the educational requirements are just fine for those providing pre hospital EMS?

Once again the bottom line is where is the return on investment for people that put in the extra time and effort to advance their education? Why should anyone put any extra effort into obtaining above what is required to meet certification?If people want to advance their education because they get all warm and fuzzy then have at it. Glad they have the money and free time. For those of us that would like to be able to make a decent living,show us the money.


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## VFlutter (Aug 2, 2012)

Level1pedstech said:


> Like it or not they actually do for the way the system is currently set up.
> 
> Once again the bottom line is where is the return on investment for people that put in the extra time and effort to advance their education? Why should anyone put any extra effort into obtaining above what is required to meet certification?If people want to advance their education because they get all warm and fuzzy then have at it. Glad they have the money and free time. For those of us that would like to be able to make a decent living,show us the money.



This has been brought up so many times but I will say it again; Unfortunatly that is why paramedics will be stuck where they are. That is not the way things work. The education must come first. No one is going to "show you the money" with the hopes that the profession will eventually catch up. Why would you pay someone more money without them improving their marketability first? Again look at the numerous medical professions that faced this exact same problem....


Again going back to the intubation example. How much education does a resident have to receive before they are allowed to intubate?


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## JPINFV (Aug 2, 2012)

Level1pedstech said:


> Like it or not they actually do for the way the system is currently set up. Replacing or adding additional education is not something that sits high on the list of things to do for most people.


 
True, but the things that higher education can justify (increased reimbursment, increased scope, increased autonomy) does generally rank higher. It's like a kid who wants dessert without eating dinner first. 


> What would happen to the people that get displaced because they are not able to advance their education due to cost or available time. Wait I know we can have another grand government program sold to us with the promise of EMS jobs for everyone. What about those that think the educational requirements are just fine for those providing pre hospital EMS?


 
No one is crying about the computer putting typewriter companies and typewriter repair companies out of business. There's no outrage that the car destroyed many buggy whip manufactueres and retailers. Evolving EMS isn't going to be painless either, however maintaing the status quo is unacceptable. 



> Once again the bottom line is where is the return on investment for people that put in the extra time and effort to advance their education? Why should anyone put any extra effort into obtaining above what is required to meet certification?If people want to advance their education because they get all warm and fuzzy then have at it. Glad they have the money and free time. For those of us that would like to be able to make a decent living,show us the money.


 ...and here's the problem with EMS. The minimum is treated as the maximum. Why learn anything more if you can't actually use it, and it's an extremely valid point.


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## JPINFV (Aug 2, 2012)

ChaseZ33 said:


> Again going back to the intubation example. How much education does a resident have to receive before they are allowed to intubate?


 
Depends... I have an anestheiology rotation near the end of 3rd year of medical school (elective rotation), and I should be intubating during that rotation. Similarly, I imagine most EM physicians end up intubating sometime during their audition rotations during 4th  year. The bigger question is what about non-ENT, non-EM, non-anesthiology physicians where intubation isn't really in their skill set.


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## Level1pedstech (Aug 2, 2012)

ChaseZ33 said:


> This has been brought up so many times but I will say it again; Unfortunatly that is why paramedics will be stuck where they are. That is not the way things work. The education must come first. No one is going to "show you the money" with the hopes that the profession will eventually catch up. Why would you pay someone more money without them improving their marketability first? Again look at the numerous medical professions that faced this exact same problem....
> 
> 
> Again going back to the intubation example. How much education does a resident have to receive before they are allowed to intubated?



 Really I should have said there is no money to show and in the future its only going to get worse. When the press is giving mass coverage to the bodies piling up on the streets due to the lack of education of the nations EMS providers you might get some change. You need to show proof that change to a better system is needed. By proof I dont mean a comparison to the EMS system in some socialistic hell hole that provides your idea of dream service for 25 million people. We have a current population of 300 million give or take a few illegals in case you didnt know.

Again there is no money for agencies to up the pay for advanced education. Put them in a position where they have to pay more and the doors will close. Lay offs are becoming more common than hirings and the market is flooded with people jumping at the chance to work for chump change. 

After all the time and effort you have put into your education would you be willing to give up nursing and go hit the streets as a full time medic for 25k a year?


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## NYMedic828 (Aug 2, 2012)

I'm going to state the painful truth as bluntly as I can.

EMS IS GOING TO DIE A PAINFUL DEATH.

That's all there is to it. There is no need to argue about it, just accept the facts.

It may not be now or any time soon but EMS can not go on this way. I dont mean the concept of EMS will die, but the current system certainly will. Unfortuntately the only way to fix it is to completely throw it away and start over.

The medical world is advancing FAR too quickly for a bottom of the food chain service to keep up. We are already behind and it only gets worse from here.

Go ahead and tell me I'm wrong and my attitude is poor but I have accepted reality. That's all their is to it.

Grab some popcorn, buckle your seatbelt and just wait.


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## VFlutter (Aug 2, 2012)

Level1pedstech said:


> After all the time and effort you have put into your education would you be willing to give up nursing and go hit the streets as a full time medic for 25k a year?



Of course this will sound like proof of your argument but Nope, because I feel like my education deserves a higher pay. And since I do have an education I have leverage to bargain with to demand higher pay. I would not settle for anything less, and I am sure there are companies out there that would gladly pay more so that they can say they have the most educated employees. Think if an ambulance company could say all their paramedics are bachelors educated... Do you think public image would be better? Would they get more contracts? Would hospitals give them all the CCT? 

On the flip side I spent an extra ~$15k+ to get a BSN when I could have saved the money getting an ADN and still made the same amount as an RN. But I wanted to get the highest education possible for myself and set my self up for advancement in the future.. Personal choice with no monetary incentive.


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## rescue1 (Aug 2, 2012)

Level1pedstech said:


> You need to show proof that change to a better system is needed. By proof I dont mean a comparison to the EMS system in some socialistic hell hole that provides your idea of dream service for 25 million people. We have a current population of 300 million give or take a few illegals in case you didnt know.



Why would comparison to a functioning and effective EMS system be a bad thing? Obviously there are differences due to size, taxes, and government structure, but EMS is funded similarly in most western countries--municipal taxes.

Besides, I was in Canada last week, and it didn't seem too hellish. Kind of chilly, actually.


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## usalsfyre (Aug 2, 2012)

Level1pedstech said:


> Really I should have said there is no money to show and in the future its only going to get worse. When the press is giving mass coverage to the bodies piling up on the streets due to the lack of education of the nations EMS providers you might get some change. You need to show proof that change to a better system is needed. By proof I dont mean a comparison to the EMS system in some socialistic hell hole that provides your idea of dream service for 25 million people. We have a current population of 300 million give or take a few illegals in case you didnt know.
> 
> Again there is no money for agencies to up the pay for advanced education. Put them in a position where they have to pay more and the doors will close. Lay offs are becoming more common than hirings and the market is flooded with people jumping at the chance to work for chump change.
> 
> After all the time and effort you have put into your education would you be willing to give up nursing and go hit the streets as a full time medic for 25k a year?



This is attitude is why EMS will die the painful death referenced above. Level1pedstech, you've referenced in the past your at the end of your career. Understanding that's your point of view, please try not to influence too many of the younger generation of providers.


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## lateralligator (Aug 2, 2012)

So hang on...an EMT-P with an associates degree makes $10-$17/hr? Or is that for an EMT-B?

Sorry for the confusion...I make about $36k as a massage therapist and will top out in a couple more years at maybe $40k. Im interested in paramedic training for more/ new challenges, very good health benefits (have none now) and MORE income (as in 50k+).

Am I barking up the wrong tree as far as income?

Im 48. Time's a-wastin.' :blink:


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## Level1pedstech (Aug 2, 2012)

ChaseZ33 said:


> Of course this will sound like proof of your argument but Nope, because I feel like my education deserves a higher pay. And since I do have an education I have leverage to bargain with to demand higher pay. I would not settle for anything less, and I am sure there are companies out there that would gladly pay more so that they can say they have the most educated employees. Think if an ambulance company could say all their paramedics are bachelors educated... Do you think public image would be better? Would they get more contracts? Would hospitals give them all the CCT?
> 
> On the flip side I spent an extra ~$15k+ to get a BSN when I could have saved the money getting an ADN and still made the same amount as an RN. But I wanted to get the highest education possible for myself and set my self up for advancement in the future.. Personal choice with no monetary incentive.



So your education deserves better pay,got it. As far as having leverage to bargain,last time I checked there were not 100 or so RN applicants per job. The proof to my arguement is that when you have a medical emergency in most developed areas of the country you dial 911 you get help. Now the educational level of those providers responding may not be up to the expectations of some or even all of those in the EMS community but most people could give a rats butt. 

The point is that people know when they dial 911 they get the help they need,until it gets to the point of a mass system failure (think the massive power failure in India) there will be no large scale change. Besides change should be started at the local level and if sucessful would serve as a model for national change.

Personal choice with no monetary incentive is how it should be. Like I said if people want to become better educated providers then have at it. Forcing an increase in education standards thinking employers will reward that education is naive to say the least.


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## triemal04 (Aug 2, 2012)

lateralligator said:


> So hang on...an EMT-P with an associates degree makes $10-$17/hr? Or is that for an EMT-B?
> 
> Sorry for the confusion...I make about $36k as a massage therapist and will top out in a couple more years at maybe $40k. Im interested in paramedic training for more/ new challenges, very good health benefits (have none now) and MORE income (as in 50k+).
> 
> ...


I have a degree and make considerably more than that; not because of my degree though.

There's probably some exceptions, but off the top of my head I can't think of any place where having a degree will automatically get you a raise.  If it's a field job with a variable starting pay it might be taken into consideration, but still probably not a gaurentee.

Most people will tell you that paramedics get paid ****...and they aren't completely wrong, but they aren't completely right either.  Everybody can bring up stories about medic's getting paid $10-12/hr, but just because that's what happens in that particular area doesn't make it the norm, or mean that every place is like that.

There are plenty of well paying jobs with good benefits and decent retirement plans out there.  You just have to a)put in the time and effort in finding them, b)be willing to go to the job, not expect it to come to you; ie move, and c)have the qualities/experience/education/personality that the service wants.  Way to many people aren't willing to do these things and think their area is representative of the whole; hence why you get the line about how all paramedics don't get paid squat.

You can easily make close to 50K a year without killing yourself with overtime as a medic; for a job that pays that much you probably won't have to search to hard (depending on your area of course).

Average pay may be lower than it should be, but with a bit of effort and some brains you can easily increase that for yourself.


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## VFlutter (Aug 2, 2012)

Level1pedstech said:


> So your education deserves better pay,got it. As far as having leverage to bargain,last time I checked there were not 100 or so RN applicants per job. The proof to my arguement is that when you have a medical emergency in most developed areas of the country you dial 911 you get help. Now the educational level of those providers responding may not be up to the expectations of some or even all of those in the EMS community but most people could give a rats butt.
> 
> The point is that people know when they dial 911 they get the help they need,until it gets to the point of a mass system failure (think the massive power failure in India) there will be no large scale change. Besides change should be started at the local level and if sucessful would serve as a model for national change.
> 
> Personal choice with no monetary incentive is how it should be. Like I said if people want to become better educated providers then have at it. Forcing an increase in education standards thinking employers will reward that education is naive to say the least.



Actually the large magnet hospital in my area just had an graduate nurse application session this summer. 700 people applied for 100 jobs. So they got to be as selective as they wanted. A large majority of those hired were BSN nurses, many ADN new grads didn't even get an interview. 

I do not think it is that naive with how competitive healthcare is becoming. Hospitals, ambulance companies, HEMS are going to have a much harder time getting reimbursement and will need to work harder to attracted "costumers".


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## Level1pedstech (Aug 2, 2012)

usalsfyre said:


> This is attitude is why EMS will die the painful death referenced above. Level1pedstech, you've referenced in the past your at the end of your career. Understanding that's your point of view, please try not to influence too many of the younger generation of providers.



These younger people coming into the field need to be aware of what awaits them in the real world. Low wages,crappy benefits,poor working conditions and fellow workers with horrible attitudes is just the start. 

I highly suggest a bypass around field EMS and a path into the higher levels of health care. Besides what kind of message do you think the doom and gloomers are sending.


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## triemal04 (Aug 2, 2012)

Level1pedstech said:


> ,last time I checked there were not 100 or so RN applicants per job.


Check again boyo.  While it may vary a bit from hospital to hospital and state to state, the numbers are on the way up.  As is the call for BSN instead of ASN's...hmmm....



Level1pedstech said:


> ,Forcing an increase in education standards thinking employers will reward that education is naive to say the least.


Not entirely.  Expecting employers to automatically increase the pay just because you hold a degree isn't completely realistic, though it's not completely wrong either.  But expecting employers to increase your pay because you are able to provide them with more money because of your degree, that's a completely different ballgame.

I hate to compare the professions, but look at what happened with nurses, and to some extent is still happening with NP's.  The educational requirements went up to a standard minimum level that met a definable educational level, an associates degree, and nurses (and administrators) were able to argue that since their job was complex enough to require that additional training, and prove it by mandating that everyone met it, that they should be able to get better reimbursements from medicare/medicaid, insurance comanies, charge more for their care in-hospital, etc.  And you know what?  It worked.  And pay for nurses increased.  You can look and most medical professions are doing the same thing; RT's, pharmacists, physical therapists, hell, even x-ray techs are doing it!

What makes people in EMS think we are so special that it wouldn't work for us?  Other than pure stupidity?  

Wait...I just answered my own question.


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## Level1pedstech (Aug 2, 2012)

triemal04 said:


> Check again boyo.  While it may vary a bit from hospital to hospital and state to state, the numbers are on the way up.  As is the call for BSN instead of ASN's...hmmm....
> 
> 
> Not entirely.  Expecting employers to automatically increase the pay just because you hold a degree isn't completely realistic, though it's not completely wrong either.  But expecting employers to increase your pay because you are able to provide them with more money because of your degree, that's a completely different ballgame.
> ...



 There is no money to spend,if there was they would be spending it. How about this,why dont we do better with the money we have before asking for more?


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## triemal04 (Aug 2, 2012)

Level1pedstech said:


> These younger people coming into the field need to be aware of what awaits them in the real world. Low wages,crappy benefits,poor working conditions and fellow workers with horrible attitudes is just the start.
> 
> I highly suggest a bypass around field EMS and a path into the higher levels of health care. Besides what kind of message do you think the doom and gloomers are sending.


Perhaps you should stick to truck driving.

People should be aware of what the profession is like right now, meaning the good and the bad.  They should also be aware of why it is like that (ie people like you), and what it would realistically take to improve things (which means much more than just increasing educational levels), where the profession is going, and where it could be going.

They should be aware of the resistance to change that they will encounter if they try and change things for the better by doing things in a manner that will work.  They should be aware that asking for more without a definable reason that is more than a dramatic whine doesn't work.  They should be aware that many people on the periphery of EMS will whine and complain, but since they aren't actually part of it have no say in what needs to happen.  They should be aware that there are a lot of competing interests out there, many of whom are not doing things to improve EMS but to help themselves or their specific group.  They should be aware that change comes slowly, that it does not happen all at once, and that keeping things the way they are will not make things better.

They should be aware that nobody will fix EMS for us.  They should know it is a broken system that still functions, albeit only because nobody knows it's broken.  They should know that we are the ones who need to step up and demand change, because nobody else will.

This is what people should be aware of before starting a career.

What message do I think people like you are sending?  A pretty pathetic one actually.


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## lateralligator (Aug 2, 2012)

Thanks, triemal04--I am MORE than willing to relocate. I HOPE to relocate. So there's that. Put my wanderlust to work!


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## triemal04 (Aug 2, 2012)

Level1pedstech said:


> There is no money to spend,if there was they would be spending it. How about this,why dont we do better with the money we have before asking for more?


Actually, no, that isn't how it works.  There is no reason for any reimbursement to increase, be it federal or private insurance, unless a reason is shown.  Reimbursement rates are as low as they are because nobody can show a need for the services rendered, or any reason why a paramedic level call should get more than an EMT level call; after all, they both just have a few hours of vocational training.

Healthcare in this country is a buisness.  Are you so naive that you actually think more money would be paid out for services rendered just because it's there?  Holy hell...


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## Level1pedstech (Aug 2, 2012)

triemal04 said:


> Perhaps you should stick to truck driving.
> 
> People should be aware of what the profession is like right now, meaning the good and the bad.  They should also be aware of why it is like that (ie people like you), and what it would realistically take to improve things (which means much more than just increasing educational levels), where the profession is going, and where it could be going.
> 
> ...



So the mills should keep cranking out providers into what in most areas is a saturated job market. Alot of these peopke never even end up with a job in pre hospital EMS. Almost everyday someone is on this site trying to get help finding work.

Yes I will stick to trucking,getting paid 97k a year to sit and hold a steering wheel is really rough but I think I can get by. Years ago I was weeks away from medic school when I started working in the ER where by the way my EMT skills were rewarded with pay equal to the medics I worked with on the outside.

 Had I not chosen to move for a new job I would have stayed on part time until I retired from the teamsters. After retirement at 57 I would have gone full time in the ER doing 3 12's for 24.00+ per hour while collecting a very nice pension.

 There are ways to be involved in emergency medicine and make a good living trouble is most people dont have the drive or work ethic that it takes.


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## Level1pedstech (Aug 2, 2012)

triemal04 said:


> I have a degree and make considerably more than that; not because of my degree though.
> 
> There's probably some exceptions, but off the top of my head I can't think of any place where having a degree will automatically get you a raise.  If it's a field job with a variable starting pay it might be taken into consideration, but still probably not a gaurentee.
> 
> ...



 Really 50k, is that with a degree? For every ten medics how many of them will end up ever be non fire making 50k without massive OT,


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## VFlutter (Aug 2, 2012)

Level1pedstech said:


> There are ways to be involved in emergency medicine and make a good living trouble is most people dont have the drive or work ethic that it takes.



I completely lost track of your argument, you are arguing that paramedics should not increase their level of education because they are not paid enough yet you criticize them for not having the drive or work ethic and then expect companies to pay paramedics more so they will get education?


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## Level1pedstech (Aug 2, 2012)

lateralligator said:


> So hang on...an EMT-P with an associates degree makes $10-$17/hr? Or is that for an EMT-B?
> 
> Sorry for the confusion...I make about $36k as a massage therapist and will top out in a couple more years at maybe $40k. Im interested in paramedic training for more/ new challenges, very good health benefits (have none now) and MORE income (as in 50k+).
> 
> ...



Why not do both?


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## Level1pedstech (Aug 2, 2012)

ChaseZ33 said:


> I completely lost track of your argument, you are arguing that paramedics should not increase their level of education because they are not paid enough yet you criticize them for not having the drive or work ethic and then expect companies to pay paramedics more so they will get education?



 Chase who said anything about medics, I was talking aout going tech to RN as a way to make money in emergency medicine.


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## medicconnor (Aug 2, 2012)

I feel that in some states Paramedics get paid correctly for what they are allowed to preform, I feel in more agressive states that they get paid way to little. 

I personally think that Nurses as a whole have made themselves appear to be more valuable in the world and they have as a unit be able to make it where they get respectable wages. I feel that EMS as a whole needs to find a way to be able to prove that we are more that just ambulance drives to the world and that the pay would follow. EMS is also fairly young compared to the world of nursing and Drs, and when it was established they truly were just ambulance drivers and that has kind of just stuck around.


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## Level1pedstech (Aug 2, 2012)

triemal04 said:


> Actually, no, that isn't how it works.  There is no reason for any reimbursement to increase, be it federal or private insurance, unless a reason is shown.  Reimbursement rates are as low as they are because nobody can show a need for the services rendered, or any reason why a paramedic level call should get more than an EMT level call; after all, they both just have a few hours of vocational training.
> 
> Healthcare in this country is a buisness.  Are you so naive that you actually think more money would be paid out for services rendered just because it's there?  Holy hell...



Put your big boy pants on calm down and lets go thru it again. Increasing the educational pedigree of medics is not going to earn them more pay in MOST cases. MOST employers would laugh at you if you EXPECTED them to pay more than what they can get by paying now. MOST pre hospital EMS workers will NEVER make it into one if those "dream jobs" alot of you talk about. Stop blowing sun shine up their back sides.

EMS is full of chumps working for wages that allow them to collect food stamps and other govt aid in MOST parts of the country. Am I wrong for pointing that out or am I being honest with the new people. Start with the chumps organize them and stand your ground if you think you have a battle worth winning. Take a lesson from the Teamsters,wait dont do that because it might get bloody and you could get hurt. You have a long tough road ahead of you,keep us posted.


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## rescue1 (Aug 2, 2012)

The answer to the problems with US EMS is not to just become ER nurses instead. No problem has ever been fixed by people ignoring it and doing something else.


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## medicconnor (Aug 2, 2012)

Agreed!


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## VFlutter (Aug 2, 2012)

Level1pedstech said:


> Chase who said anything about medics, I was talking aout going tech to RN as a way to make money in emergency medicine.



Um this whole argument/thread is about medics? Maybe i misread something


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## Level1pedstech (Aug 2, 2012)

rescue1 said:


> The answer to the problems with US EMS is not to just become ER nurses instead. No problem has ever been fixed by people ignoring it and doing something else.



No but if you want to be rewarded for the time and effort that it takes to obtain a quality education it is. Then you take a little of your free time to give back to your community by helping to educate the providers you rely on. It sounds ultra simplistic but if you think just on the local level it is possible. Why is it things have to be elevated to a national level?

No one is ignoring the issue its just not a huge priority for most people. As far as doing something else thats an individual decision. The need to provide for my family in a slightly above average fashion is what drove me away from paid EMS.


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## triemal04 (Aug 2, 2012)

level1pedstech-





Level1pedstech said:


> So the mills should keep cranking out providers into what in most areas is a saturated job market. Alot of these peopke never even end up with a job in pre hospital EMS. Almost everyday someone is on this site trying to get help finding work.


No, they shouldn't and it would be very beneficial if they stopped, but the way the system is set up there is nothing to stop them from doing what they do.  Part of the reason why reform in how paramedics (and EMT's) are trained is needed.  It's quite simple and germain to the rest of what I'm going to say: make it a national mandatory requirement that paramedic's have at minimum an associate's degree.  

Once that is done the mills will become fewer and fewer.  It will also decrease the number of new paramedic's, something which is needed as there are way, way to many currently.  As the supply decreases the demand for that level of service will go up and the people willing to work for peanuts should drop.  Add in that fewer people would want to become paramedic's anyway, especially in the beginning, and the result is the same.  There are also other benefits, but I'll get to that in a minute.



Level1pedstech said:


> After retirement at 57 I would have gone full time in the ER doing 3 12's for 24.00+ per hour while collecting a very nice pension.


Huh.    And yet you don't seem to believe that it's appropriate for paramedic's, or that anything should be done to change conditions so that wage would be a more common reality.  Huh.   




Level1pedstech said:


> Really 50k, is that with a degree? For every ten medics how many of them will end up ever be non fire making 50k without massive OT


Actually more than you think.  While probably not a majority, it's not really that unheard of.  



Level1pedstech said:


> Increasing the educational pedigree of medics is not going to earn them more pay in MOST cases. MOST employers would laugh at you if you EXPECTED them to pay more than what they can get by paying now. MOST pre hospital EMS workers will NEVER make it into one if those "dream jobs" alot of you talk about. Stop blowing sun shine up their back sides.


I don't actually know how to respond to this.  



Level1pedstech said:


> EMS is full of chumps working for wages that allow them to collect food stamps and other govt aid in MOST parts of the country. Am I wrong for pointing that out or am I being honest with the new people.


You are absolutely not wrong to do that.  It actually needs to be done more often.  

edit:  I should probably add that there are far, far more problems facing EMS in the US than just educational standards, and only increasing that would not be a blanket solution.  It's just one step that needs to be taken for things to change, and one that would have a good sized impact.  Also that many of the problems are not just faced by us.

*This post has been edited by a community leader to meet the rules of the forum while to the extent possible retaining it's content value*


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## Level1pedstech (Aug 2, 2012)

ChaseZ33 said:


> Um this whole argument/thread is about medics? Maybe i misread something



To be honest I kinda lost track myself,like that never happens. I think my point was that if you want to be paid better than the average basic or medic you  might have to be willing to pursue a position on the inside. 

This can be done without additional education (EMT to ER Tech) but the hard work and effort it takes is more than alot of people are willing to put out. The pay off at least for me was 19.00 an hour as a tech instead of 12.00 working as a PMA on an ALS car. The medic I would have been assisting was making 15.00.


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## bigbaldguy (Aug 3, 2012)

Ok let's open this back up as there was a good dialogue going until it slewed off the tracks. Please be aware this thread is now being watched. Let's get back on topic and keep it professional folks.


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## Tigger (Aug 4, 2012)

Level1pedstech said:


> So the mills should keep cranking out providers into what in most areas is a saturated job market. Alot of these peopke never even end up with a job in pre hospital EMS. Almost everyday someone is on this site trying to get help finding work.
> 
> Yes I will stick to trucking,getting paid 97k a year to sit and hold a steering wheel is really rough but I think I can get by. Years ago I was weeks away from medic school when I started working in the ER where by the way my EMT skills were rewarded with pay equal to the medics I worked with on the outside.
> 
> ...




Could you suggest how there is a good way to make a living in emergency medicine in which one only works in emergency medicine? You state that the dream jobs that pay well do not exist in any sizable quantity, so what now? I don't think it's right nor realistic for others to follow in your footsteps and make their primary income outside of medicine. Most of us get into this fix to make it our living, are we all doing it wrong?


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## Veneficus (Aug 4, 2012)

Tigger said:


> Most of us get into this fix to make it our living, are we all doing it wrong?



Yes.

EMS, with the exception of a few select places doesn't pay a decent wage.

I made the most in EMS working in a hospital. 

When you look at the fact that many emergency agencies hire part time coupled with the amount of "advice" to volunteer for experience (lots of volunteer EMS around the US) then it is really not a widely viable career option. 

I have worked tremendous OT and 3 different jobs to make a living in EMS. 

I have even had to work outside fire/EMS so I could spend money on fire/EMS. 

looking back, it was not a wise decision. It was based on fantasy.

Certainly I could not have done that and viably had a family.

The fact is, only a few places in the US value Emergency services enough to fund them properly. But they always talk about what heroes they are. They always support them after the immediate disaster. 

But they never show them the money.


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## Tigger (Aug 4, 2012)

Veneficus said:


> Yes.
> 
> EMS, with the exception of a few select places doesn't pay a decent wage.
> 
> ...



Well then given all this, isn't some significant change needed? Surely it is to no one's advantage to have EMS become every provider's hobby, constantly playing second fiddle to the bacon bringing job?


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## NYMedic828 (Aug 4, 2012)

Veneficus; said:
			
		

> The fact is, only a few places in the US value Emergency services enough to fund them properly. But they always talk about what heroes they are. They always support them after the immediate disaster.
> 
> But they never show them the money.



You are essentially describing FDNY/NYPD/NYC.

FDNY Fire and NYPD make livable wage and FDNY has the two days a week going for them but EMS does not. A firefighter and LEO makes a minimum top pay for roughly $75,000. An EMT, $44,000 and a paramedic $60,000.

There is no reason a medic should not match firefighter under the same agency. Many people are highly offended that firefighter is actually considered a promotion from paramedic or EMS Lieutenant.

All 3 agencies, Fire/EMS/PD are highly funded and we have new vehicles and new equipment but the workers rarely see a dime.


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## Veneficus (Aug 4, 2012)

Tigger said:


> Well then given all this, isn't some significant change needed? Surely it is to no one's advantage to have EMS become every provider's hobby, constantly playing second fiddle to the bacon bringing job?



I agree.

I have detailed the logical steps to do that.

But we always see the same nay sayers claim they want money upfront before increasing education in order to demand an increase in reimbursement from insurance and medicare. 

I and many others here have demonstrated how other healthcare providers have been successful doing exactly that.

I have even stipulated a responsible, and while not perfect, viable way to change over time instead of an abrupt mandate. 

Bottom line, EMS providers both individual and organizational do not want to do what it takes to change the job (I intentionally never use the word "profession" if I can help it, because it is not) so that they and fututre providers can economically benefit. 

In no vocation, profession, job, whatever, have individuals seen an increase in pay prior to increasing their own capability.

People simply don't get paid for promising to do valuable work in the future, they get paid after having done valuable work.

Could you imagine going to a job interview and stating: "I will work hard this year, but only if you agree to give me a raise next year today."

sounds awefully like "I will gladly pay you tomorrow for a hamburger today"


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## Veneficus (Aug 4, 2012)

NYMedic828 said:


> You are essentially describing FDNY/NYPD/NYC..



It describes 95+% of all EMS in the US unfortunately.


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## firetender (Aug 4, 2012)

*Pay and revolving doors*

I keep going back to turnover being the biggest problem to medics not getting decent pay; that people don't stay with the field long enough to invest in themselves and it as a profession.

Logically, as is being done here, much focus goes on pay and what an un-remunerative gig ambulancing is. But I believe the REASON for this has more to do with not enough people sticking around long enough to raise the standards so they get paid what they deserve.

And why don't people stick around long enough to make elevation of pay part of the elevation of the profession?

Because they burn out on the pressures of the work! 

These are the human-being-like challenges; the psychological, emotional, moral, psychic and spiritual conflicts that go unresolved and build up until, one day compounded by the dismal career/economic path and the toll it all takes on your personal relationships, BOOM! You're outta there!

The systems are responding to this steady circulation of personnel rather than creating it. By not looking at it squarely and putting into place systems of support for their personnel, they are, in a sense, taking advantage of the situation and in my opinion, exploiting workers and sending walking wounded back into society.

The truth is, MOST people can't handle this work, but lots want to try. 

You get so many coming in who shortly down the road (within about five years) silently admit to themselves that the pressure they're putting themselves under just ain't worth it.

(Oh, hell, this'll probably end up on my blog, too!)


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## Jack Bode (Aug 5, 2012)

*Say What ??*



BigBad said:


> Unless you find your niche specializing in teaching or emergency management or CQI you would be a fool to think you can find a street paramedic job paying 69K a year.




I work at a service with 130 full time paramedics. A quick calculation estimates that 47 of us make over 70K a year. A handful of us make over 100K with overtime. We have a 40hr/wk schedule and excellent benefits.

We got in this position by demonstrating value to our employer - a hospital. It didn't happen over night.


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## Asclepius911 (Aug 5, 2012)

Probably because we are known as the human taxi as oppose to a medical practitioner ... one night as a reserve I was sent to pick up an ER doc. To take him to another hospital,  and being the curious Guy that I am I began asking him about the use of different medications, he was amazed that I had some medical knowledge. This made me wonder,  if all docs and nurses just view us as the US postal service," we don't know the content of the envelope all we do is deliver"


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## NYMedic828 (Aug 5, 2012)

Jack Bode said:


> I work at a service with 130 full time paramedics. A quick calculation estimates that 47 of us make over 70K a year. A handful of us make over 100K with overtime. We have a 40hr/wk schedule and excellent benefits.
> 
> We got in this position by demonstrating value to our employer - a hospital. It didn't happen over night.



FDNY base top pay without longevity bonuses is 60k. Most people clear 70 no problem as a medic. Problem is the cost of living here is outrageous.



Asclepius911 said:


> Probably because we are known as the human taxi as oppose to a *medical practitioner* ... one night as a reserve I was sent to pick up an ER doc. To take him to another hospital,  and being the curious Guy that I am I began asking him about the use of different medications, he was amazed that I had some medical knowledge. This made me wonder,  if all docs and nurses just view us as the US postal service," we don't know the content of the envelope all we do is deliver"



Because you aren't formally considered a medical practitioner. You are considered  vocationally educated semi-skilled labor. A carpenter/plumber/mechanic/electrician/hair dresser ALL have more baseline education in their craft than a paramedic. Forget EMT altogether at that point.

This is one of the major problems holding us back. People actually think they are a doc in a box at 60mph. To those of you who actually believe such a ludicrous thing, YOU AREN'T!


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## Asclepius911 (Aug 5, 2012)

I'm not saying I'm a doctor ... atleast not yet... but people are unaware what we do, and I agree with the person that posted up there that it might be because of our hours of education, our lack of requisites to enter a program, the mere fact that ems does not exist as a major and the trade is taught at a JC, however we are still medical practitioners (well paramedics , us emts are mostly transportion) we are taught how to assess and administer medication on standing orders.


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## Asclepius911 (Aug 5, 2012)

Lol who in the right mind thinks that a medic is anything near a doctor, the treatments given in the pre-hospital field is to temporarily hold the patient till "delivered to definative care" nitro does not cure, morphine does not cure, tracheotomy does not cure either we keep them living till an actual Dr. Actually begin looking for cures, causes, diseases, biopsies, and things which is above our basic knowledge of medicine. The only issue with ems is that we are not considered a profession maybe because it lacks the approval of academia, unlike England where they have real drs.  Out in the pre hospital field now that is different


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## DrParasite (Aug 5, 2012)

NYMedic828 said:


> This is one of the major problems holding us back. People actually think they are a doc in a box at 60mph. To those of you who actually believe such a ludicrous thing, YOU AREN'T!


Why is this a bad thing?  Based on that description, I would think the public would think that we are very valuable, and would pay would equal that.  But that's not the case now is it?


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## Asclepius911 (Aug 5, 2012)

I agree with you Dr. Parasite


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## VFlutter (Aug 5, 2012)

DrParasite said:


> Why is this a bad thing?  Based on that description, I would think the public would think that we are very valuable, and would pay would equal that.  But that's not the case now is it?



Really? Yes, it is a bad thing. You are honestly saying the public should value and respect medics the same as a doctor? The reason they are not seen as valuable is because of the lack of education and the fact that almost anyone can be a medic in a very short time. Compared to a doctor who spent 10+ years to get into the position they are in.


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## Tigger (Aug 5, 2012)

DrParasite said:


> Why is this a bad thing?  Based on that description, I would think the public would think that we are very valuable, and would pay would equal that.  But that's not the case now is it?



I agree, we need to make ourselves look more valuable to the public. It just seems to me that the people with this mentality are also obnoxious morons who think they know all there is to know about medicine and do not bother with furthering their knowledge. I wish we were perceived better by the public, but I also wish that many in EMS also adjusted their perceptions to see EMS for what it really is, and not as street doctors essential to the survival of the human race.


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## Asclepius911 (Aug 5, 2012)

Leading back to the lack of education and low requisites for admission to a medic program ... when I get into MD ...or DO,  ill definatly would like to help ems grow as a profession ...


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## NYMedic828 (Aug 5, 2012)

The answer shouldnt be to create a facade to make EMS only look more valuable. The answer is to actually make EMS more valuable.

People thinking they are as good as a doctor is VERY bad because it gives this widespread mindset that we know what we need to and we don't need
to strive to learn more.


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## bigbaldguy (Aug 5, 2012)

Ok guys the tone is starting to slip. Stay on topic.


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## Tigger (Aug 5, 2012)

bigbaldguy said:


> Ok guys the tone is starting to slip. Stay on topic.



The fact that the general public has no idea what paramedics actually do is highly relevant to the fact that medics get paid dirt if you ask me. It's just another reason within the laundry list of reasons why EMS commands so little compensation.


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## EpiEMS (Aug 5, 2012)

Tigger said:


> The fact that the general public has no idea what paramedics actually do is highly relevant to the fact that medics get paid dirt if you ask me. It's just another reason within the laundry list of reasons why EMS commands so little compensation.



Compared to, say, fire, where the opposite is true - people think they know what fire departments do, but they actually have no idea, viz.:






EMS is in a tough spot, as far as compensation goes. I'd like to think there'd be  a better revenue model than either billing patients or taxpayer money (which often end up paying for patient's bills anyway...), but I'm not smart enough to come up with anything.


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## lateralligator (Aug 6, 2012)

It's interesting to follow this thread, as I consider changing careers at 48. I had no idea that the public perception of paramedics was so devaluing.

I have a pretty high IQ and a graduate-level education. I've been a massage therapist for almost 20 years. I have always known that, had I chosen to be a doctor, I could have gone to med school and become one. I have NOT always thought, "Hey, I can be a paramedic anytime. Easy peasy." No, I thought,":censored::censored::censored::censored:, I could NEVER do that. That's intense." Until recently. I don't presently have "M.D." after my name. I have "L.M.T." after my name. And in my world and value system, what I do for others is just as important. I have simply been doing it •long enough• and want a change and new challenges. I've never perceived EMT personnel as less-than. 

Anyway. :mellow:


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## Asclepius911 (Aug 8, 2012)

Its not all about the title or the reputation,  its about you,  its about being pationate about helping others. I went from getting payed well to getting payed as low as a fast food employee in ems but its not about the money either its about being happy in what you do.


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## Veneficus (Aug 8, 2012)

Asclepius911 said:


> Its not all about the title or the reputation,  its about you,  its about being pationate about helping others. I went from getting payed well to getting payed as low as a fast food employee in ems but its not about the money either its about being happy in what you do.



I used to believe this.

I love what I do. If I didn't need the money I would do it for free, with the same passion I have for it now. (Sometimes I can't believe people pay me for it.) 

But... The fact of the matter is I do need the money and so do all of the EMS people I know. 

I do more than my fair share of pro bono work, but as far as employment is concerned, 

"Show me the money,"

otherwise we have nothing further to talk about. 

Title and reputation doesn't buy goods and service.


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## epipusher (Aug 8, 2012)

Hence the reason I am in nursing school. I want to make more money with less responsibility.


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## VFlutter (Aug 8, 2012)

epipusher said:


> Hence the reason I am in nursing school. I want to make more money with less responsibility.



....Great way to put it


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## terrible one (Aug 8, 2012)

Asclepius911 said:


> I went from getting payed well to getting payed as low as a fast food employee in ems but its not about the money either its about being happy in what you do.



Could it be more cliché?

It’s real easy to tell someone to do what they love and money doesn’t matter until reality sets in. EMS has historically been a young person’s occupation with the majority of its members leaving for better paying, more stable careers after only a few years. 

If most in EMS were doing it because it is what they love, regardless of pay or conditions, why is there such a high turnover rate? How many actually retire from working in the field with EMS being their sole occupation? Less than 5%? maybe?

I’d warn anyone looking at EMS because it makes them ‘happy’ to start looking at the real facts. Can you support a family on this income? (regardless if you have a family yet or not) Can you afford to purchase a home? Are you able to retire on an EMS salary? Is there a possibility of a transition of management or the company you work for being sold, bought out, or taken over by fire in the near future?  

At least once a week there is a thread about someone transitioning into EMS from a much more lucrative career because they are unhappy with their current job. While the switch may be refreshing at first how long before financial stress, sleeping patterns, a bad call, jaded partners wear them done and they are just as unhappy as before on half the salary?

Again it’s real easy for younger members or those who haven’t been doing this job long and who also don’t have a mortgage, family to support, or retirement concerns to think about go on and on about how great this job at minimum wage. But these same members will probably move on to FD, PD, RN, MD after a few years, then the next batch will come in and state the same thing continuing this illusion that money doesn’t matter and satisfaction from your work will sustain you through life.


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## EpiEMS (Aug 8, 2012)

Veneficus said:


> Title and reputation doesn't buy goods and service.



Same reason why I'm never going for an MD, that is, unless I can finance it in cash.

Anyway, back to the topic.

There's good data on the paramedic workforce out there. For example: http://www.ems.gov/pdf/EMSWorkforceReport_June2008.pdf


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## Asclepius911 (Aug 9, 2012)

In the upside to things, you can always feel like a millionaire at a 99¢ store ... lol,  hey, do what you guys like, paramedics might be another stepping stones to another carrier,  RN is popular,  or RTs,  or PAs ... and if you guys can't afford it get a loan, it will be payed for within your first years in your new carrier. As for me I will be pursuing my paramedics next year love this industry and will continue to excel to MC Donald's supervisor pay .. lol


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## Sandog (Aug 9, 2012)

When you are young, 20-30ish, you need to make some money, get a place as in own, pay it off, then when your 50ish your mortgage is paid, what you do after that, just has to pay for travel, groceries and other small expenses. The trick is, own property as young as you can, then no more rent increases, and cost of living goes down. Worked for me, now I can live with modest income and do what I like to do.


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## Veneficus (Aug 9, 2012)

Sandog said:


> When you are young, 20-30ish, you need to make some money, get a place as in own, pay it off, then when your 50ish your mortgage is paid, what you do after that, just has to pay for travel, groceries and other small expenses. The trick is, own property as young as you can, then no more rent increases, and cost of living goes down. Worked for me, now I can live with modest income and do what I like to do.



That is definately one way to do it.

I chose another.

Find a profession that earns you enough to support yourself and your family and not own property to maintain mobility. 

My question is not whether or not I will have enough money, my question is what country would I like to live in next?

Your milage may vary.


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## MikeC (Feb 12, 2017)

Level1pedstech said:


> Trust me with this advice because I have seen several people go the route Im going to recommend. They are doing what they love, are very happy and more importantly financialy secure.
> 
> Get your RN out of the way then do what you need to get your medic cert. With a nursing job you will have a schedule that better allows for you to pursue your outside interests. Your pay could be double if not more than what you would be able to make as a medic.
> 
> Also with the higher education your going to be a valuable asset to any agencies EMS operation paid or volunteer. You will be a better educated field provider and your ability to teach others will be greatly enhanced. Its a win all the way around.



Long but good thread.

I'm currently an EMT-B student. The local ambulance company hires EMT-B at $10.00 an hour.  From what I'm TOLD (which is frustrating as it seems to be often different that what is HAPPENING), part-time positions at an EMT are easy to come by. I graduate in a month and expect to pass both the written as well as psychomotor exams. I'm the top student in my class. It seems a majority of my class is struggling with the material.

The topic of Paramedic vs RN is of great interest as I have all the college courses required for application to an RN program. It's more expensive however, but with greater income potential and it seems better career versatility. I'm looking at doing exactly what was posted here.  I applied to a local BSN accelerated nursing program and will know pretty shortly whether I was accepted.  After obtaining the RN with an already existing EMT-B, I plan on focusing on taking the test to also become a Paramedic.


Contrary to what is posted here, there is a demand for Paramedics where I currently live in mid-south PA.  I have no idea what they are starting Paramedics at our relatively high call volume location, but from what I hear it's not all that great.

So it seems that there is more at play than SIMPLY supply and demand concepts.  I have a feeling it has more to do with reimbursement constructs within Medicare and Medicaid.  Ultimately there is only so much money to be paid people.

I could be wrong. Just getting my feet wet in EMS.  As the pay is pretty low, I'm doing it mostly for personal growth and learning to be able to serve in a variety of capacities. I could make more than $10/hour locally, but working as an EMT provides personal growth where I can utilize my skills to assist the community.

Whether I can financially work in this field with my multiple current part-time jobs is yet to be seen.  I'm hoping to get on with a couple companies part-time, as full-time work is hard to come by. I am unable to volunteer.  Ultimately, I have bills that need paid.


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## akflightmedic (Feb 12, 2017)




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## TransportJockey (Feb 12, 2017)

MikeC said:


> Long but good thread.
> 
> I'm currently an EMT-B student. The local ambulance company hires EMT-B at $10.00 an hour.  From what I'm TOLD (which is frustrating as it seems to be often different that what is HAPPENING), part-time positions at an EMT are easy to come by. I graduate in a month and expect to pass both the written as well as psychomotor exams. I'm the top student in my class. It seems a majority of my class is struggling with the material.
> 
> ...


Just so you know, in most parts of the country, getting your medic after passing your nclex is more than just taking a test. You'll have to complete a paramedic program just like anyone else. PA, however, does recognize prehospital RNs, something most of the country does not. 

Sent from my SM-N920P using Tapatalk


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## MikeC (Feb 12, 2017)

TransportJockey said:


> Just so you know, in most parts of the country, getting your medic after passing your nclex is more than just taking a test. You'll have to complete a paramedic program just like anyone else. PA, however, does recognize prehospital RNs, something most of the country does not.
> 
> Sent from my SM-N920P using Tapatalk



According to w w w nasemso  dot org RNs in Pennsylvania can sit for the exam for Paramedic.

In their words, "Pennsylvania We allow RNs to “test out” as an Paramedic".

I've also been informed by Paramedics in the state that RN's can "challenge" the exam without going through a year of Paramedic school.

It seems the same is true for Maryland, which is the location I look to work in.

unfortunately I can't post the actual link until I have 5 posts.


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## TransportJockey (Feb 12, 2017)

MikeC said:


> According to w w w nasemso  dot org RNs in Pennsylvania can sit for the exam for Paramedic.
> 
> In their words, "Pennsylvania We allow RNs to “test out” as an Paramedic".
> 
> ...


I was under the impression PA was a registry state. If that's the case then it might get interesting since registry doesn't allow a nurse to sit for the registry exam without first taking a paramedic course

Sent from my SM-N920P using Tapatalk


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## TransportJockey (Feb 12, 2017)

And looking here 
http://www.nasemso.org/legislation/Pennsylvania/pavii1003.21.html
It doesn't seem to have a loophole for nurses to challenge the test. But with PA having PHRNs recognized it doesn't seem to be needed. Maryland I'm not sure about but I was under the impression they, too, were a registry state. 

Sent from my SM-N920P using Tapatalk


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## TransportJockey (Feb 12, 2017)

OK got bored. 
	

	
	
		
		

		
		
	


	



Maryland might let you but it shows you still must be nationally registered 

Sent from my SM-N920P using Tapatalk


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## MikeC (Feb 12, 2017)

Thanks for posting Transport Jockey. Ultimately, because RN provides more financially and diversity, if I had to choose between the two I'd have to pick RN.  I think I'd enjoy as well as do well in emergency medicine; however.

*So question, if I was to sit for the Paramedic exam in MD as a RN, will that license be transferable to other states?*


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## NomadicMedic (Feb 12, 2017)

MikeC said:


> Thanks for posting Transport Jockey. Ultimately, because RN provides more financially and diversity, if I had to choose between the two I'd have to pick RN.  I think I'd enjoy as well as do well in emergency medicine; however.
> 
> *So question, if I was to sit for the Paramedic exam in MD as a RN, will that license be transferable to other states?*



Probably not. Most states require NREMT for initial licensure, and you can't obtain NREMT without attending an accredited program. But, the EMS world is full of loopholes, so YMMV.


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## MikeC (Feb 12, 2017)

NomadicMedic said:


> Probably not. Most states require NREMT for initial licensure, and you can't obtain NREMT without attending an accredited program. But, the EMS world is full of loopholes, so YMMV.



Well I'll be NREMT licensed hopefully for EMT-B at the beginning of March. I should pass the tests with flying colors.  Albeit what's posted here, I think a majority of my class is struggling with the volume of information and based upon the practice NREMT exam tests I've taken it's not an easy test. From talking to my instructors, they've had a pretty low pass rate in the past for the written exam.

I certainly don't believe "anyone" can pass the course or even function as a competent EMT-B even. It takes dedication. I really think those that aren't putting in that effort aren't going to make it, especially the first test around.  We have some pretty good Paramedics in our local company, although they are short staffed at times.

With the risks EMS providers take on both physically and legally, I certainly believe they should be compensated better. The decisions they make directly impact someone's life, and often times they are putting their own life at risk.  Carfentanil, Hydrogen sulfide gas, inhalation could easily kill first responders in small doses very quickly.

Pretty sad they don't even pay health insurance when it's sometimes mandatory for EMS responders to get vaccines, treatments to various exposures such as Meningitis, etc.  I could go on and on, but I find it a bit appalling that all of this is starting at $10/hour.  Oh well will do it for the experience as long as I can afford it, and then move on to something else.  I can't afford making $10/hour for long.  I'm currently making $13.50/hour at another part-time job in academia tutoring the sciences.  That doesn't require insurance, cont ed, etc.

Overall I'm happy to have taken the course, but it looks like I won't be in it long. Ultimately bills need to be paid.


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## NomadicMedic (Feb 12, 2017)

Glad to see you've got it all figured out. 

Best in your future endeavors.


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## CALEMT (Feb 12, 2017)

akflightmedic said:


> View attachment 3517



At least he's keeping it relevant, gotta give him props for that.


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## MikeC (Feb 12, 2017)

Asclepius911 said:


> Its not all about the title or the reputation,  its about you,  its about being pationate about helping others. I went from getting payed well to getting payed as low as a fast food employee in ems but its not about the money either its about being happy in what you do.



I hear this a lot actually in just about every health profession it seems.  Ultimately, compassion and altruism does not pay the bills however. They should be a predominant factor, but finances is important. There's nothing wrong with making some money.

I have a feeling many healthcare workers don't get paid what I believe they are worth due to that type of mentality.


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## MikeC (Feb 12, 2017)

NomadicMedic said:


> Glad to see you've got it all figured out.
> 
> Best in your future endeavors.



I certainly don't have all the answers, but in my experience I've done more research than most. I also have more already invested in both time and money into this process.


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## NomadicMedic (Feb 12, 2017)

So, since you've done a fair amount of research on EMS careers, let me address some of this.



MikeC said:


> Well I'll be NREMT licensed hopefully for EMT-B at the beginning of March. I should pass the tests with flying colors.  Albeit what's posted here, I think a majority of my class is struggling with the volume of information and based upon the practice NREMT exam tests I've taken it's not an easy test. From talking to my instructors, they've had a pretty low pass rate in the past for the written exam.



EMT is really just basic first aid, with the course material written at an 8th grade level. It ain't rocket science. In fact, I'll say if you possess even baseline competency, it's an easy test.



> I certainly don't believe "anyone" can pass the course or even function as a competent EMT-B even. It takes dedication. I really think those that aren't putting in that effort aren't going to make it, especially the first test around.



Agreed. The reason most candidates who fail the NREMT don't understand how adaptive testing work and they're used to the "study and regurgitate the answers" type of testing. The CBT is _nothing_ like that. It tests the candidate on core knowledge and the ability to use critical thinking to solve the problem. You may kill it in class and still fail the CBT.



> With the risks EMS providers take on both physically and legally, I certainly believe they should be compensated better. The decisions they make directly impact someone's life, and often times they are putting their own life at risk.  Carfentanil, Hydrogen sulfide gas, inhalation could easily kill first responders in small doses very quickly.



Which legal risks do EMS providers take on?  And as far as physical risks, FWIW, noxious gasses can kill utility workers, HVAC techs and the guy that delivers fertilizer to the local soybean farm just as quickly as they kill first responders. The risk of injury or death is one of the many risks that you assume when you become a EMS provider. As a profession we do our best to mitigate the risk, but it's still there. You have a better chance of suffering a career ending injury carrying an obese patient than you do of coming in contact with Carfentanil or  H₂S

Here's a question, how much more compensation do you believe that EMS workers should receive? One dollar an hour? Two? Five? What do you base that on? The fact that they may die when taking granny to her dialysis appointment? So may the Uber driver. Fact is, a less than 200 hour, one semester community college course shouldn't entitle you to any more than what any other minimally trained blue collar worker makes. If there were only 25 EMS providers in a community, I could see paying them a significantly higher wage. But there's not. There's hundreds of mouth breathing EMT minions that'll do this job for FREE to drive an ambulance with lights and sirens.



> Pretty sad they don't even pay health insurance when it's sometimes mandatory for EMS responders to get vaccines, treatments to various exposures such as Meningitis, etc.



All of my required vaccines, yearly health exam, PPD and treatment for any on the job exposure is fully covered by Occupational Health and has been at EVERY EMS job I've ever had. Plus, at my current hospital based system, the cost of health, dental and vision benefits for my entire family is extremely minimal.



> I find it a bit appalling that all of this is starting at $10/hour.  Oh well will do it for the experience as long as I can afford it, and then move on to something else.  I can't afford making $10/hour for long.  I'm currently making $13.50/hour at another part-time job in academia tutoring the sciences.  That doesn't require insurance, cont ed, etc.



Then move somewhere EMTs are paid more. In Seattle it's not uncommon for basic EMTs to make $20/hour. Cost of living, don't ya know. Paramedics in Washington State regularly make around 80k. Sound more doable? I'm in a very affordable part of the country and I'll make about 50k this year and I only work 2 days a week. If I want more, I'll work some OT. Sounds like a good life/work balance to me.



> Overall I'm happy to have taken the course, but it looks like I won't be in it long. Ultimately bills need to be paid.



As the McDonald's employee of EMS, a basic EMT is paid exactly what they deserve. And that's a simple matter of supply and demand. A large supply of worker bees who'll do the job for $10/hour means that the wage will never be higher than that.


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## MikeC (Feb 12, 2017)

NomadicMedic said:


> So, since you've done a fair amount of research on EMS careers, let me address some of this.
> 
> 
> 
> ...



Long post.I'll just make a few comments.

From what I hear, the majority of class struggles with the NREMT national exam. Now this could be the class in of itself, but I hear from people in other curriculums the same type of problem. As for me, I have taken a number of NREMT practice exams including through the official jblearning website written by those that wrote the exam.  I did quite well and am not concerned at all about taking it.

As for your point on EMTs making less due to supply and demand, what I see is a short-lived position where people move on to other careers, as I'm planning on doing.  Now maybe that's the role EMS is established as. Not really a place to settle in for a career long-term, but to obtain skills and move onto something else.

I live in a rural area.  There are plenty of volunteer companies, but they are staffed by the older generations mostly.  The reality is, the younger generations do not have the time to volunteer for services. With the increased costs of living and costs of education, there is no way I could do this on a volunteer basis. It's just not fiscally possible. I don't know of any younger EMT that has any desire to work as a volunteer for a local ambulance company.  All of them are looking for paid positions. Is there enough demand for services, that's yet to be seen.

As for environmental hazards, yes a farmer could inhale hydrogen sulfide and die but they are not RUNNING INTO environments with unknown drug substances that upon inhalation could kill a person instantly or routinely enter situations that at a moment's notice could turn hostile is a different situation entirely. As for legal liability, every patient encounter risks for both criminal and civil liability.  This is not the case in your local factory.


I'm not complaining at all. It is what it is. While I plan on enjoying the work for a time, it is short term and am looking to move onto something with more career stability.  Part-time work at $10/hour barely pays for my gas and food for the day, let alone health insurance, rent, etc.

Increase the wage to whatever is respectable for a person that you'd feel comfortable working on your mom with reported chest pain.  Or not and let the revolving door of EMS make the new grad EMT make the decision.  To equivocate an EMT worker to a minimum wage worker is misguided. If you're a medic, you must have worked with some terrible EMTs to come to the conclusions you've come to.

In the state of PA, EMTs do more than just drive the ambulance and transport grandma from the nursing home.


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## STXmedic (Feb 12, 2017)




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## MikeC (Feb 12, 2017)

STXmedic said:


>



Care to elaborate the false knowledge?


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## STXmedic (Feb 12, 2017)

MikeC said:


> Care to elaborate the false knowledge?


Wow, somebody is a little defensive  I literally said nothing in this thread. How do you know my stance on this subject?


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## CALEMT (Feb 12, 2017)

STXmedic said:


> Wow, somebody is a little defensive  I literally said nothing in this thread. How do you know my stance on this subject?



Everyone gets defensive when someone says EMTs get paid fairly at $10/hr.


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## MonkeyArrow (Feb 12, 2017)

@MikeC Your grasp of operational EMS seems very well established for someone who hasn't worked a day in the field. Based on what have you drawn many of these conclusions?


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## Handsome Robb (Feb 12, 2017)

My base pay rate as a Paramedic is close to 58/year in an affordable area to live and I only work 10 shifts a month. 

I'll clear 70 easily this year with my OT that I work.


Sent from my iPhone using Tapatalk


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## NomadicMedic (Feb 12, 2017)

MikeC said:


> Long post.I'll just make a few comments.
> 
> From what I hear, the majority of class struggles with the NREMT national exam. Now this could be the class in of itself, but I hear from people in other curriculums the same type of problem. As for me, I have taken a number of NREMT practice exams including through the official jblearning website written by those that wrote the exam.  I did quite well and am not concerned at all about taking it.
> 
> ...




All I'm going to say here is, it is blindingky obvious that you don't know what you don't know. But, hey... You're the top student in your EMT class, so I'm sure you have a good grasp on it. Best of luck to you.


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## MikeC (Feb 12, 2017)

STXmedic said:


> Wow, somebody is a little defensive  I literally said nothing in this thread. How do you know my stance on this subject?


Not defensive at all. You posted a pic of a guy stating "beware of false knowledge". As there's nothing written, I can only guess this has something to do with the conversation. I'm at a loss to what though. Simply curious.


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## MikeC (Feb 12, 2017)

MonkeyArrow said:


> @MikeC Your grasp of operational EMS seems very well established for someone who hasn't worked a day in the field. Based on what have you drawn many of these conclusions?



Okay so educate me on where I am incorrect. This is a discussion forum. I'm simply probing for information.


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## STXmedic (Feb 12, 2017)

MikeC said:


> Not defensive at all. You posted a pic of a guy stating "beware of false knowledge". As there's nothing written, I can only guess this has something to do with the conversation. I'm at a loss to what though. Simply curious.


That's a quote that's on the bottom of every one of my posts...


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## MikeC (Feb 12, 2017)

NomadicMedic said:


> All I'm going to say here is, it is blindingky obvious that you don't know what you don't know. But, hey... You're the top student in your EMT class, so I'm sure you have a good grasp on it. Best of luck to you.



I'm hear to learn what I don't know. I will pass this course and become licensed. Chances are, I will be running at least one part-time job with an ambulance service in the near future as a EMT-B BLS crew.

By all means, inform me where I'm wrong. This statement is not a challenge thinking I have all the answers but simply a probe looking for more answers.


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## NysEms2117 (Feb 12, 2017)

NomadicMedic said:


> EMT is really just basic first aid, with the course material written at an 8th grade level. It ain't rocket science. In fact, I'll say if you possess even baseline competency, it's an easy test.


couldn't agree more, common sense/ability to listen and say yes sir/ma'am is all that is needed for EMT-B


MikeC said:


> With the risks EMS providers take on both physically and legally, I certainly believe they should be compensated better.


Your protocols and on-line medical control are there for a reason...

I cannot speak to health insurance and life insurance, that is through my main job.
EMT's in Albany NY, can in fact live and support a family off of working reasonable hours (yes a bit of overtime is factored in).


MikeC said:


> but they are not RUNNING INTO environments with unknown drug substances that upon inhalation could kill a person instantly or routinely enter situations that at a moment's notice could turn hostile is a different situation entirely


Should you be running into that environment?? Sure sounds like the scene is unsafe, sounds like a job for the police or hazmat.

Your cost of living determines everything. If you live in the middle of the desert in New Mexico, or NYC or *insert giant city here*, There will and SHOULD be a huge pay difference. Even in the state there may be, take NYS for example. The state of NY will pay folks that live in Rockland county/southern(by NJ) about 4k more per year, because the cost of living is higher. Capital district(Albany/me) +2k, because pay needs to be adjusted. In New Mexico 100k will buy you about 10x more then what it will in NYC.
Edit: proper grammar will go a long way as well.


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## MikeC (Feb 12, 2017)

STXmedic said:


> That's a quote that's on the bottom of every one of my posts...



Ok.  That's all I saw posted. Good quote ultimately.


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## MikeC (Feb 12, 2017)

NysEms2117 said:


> couldn't agree more, common sense/ability to listen and say yes sir/ma'am is all that is needed for EMT-B
> 
> Your protocols and on-line medical control are there for a reason...
> 
> ...



You know how it goes.. dispatched to possible drug overdose.. everyone's gone but the person laying there half dead from an opioid overdose. You don't know what you have until you see syringes laying around, little baggies everywhere, etc.. find out later what the substance was carfentanil laced heroin and a small whiff of the powder could quickly send you into respiratory arrest.


There is standard precautions, but it's not a perfect system.  A patient can become violent at any time in a seemingly "safe" situation.


How much do EMT-B start out where you're talking about?


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## NysEms2117 (Feb 12, 2017)

MikeC said:


> You know how it goes.. dispatched to possible drug overdose.. everyone's gone but the person laying there half dead from an opioid overdose. You don't know what you have until you see syringes laying around, little baggies everywhere, etc.. find out later what the substance was carfentanil laced heroin and a small whiff of the powder could quickly send you into respiratory arrest.
> 
> 
> There is standard precautions, but it's not a perfect system.  A patient can become violent at any time in a seemingly "safe" situation.


I do know how it is. On both sides in fact. If i'm wearing my EMT hat, first whiff*see what i did there?* of a patient becoming combative, "hello yes i'd like a police officer to assure patient and crew safety". I'm also going with option 2, my option of, remove patient from possible containment areas, or wait for somebody else stupid enough to go "running in", i do my job, however i'm not looking to be a hero, so no running into mysterious drug houses for me. Walk in after i have assured my crew's safety, as well as mine, sure! Or theres the option to wear a mask.
Trying not to be an *** here, just trying to show theres a million different things that can happen. You can ask the question, why are garbagemen/women paid so little, they inhale fumes all day. Why are teachers paid so little, they work in gun free zones. See where i'm going?

Edit: EMT's at the cheapest company in albany, start at 41k from what i can gather. However, working for any of the other 3 EMS providers they start at 46k, and only go up. Well beyond enough to live off of.


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## NomadicMedic (Feb 12, 2017)

MikeC said:


> You know how it goes.. dispatched to possible drug overdose.. everyone's gone but the person laying there half dead from an opioid overdose. You don't know what you have until you see syringes laying around, little baggies everywhere, etc.. find out later what the substance was carfentanil laced heroin and a small whiff of the powder could quickly send you into respiratory arrest.



Curious how many scenes you've been on like this? Or how many scenes period?


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## MikeC (Feb 12, 2017)

NomadicMedic said:


> Curious how many scenes you've been on like this? Or how many scenes period?



This scene was just shared by our county coroner.  Ultimately the man that overdosed died with his head in the toilet. The carfentanil-laced heroin in powder form was on the edge of the sink.  It would have been easy to knock off and breathe in. As the man was confirmed DOA, the PD and Coroner was on scene.  I didn't have to be there to see the implications. The PD is now carrying Naloxone for themselves due to the opioid epidemic in the area which may take up to 4 or 5 doses of Narcan to restore the respiratory drive.


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## MikeC (Feb 12, 2017)

NysEms2117 said:


> I do know how it is. On both sides in fact. If i'm wearing my EMT hat, first whiff*see what i did there?* of a patient becoming combative, "hello yes i'd like a police officer to assure patient and crew safety". I'm also going with option 2, my option of, remove patient from possible containment areas, or wait for somebody else stupid enough to go "running in", i do my job, however i'm not looking to be a hero, so no running into mysterious drug houses for me. Walk in after i have assured my crew's safety, as well as mine, sure! Or theres the option to wear a mask.
> Trying not to be an *** here, just trying to show theres a million different things that can happen. You can ask the question, why are garbagemen/women paid so little, they inhale fumes all day. Why are teachers paid so little, they work in gun free zones. See where i'm going?
> 
> Edit: EMT's at the cheapest company in albany, start at 41k from what i can gather. However, working for any of the other 3 EMS providers they start at 46k, and only go up. Well beyond enough to live off of.



Agreed 41k to 46k is good for an EMT.  While I hear those types of numbers, what I see locally is $10/hour offers. This area must be at the bottom of the barrel of the spectrum. Full time isn't even breaking 20k/year gross.


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## NysEms2117 (Feb 12, 2017)

MikeC said:


> Naloxone for themselves due to the opioid epidemic in the area which may take up to 4 or 5 doses of Narcan to restore the respiratory drive.


again trying not to be an absolute prick, but your title says student. Not saying your not smart, but i am certainly more inclined to believe that when somebody with higher proven education tells me that. 
Wherever "here" is i'd presume has an extremely low cost of living. Also you can move to a higher EMS paying area if you so choose.


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## SandpitMedic (Feb 12, 2017)




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## SandpitMedic (Feb 12, 2017)

Enjoy nursing dude...
Thanks for sparing some poor soul 12 hours in a rig from your pretentious rantings.


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## VentMonkey (Feb 12, 2017)




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## SpecialK (Feb 13, 2017)

I don't think ambulance personnel are paid "little" at all; for example a new national agreement has been reached which sees reasonable pay increases and a fair approach taken to ensuring access to the legislated 11 statutory holiday days plus five weeks annual leave.  Paramedic will begin in the mid 60ks and top out almost at 70k while an ICP will start in the early 70ks and top out near 80k.

From what I understand Australia pays similar as does England, particularly London when considering the London weighting supplement.


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## EpiEMS (Feb 13, 2017)

@SpecialK, aren't your folks required to have a bachelors' degree (or something along those lines)?


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## MikeC (Feb 13, 2017)

SandpitMedic said:


>



Feel free to add something objective to the discussion.


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## MikeC (Feb 13, 2017)

SpecialK said:


> I don't think ambulance personnel are paid "little" at all; for example a new national agreement has been reached which sees reasonable pay increases and a fair approach taken to ensuring access to the legislated 11 statutory holiday days plus five weeks annual leave.  Paramedic will begin in the mid 60ks and top out almost at 70k while an ICP will start in the early 70ks and top out near 80k.
> 
> From what I understand Australia pays similar as does England, particularly London when considering the London weighting supplement.



Thanks for posting.  Could you provide a link?


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## MikeC (Feb 13, 2017)

SandpitMedic said:


> Enjoy nursing dude...
> Thanks for sparing some poor soul 12 hours in a rig from your pretentious rantings.



I neither have all the answer nor am ranting. Simply looking for answers. Feel free to contribute instead of sitting on the sidelines criticizing.


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## MikeC (Feb 13, 2017)

NysEms2117 said:


> again trying not to be an absolute prick, but your title says student. Not saying your not smart, but i am certainly more inclined to believe that when somebody with higher proven education tells me that.
> Wherever "here" is i'd presume has an extremely low cost of living. Also you can move to a higher EMS paying area if you so choose.



"*Be ready to administer naloxone in the event of exposure. * Naloxone is an antidote for opioid overdose.  Immediately administering naloxone can reverse an overdose of carfentanil, fentanyl, or other opioids, although multiple doses of naloxone may be required.  Continue to administer a dose of naloxone every 2-3 minutes until the individual is breathing on his/her own for at least 15 minutes or until EMS arrives."

https://www.dea.gov/divisions/hq/2016/hq092216.shtml

According to local EMS providers that have treated this, it will be required.  Naloxone is intended for heroin overdose. Pure cartentanil is 10k times more potent than morphine.


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## EpiEMS (Feb 13, 2017)

MikeC said:


> A patient can become violent at any time in a seemingly "safe" situation.



Bank tellers make circa minimum wage, too. They don't ask to get robbed at gunpoint.

The key reason why EMS providers don't make very much money (in most places) are pretty simple, and align pretty nicely to a very simple supply/demand framework. This reason is low barriers to entry for EMS providers (i.e. relatively high supply/low price at any quantity demanded). It doesn't take much to get into EMS, and lots of people will do it (because, say, they like the woo-woos). Compare EMS initial entry criteria to similar fields (from the same source, the Bureau of Labor Statistics' Occupational Outlook Handbook) and you'll see that EMS barriers to entry are (relatively) low.

Also, don't forget - if I own an ambulance company, I can't bill Medicaid for more money if I have better providers (ceteris paribus). For example, if I have a transport from Hospital A to Hospital B for Elderly Patient A, I can only expect reimbursement for the transport of $X dollars, regardless of whether my personnel are paramedics with college degrees or paramedics with a non-degree certificate. Obviously, I'm oversimplifying the issue - but the core point is that there is no explicit link between things like provider quality and revenue, so what reason does a provider have to pay more for more education (beyond the statutory minimum)?

You should read this document. It provides a lot of insight.


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## NysEms2117 (Feb 13, 2017)

MikeC said:


> "*Be ready to administer naloxone in the event of exposure. * Naloxone is an antidote for opioid overdose.  Immediately administering naloxone can reverse an overdose of carfentanil, fentanyl, or other opioids, although multiple doses of naloxone may be required.  Continue to administer a dose of naloxone every 2-3 minutes until the individual is breathing on his/her own for at least 15 minutes or until EMS arrives."
> 
> https://www.dea.gov/divisions/hq/2016/hq092216.shtml
> 
> According to local EMS providers that have treated this, it will be required.  Naloxone is intended for heroin overdose. Pure cartentanil is 10k times more potent than morphine.


Do you know what naloxone does? what route should this be given? Have you ever given it? In my personal real life application of narcan/naloxone, it wakes them up right away, *however *if BLS narcan doesn't do anything, giving them more and more BLS(IN) narcan is like pissing on a fire. They need to have a line, and narcan pushed through the line.

On a side note, with your current attitude towards some of the senior members here, the folks that really know what they're talking about, your not going to get very far. If i were you, i'd apologize to @SandpitMedic, and whoever else you were being hasty towards. There are multiple reasons to your original question, and you got most of them.. ranging from education(lack there of), cost of living, and if i'm honest, just you being rather wrong. It seems to me EMT's around the country make enough to live, your not driving beamers, but you can survive(except where you are ofc, because they only make 20k a year).


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## VentMonkey (Feb 13, 2017)

MikeC said:


> "*Be ready to administer naloxone in the event of exposure. * Naloxone is an antidote for opioid overdose.  Immediately administering naloxone can reverse an overdose of carfentanil, fentanyl, or other opioids, although multiple doses of naloxone may be required.  Continue to administer a dose of naloxone every 2-3 minutes until the individual is breathing on his/her own for at least 15 minutes or until EMS arrives."
> 
> https://www.dea.gov/divisions/hq/2016/hq092216.shtml
> 
> According to local EMS providers that have treated this, it will be required.  Naloxone is intended for heroin overdose. Pure cartentanil is 10k times more potent than morphine.


@MikeC your passive-aggressiveness isn't getting you very far. I get that you may have life-experience, but you're new to _this_. You know? The whole two ears, and one mouth principle.

The "I'm all ears" approach, then turning around and citing facts about a drug we're all well aware of does nothing to make anyone here, and most likely on an ambulance, or wherever you'll end up want to help you. You need to take it down a bit.

So you know facts about EMS, and aren't happy about the wages? So what. EMS doesn't need you anymore than you need it.
Instead of spewing repeated facts about it maybe effect change first. You're still a student, yes? Humility, it really does transcend even through an online forum; you sincerely seem to be lacking this, and aren't fooling anyone so they (we) called your bluff.

As far as carfentanil, this isn't something super new, or that anyone isn't aware of. Here, take a look, I made a thread about it a while back:

https://emtlife.com/threads/carfentanil.44467/#post-619811

Again, do your research yourself, actually work in the field maybe about 6 months to a year then see why it is you think $10/ hour is insufficient. No one likes a fresh, new whiner.

P.S. Your Carfentanil scenario was ridiculous.

EDIT: includes waiver not to get @EpiEMS started on EBM, and stats. Lol, he's got us all beat


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## MikeC (Feb 13, 2017)

VentMonkey said:


> @MikeC your passive-aggressiveness isn't getting you very far. I get that you may have life-experience, but you're new to _this_. You know? The whole two ears, and one mouth principle.
> 
> The "I'm all ears" approach, then turning around and citing facts about a drug we're all well aware of does nothing to make anyone here, and most likely on an ambulance, or wherever you'll end up want to help you. You need to take it down a bit.
> 
> ...





The Carfentanil scenario came directly from the coroner and actually happened.  If you believe it's ridiculous, so be it.  It's not a new drug, but is becoming more popular than ever in this area specifically.


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## MikeC (Feb 13, 2017)

NysEms2117 said:


> Do you know what naloxone does? what route should this be given? Have you ever given it? In my personal real life application of narcan/naloxone, it wakes them up right away, *however *if BLS narcan doesn't do anything, giving them more and more BLS(IN) narcan is like pissing on a fire. They need to have a line, and narcan pushed through the line.
> 
> On a side note, with your current attitude towards some of the senior members here, the folks that really know what they're talking about, your not going to get very far. If i were you, i'd apologize to @SandpitMedic, and whoever else you were being hasty towards. There are multiple reasons to your original question, and you got most of them.. ranging from education(lack there of), cost of living, and if i'm honest, just you being rather wrong. It seems to me EMT's around the country make enough to live, your not driving beamers, but you can survive(except where you are ofc, because they only make 20k a year).



The PD is carrying the .1mg intranasal atomizer spray as BLS crews are using. IM are available but expensive. From what I've heard, some ALS crews may or may not have it available.


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## MikeC (Feb 13, 2017)

Thank you all for the responses. I received the answers to the questions I was looking for.


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## NysEms2117 (Feb 13, 2017)

MikeC said:


> The PD is carrying the .1mg intranasal atomizer spray as BLS crews are using. IM are available but expensive. From what I've heard, some ALS crews may or may not have it available.


may want to learn the fact that narcan is also IV. ALS has narcan IV, which is more effective- narcan up a damaged nose? or narcan direct into a a vein?


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## MikeC (Feb 13, 2017)

EpiEMS said:


> Bank tellers make circa minimum wage, too. They don't ask to get robbed at gunpoint.
> 
> The key reason why EMS providers don't make very much money (in most places) are pretty simple, and align pretty nicely to a very simple supply/demand framework. This reason is low barriers to entry for EMS providers (i.e. relatively high supply/low price at any quantity demanded). It doesn't take much to get into EMS, and lots of people will do it (because, say, they like the woo-woos). Compare EMS initial entry criteria to similar fields (from the same source, the Bureau of Labor Statistics' Occupational Outlook Handbook) and you'll see that EMS barriers to entry are (relatively) low.
> 
> ...



Very good post. Thanks for posting.


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## MikeC (Feb 13, 2017)

NysEms2117 said:


> may want to learn the fact that narcan is also IV. ALS has narcan IV, which is more effective- narcan up a damaged nose? or narcan direct into a a vein?



Thank you yes .4mg IV naloxone via PA state protocol can be administered by ALS. The local PD are carrying the intranasal spray at .1mg/dose which is what the article is referring to in requiring multiple doses.


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## MikeC (Feb 13, 2017)

So to bring the topic back on track of the original thread concerning the factors that influence pay for EMS providers, the influencing factors are mostly supply of workers, demand for services, and reimbursement capabilities through Medicare and Medicaid. Are there any other major factors to consider?

I don't know how grants play into it or if they do.


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## CALEMT (Feb 13, 2017)

Don't mind me, just enjoying the responses...


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## EpiEMS (Feb 13, 2017)

MikeC said:


> Are there any other major factors to consider?



The proximate factors we have to consider are supply (of workers) and demand (for workers). Everything else gets us to the "equilibrium", i.e. where the number of workers are available (at a given wage) and equals how many are needed (at a given wage). 

Those other things (Medicaid reimbursements, lawsuits, etc.) feed into demand for workers and supply for workers.


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## Jim37F (Feb 13, 2017)

I posted an answer on another website (Quora, think the 100% Directionless thread turned into an entire forum of it's own),  the question I answered was:


> Is there any way for me to fight the ambulance charges that I feel are way out of proportion to the services rendered?


I'm going to copy/paste my answer from there to here because I think it's directly applicable to this conversation:

"TINSTAAFL. Remember TINSTAAFL from high school economics class? Its an acronym that stands for There Is No Such Thing As A Free Lunch. In other words even if you recieve a product or service for free, someone is paying for it somewhere else.

I work for a private ambulance company in Los Angeles that has a contract with the County to provide 911 response and transport. As a private company we recieve ZERO tax dollars to provide services.

Ambulances are expensive vehicles. A basic Ford E350 van (not even modified with a box on the back but just a regular van on the outside) can easily cost upwards of $100,00+. Then you have to pay for insurance (and you know insurance for a fleet of vehicles that routinely run red lights, oppose traffic, park in the middle of the street, etc, isn’t gonna be the cheapest insurance available…) plus all the usuall taxes and registration fees. Oh and gas, each rig gets a full tank pretty much every single day, I’ve been told our company expects to spend roughly $1000 on fuel each DAY.

And I haven’t even touched on the costs of the stuff inside that vehicle, not just a couple boxes of bandaids and kerlex rolls, but also specialized large oxygen tanks (which itself you have to buy medical grade oxygen to refill), gurney, stair chair, backboards, splints, etc. If you’re a Paramedic (Advanced Life Support) ambulance like what would typically respond to a cardiac call like yours, they also have highly specialized cardiac monitors and defibrillators, dozens of different specialized prescription medications and all the needles and other equipment to administer those, etc.

Oh and the EMTs and Paramedics that staff those units 24/7 including holidays have bills to pay and families to feed, so we like to get a paycheck as well. You know how much I get paid? Minimum wage. That’s right, the EMT’s you summoned can be making less per hour than a burger flipper at McDonalds…..why do I mention that? Because it’s EXPENSIVE to provide ambulance services, and it’s not going to lavish paychecks you can demand your ambulance provider cut (as some people seem to believe we all make $100K per year and the best way to cut ambulance bills is to cut our pay vs Pay more in taxes. Funny how that works).

Generally speaking people don’t like to pay taxes, even for services they demand to be available 24/7 but don’t use more than a few times (if that) in their lives, people don’t want to pay for those services they’re not actively using. If 6 years ago your city told you they were going to raise your property taxes by $100 a year on the off chance to avoid a one time $600 bill at some vague point in the future you may not ever need to pay in the first place! So….just like the ER, we have to bill for services rendered otherwise the next time you call 911 for an ambulace there wont be one to respond because no one wants to pay for it."

(Link to the thread: https://www.quora.com/Is-there-any-...ay-out-of-proportion-to-the-services-rendered )


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## DrParasite (Feb 13, 2017)

MikeC said:


> So to bring the topic back on track of the original thread concerning the factors that influence pay for EMS providers, the influencing factors are mostly supply of workers, demand for services, and reimbursement capabilities through Medicare and Medicaid. Are there any other major factors to consider?
> 
> I don't know how grants play into it or if they do.


Grants won't raise wages.... grants are one time bumps in operational capital, often for a purchase of new equipment or budgeted for a one time purpose.

one of the biggest factors in salary is how your agency is funded.  if you are privately funded, ie, private ambulance service, than the largest source of your income will be what you can generate from billing.  your salary is just another expense, like ambulance operations, fuel, building, and company profits.  if you are public sector, you often have tax $$$ coming in, which helps offset any losses you take.  if you are hospital based, or part of a larger agency, you can sometimes have the same bonus as being tax funded.

But at the end of the day, it all boils down to supply and demand..  most agencies will only pay you the minimum that they need to.... especially if you pass on it, 5 other people will jump on the chance.

and almost everywhere is looking for paramedics, and until paramedics refuse to work for low wages, there is no incentive for employers to raise wages.  EMT, however, are a dime a dozen, and few employers are willing to pay you a decent wage, because if you don't like what they are offering, there are 10 more applicants who are willing to accept the wage they are paying.


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## TransportJockey (Feb 13, 2017)

And not to mention some places that have received the safer grant to add staffing, ends up laying those xrewembefs off when they don't get approved for the grant again 

Sent from my SM-N920P using Tapatalk


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## FLdoc2011 (Feb 13, 2017)

MikeC said:


> So to bring the topic back on track of the original thread concerning the factors that influence pay for EMS providers, the influencing factors are mostly supply of workers, demand for services, and reimbursement capabilities through Medicare and Medicaid. Are there any other major factors to consider?
> 
> I don't know how grants play into it or if they do.



I'd also add to some degree the low barrier to entry in regards to length of training/education.


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## SandpitMedic (Feb 13, 2017)

FLdoc2011 said:


> I'd also add to some degree the low barrier to entry in regards to length of training/education.


Ding!

Number one answer!


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## SandpitMedic (Feb 14, 2017)

Imagine a world where every paramedic was required to gain an associates degree by the National Registry prior to being credentialed .... (Solves most state/local issues by making it a NR requirement because most states require NR). 

How many folks do you (general you) know that would not be there in your circle of colleagues/friends? Then that number grows exponentially as you move outside your personal circle.  

Thus, in general you move towards a solution to some of our fields largest issues. Supply is limited, education is increased, quality of applicants increases, we gain higher standing in the medical community, etc. etc. 

The answer is simple, and it has been staring us in the face for a long time...The nurses did it, the PA's are doing it, the NP's did it... Barriers to entry allow for better applicants and a better position at the bargaining table.


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## VentMonkey (Feb 14, 2017)

SandpitMedic said:


> Imagine a world where every paramedic was required to gain an associates degree by the National Registry prior to being credentialed .... (Solves most state/local issues by making it a NR requirement because most states require NR).
> 
> How many folks do you (general you) know that would not be there in your circle of colleagues/friends? Then that number grows exponentially as you move outside your personal circle.
> 
> ...


Bingo. This is exactly what I was getting at in another thread post when I quoted @STXmedic.

Admittedly, I was too tired and lazy to articulate as you have here, but this...I wholeheartedly agree.


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## PCT EMS (Feb 14, 2017)

SandpitMedic said:


> Imagine a world where every paramedic was required to gain an associates degree by the National Registry prior to being credentialed .... (Solves most state/local issues by making it a NR requirement because most states require NR).
> 
> How many folks do you (general you) know that would not be there in your circle of colleagues/friends? Then that number grows exponentially as you move outside your personal circle.
> 
> ...



Agreed, but how do you account for the 80%+ of EMS services that rely on volunteers?  The time requirements and lack of incentives for training & CE would preclude lots of people who may be able to practice as a Paramedic on ambulances that would otherwise be downgraded to BLS service.


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## NomadicMedic (Feb 14, 2017)

The same way those communities have a police force and trash collectors.  If the public demands ALS, they'll find a way to pay for it.


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## VentMonkey (Feb 14, 2017)

PCT EMS said:


> Agreed, but how do you account for the *80%+ of EMS services that rely on volunteers*?  The time requirements and lack of incentives for training & CE would preclude lots of people who may be able to practice as a Paramedic on ambulances that would otherwise be downgraded to BLS service.


Is it really that remarkably high of a number?

I don't have a whole lot of experience with volunteer services. Rural? yes; volunteer, and rural? No. The EMS management course I am currently in has actually been quite enlightening with regards to management issues within an EMS operations, both paid, and volunteer/ on-call. 

I don't know many of the textbooks we read when we begin our EMT careers offer the "thrill and excitement" of EMS management, and what it actually involves.

To elaborate, my point takes SandPit's and adds this to it:

 Why is it that once the novelty of the job wears off with the "adrenaline junkies", and "reaper racers", they all too often up and turn away offering up a fresh batch of their equally gullible replacements? 

As others have pointed out, when people are willing to do this job for free, or close to it for the "glory of the job", it severely counterbalances the kindhearted vollies who really wants to serve their communities.


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## DrParasite (Feb 14, 2017)

PCT EMS said:


> Agreed, but how do you account for the 80%+ of EMS services that rely on volunteers?


 What about them? Are you telling me those 80% of volunteer EMS services are running with volunteer paramedics?  Or are they running with volunteer EMTs or intermediates and a paid paramedic coming from the next town over?

I don't know many volunteers who are willing to spend 2 years getting a degree in something that they aren't going to get paid for.... Nor should they!!!


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## PCT EMS (Feb 14, 2017)

NomadicMedic said:


> The same way those communities have a police force and trash collectors.  If the public demands ALS, they'll find a way to pay for it.


Wish that were true.   Rural towns may or may not have ALS services, but they don't have a growing pool of people who are
willing to go through the equivalent of one month of full time work simply to get their Basic so they can volunteer.   Sure they
exist and bless them for it, but the CE requirements grow, and it can be a 60mi. drive just to get to class.

What these areas do have for certain is a growing older population and an exploding opiate epidemic.  


I can join the fire service as a volunteer and get a $1500 turnout suit, the lights for my truck and free medical exams at the
local hospital.   I can try to get a police job, get a uniform, badge and gun and be above the law while getting paid, or I can
be a EMT, pay for my own stethoscope and pants, and get them puked on.


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## DrParasite (Feb 14, 2017)

PCT EMS said:


> Wish that were true.   Rural towns may or may not have ALS services, but they don't have a growing pool of people who are
> willing to go through the equivalent of one month of full time work simply to get their Basic so they can volunteer.   Sure they
> exist and bless them for it, but the CE requirements grow, and it can be a 60mi. drive just to get to class.


 and that the trade off that happens when you live in the rural areas.... It's unreasonable to expect city services when you live in the sticks... Don't like it? Move to an area that has a 24/7 staffed EMS system... 


PCT EMS said:


> I can join the fire service as a volunteer and get a $1500 turnout suit, the lights for my truck and free medical exams at the local hospital.   I can try to get a police job, get a uniform, badge and gun and be above the law while getting paid, or I can
> be a EMT, pay for my own stethoscope and pants, and get them puked on.


I can list several things wrong with what you just said.... But I'll sum it up by saying stay out of EMS (and fire and LEO), because if that's what you think, public safety is much better off without you in it


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## PCT EMS (Feb 14, 2017)

DrParasite said:


> and that the trade off that happens when you live in the rural areas.... It's unreasonable to expect city services when you live in the sticks... Don't like it? Move to an area that has a 24/7 staffed EMS system...
> I can list several things wrong with what you just said.... But I'll sum it up by saying stay out of EMS (and fire and LEO), because if that's what you think, public safety is much better off without you in it


Only takes about an hour on-line to get the haters and trolls to chime in.   

Fortunately, I was an EMT and have a full med kit at home, and have no need to waste my time with ****s like you.


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## SandpitMedic (Feb 14, 2017)

PCT EMS said:


> Agreed, but how do you account for the 80%+ of EMS services that rely on volunteers?  The time requirements and lack of incentives for training & CE would preclude lots of people who may be able to practice as a Paramedic on ambulances that would otherwise be downgraded to BLS service.


First, watch your tone. 

Second, in reply to your comment, then bye bye volley EMS. You don't see volunteer cops, nurses, doctors, teachers, retailers, etc en masse...
Personally I wouldn't volunteer even as an EMT, although, given the human element.... sure... you can have volunteer EMRs or something. (For the childrennnnn  )

No other profession has the number of volunteers that EMS does, and quite frankly 95% of the time it is for people who really don't need an ambulance anyways. 

To be objective about it as someone put it, a paramedic is a professional paid career (or is intended to be). Should we hold ourselves down for communities that refuse to pay for such services? No, they must adapt and pay to play like they do for utilities, police services, hospital services, etc... this is the first world. We're not in Botswana or Liberia where pandemics are raging and folks are constantly ill and underserviced medically. They are underserved because they choose to live in places in America without adequate services... and America is pretty darn big.

 I'll give you two examples; one is police services. Even rural folks have access to local and state law enforcement- paid professionals subsidized by tax dollars. They risk long response times, although city folk would also argue about long response times.

Another is living in a rural forest with little access to fire protection. If there is a fire you're probably going to lose everything. It's a risk.

Therefore if you live in an area where there are no medical services.... then that is a personal choice. Those communities need to come together and figure out a way to pay for such services. You want a BLS crew taking you 100 miles to the nearest town? Fine, but if you want access to ALS/CCT services then you need to pay. 

I'll just say it... volunteer EMS beyond EMRs needs to go away. And yes I am fully aware that I may be in an accident in a rural area... chopper is coming, and I'm going to pay for it. Quite frankly I wouldn't let most of the volunteers I've seen touch me with my own stethoscope. Many have no clue what they are doing in my experience, and that is not to bash them. They simply don't have the actual experience and hours necessary to be good at applying the skills they are supposed to be competent in.  

Barriers to entry need to be raised... and you will see less coo-coo for co-co puff ricky rescue volunteers. Communities will be forced to pay for EMS services, as they do for clean running water and modern day alternating current. 

I'd like to see the NREMT implement a degree requirement. The apparatus is in place, all they need to do is make the change and enforce it. Those without currently get two recert cycles to get it done.


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## ExpatMedic0 (Feb 14, 2017)

1.  Entry education/training requirements.
2. Reimbursement methods.
There are others, but in my opinion, these may be the two largest.


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## EpiEMS (Feb 14, 2017)

For what it's worth....there's a lot of good data on how much of the EMS workforce is volunteer-dependent. And yes, it is very high in rural areas, see the chart below, taken from the National Academies' 2007 paper "Emergency Medical Services: At the Crossroads".







For the above, though, keep in mind the composition of provider types!

Volunteer NREMT registrants, United States, 2003 (below):






Paid NREMT registrants, United States, 2003. (below):








See: https://www.nap.edu/read/11629/chapter/6#137 and page 45 of this document (http://www.nasemso.org/documents/EMSWorkforceReport.pdf)


What can we infer?

Volunteer services are much more BLS-heavy, and tend to be in areas that are less-population dense.

So, what does that mean for wages? Well, I'd bet that it is probably a non-issue in places where there isn't paid EMS...but if we were to see paid EMS in areas that were formerly all or mostly volunteer, BLS wages would be low, but ALS wages shouldn't be (relative to similarly skilled professions in the region).


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## NomadicMedic (Feb 14, 2017)

This is the perfect case for a hospital or community consortium ALS fly car service.  If you have to have volunteer BLS or low-paid BLS, staff a fly car or two with a single paramedic and have them respond to the rural areas to provide ALS when it's needed. I don't know why this is such a foreign concept to so many services. Only send paramedics where you need them, rather than put one on every street corner "just in case".


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## EpiEMS (Feb 14, 2017)

@NomadicMedic, I absolutely agree. One or two fly car medics is a much more effective use of resources.


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## ExpatMedic0 (Feb 14, 2017)

Does anyone know of any other modern western country in the world which can train their EMT's in 3 weeks to respond to emergency calls? Zero to hero in 3 weeks... This is the minimum standard of staffing an ambulance and the majority of our countries EMS providers.


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## EpiEMS (Feb 14, 2017)

ExpatMedic0 said:


> Does anyone know of any other modern western country in the world which can train their EMT's in 3 weeks to respond to emergency calls? Zero to hero in 3 weeks... This is the minimum standard of staffing an ambulance and the majority of our countries EMS providers.



U.S. EMT course - being a bit liberal, let's call it 200 hours.

South Africa (considered, potentially, a developing country)- Basic Ambulance Assistant, similar length to U.S. EMT course (160-200 hours, based on some quick Google-Fu - example 1, example 2)

Ireland - EMT courses are 20 days

Israel - the "Hovesh" (EMT equivalent) level is circa 200 hours (based on personal conversations with MDA providers)

However, this is *not* the case in NZ, AUS, the UK, Germany, etc.


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## ExpatMedic0 (Feb 14, 2017)

I am surprised the Basic Ambulance Assistant in SA and the EMT in Ireland have such low training. I know that their U.S. Paramedic equivalent requires a Bachelor (BTech) degree in SA.


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## SandpitMedic (Feb 14, 2017)

EpiEMS said:


> Your post and data.



That is all good info, yet it is dated. The majority of that information is from 2003... 14 years ago. The other from 2007 (10 years old) is more relevant, but just to put it in perspective... I got my initial NREMT in 2008. 

That data predates my entrance to EMS... I've been in the game for nine years. Is there any newer relevant data? _A lot_ has changed in that many years. 

I still think other than BLS/EMR volunteer should go the way of the dodo. The majority of EMS folks work in the urban and suburban areas, and therefore the focus (regarding workforce and professional standing) should be on them. 

The EMTs in those countries you talked about are more like EMRs in equivalency, but with access to oxygen and nitrous oxide... and quite frankly I'm not concerned with other countries. 

An associates degree for US Paramedics is my main point and focus. And the Bachelors degrees from most commonwealth countries are more or less equivalent to that. It is not the same 4 year Bachelors tract/concept we are used to. Most are ~2-3 years. 

Regardless, I think that most of us share the same idea on raising the bar to an Associate's degree (to start with) here in the US. That is the only way to curb the unending supply of low barrier Paramedics. It would also change the dynamic of Fire based EMS... you just might be surprised.


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## EpiEMS (Feb 14, 2017)

@SandpitMedic I totally agree with you that the data is dated (see what I did there ), but such is the state of EMS with its fractious municipal, state, and federal (non-)coordinated governance. Absent good data, which I have yet to be able to find (other than making inferences around Bureau of Labor Statistics and NREMT data), I can't make an evidence-based conclusion. That said, I would agree that we have likely had some change since then, insofar as that there is a general consensus among state EMS officials that, as stated in the, the 2011 National EMS Assessment, "it appears that purely volunteer EMS services are declining" and being replaced by "mixed, paid volunteer, and/or call pay services" (which I would, collectively, deem a type of career/volunteer mixed staffing).

Also, similarly to earlier studies, the 2011 National EMS Assessment found that:

"Over 50% of the States providing data, indicated that the majority of the First Responder and EMT-Basic level EMS professionals in their State could be considered volunteer. This is consistent with a 2004 LEADS survey completed by the National Registry of Emergency Medical Technicians that identified 49.8% of EMT-Basic level professionals as volunteer. It is noted that as the educational requirements associated with an EMS professional increase (with EMT-Paramedic having the greatest requirements) the percentage that serve in volunteer roles decrease. Over 90% of the States indicated that less than 50% of the EMT-Paramedics in their State could be considered volunteer. The 2004 LEADS survey identified 21.8% of EMT-Paramedic level professionals as volunteer."

If you look at the maps provided by the report, you can sort of infer that it's going to be in places that are more rural where volunteerism is dominant, at least, for now.



SandpitMedic said:


> The majority of EMS folks work in the urban and suburban areas, and therefore the focus (regarding workforce and professional standing) should be on them.



I am not sure if this is true - I don't have any evidence available to me. I would agree, but, I would agree with your conclusion mainly based on the fact that *more people* live in urban/suburban areas than anywhere else, thus we should focus on them.

I love the idea of first response volunteer EMS - it works in Israel (and very nicely in some U.S. areas where it is being tried or has been tried...think Hatzolah!). However, while I think EMR is probably fine, I'd like to see the levels restructured like so:
  New EMR = Old EMT
  New EMT = Old AEMT
 Paramedic = Stays the same, add a mandatory associates degree (phase in over 10 years, say)


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## Summit (Feb 14, 2017)

EpiEMS said:


> U.S. EMT course - being a bit liberal, let's call it 200 hours.


That is pretty darn generous... I think the average is in the 130-140 range after the NREMT curriculum updates. 
150 is a lot. Not that long ago 180 was a lot to get your EMT an WEMT at the same time. 200 hours would be an outlier.
Not that 200 is a lot, but is it is roughly 150% of average.


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## EpiEMS (Feb 14, 2017)

@Summit, that's a fair point. I was being as generous as I could be. That said, NYS says the range is typically150-190 hours, and UCLA (I'm taking it as representative of California) says 120-150 hours. So, you're probably right. Still, I don't think this changes the story very much - it's not really very much education, but it does have some international comparisons.

FWIW, my WEMT course (EMT + WEMT, which is basically WFR) was 20 days of 8 to 10 hours plus ~20 hours in hospital/on the ambulance, if I recall correctly - plus my (overkill) 4 hours studying a night.


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## Flying (Feb 14, 2017)

NomadicMedic said:


> This is the perfect case for a hospital or community consortium ALS fly car service.  If you have to have volunteer BLS or low-paid BLS, staff a fly car or two with a single paramedic and have them respond to the rural areas to provide ALS when it's needed. I don't know why this is such a foreign concept to so many services. Only send paramedics where you need them, rather than put one on every street corner "just in case".


_But, but, but response times! We have these heat maps!_


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## SpecialK (Feb 15, 2017)

EpiEMS said:


> @SpecialK, aren't your folks required to have a bachelors' degree (or something along those lines)?



Yes.  

EMT: One year of study
Paramedic:  Three years study (or two for EMTs)
Intensive Care Paramedic:  Four years study (Paramedic plus one extra year)

It's the same in Australia as well except they do not have the equivalent of EMT level from what I understand.  When I looked at the LAS they said the UK College of Paramedics will require a BHSc by 2020 (so three-year degree as the entry standard).  I don't know about the rest of the world but would hazard a reasonable guess that it's pretty similar.

I don't really think the degree is enough to be honest; the types of patients being seen are increasingly complex; requiring a much greater understanding particularly of general medicine and mental health.  I would really like the degree to be extended to four years or run for three full years (not the standard 26 university weeks) and include placements and learning in general medicine, geriatrics, psychiatry and community.  At the moment there's exactly zero exposure to general medicine or geriatrics and only perhaps two placements in psychiatric and maybe one in rest home?

The level of clinical decision making regarding community management and referral now is almost more than is required of the emergent patient who is going to be transported to ED.


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## EpiEMS (Feb 15, 2017)

Flying said:


> _But, but, but response times! We have these heat maps!_



They need a (science-based) smackdown, sir!



SpecialK said:


> I don't really think the degree is enough to be honest; the types of patients being seen are increasingly complex; requiring a much greater understanding particularly of general medicine and mental health.  I would really like the degree to be extended to four years or run for three full years (not the standard 26 university weeks) and include placements and learning in general medicine, geriatrics, psychiatry and community.  At the moment there's exactly zero exposure to general medicine or geriatrics and only perhaps two placements in psychiatric and maybe one in rest home?
> 
> The level of clinical decision making regarding community management and referral now is almost more than is required of the emergent patient who is going to be transported to ED.



You guys are in a much better state than we are in the U.S., that's for sure!

How much in the way of rotation time in the ED, OR, etc. do your folks get during their undergraduate training? Any minimum numbers of, say, intubations?


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## MikeC (Feb 15, 2017)

EpiEMS said:


> @SandpitMedic I totally agree with you that the data is dated (see what I did there ), but such is the state of EMS with its fractious municipal, state, and federal (non-)coordinated governance. Absent good data, which I have yet to be able to find (other than making inferences around Bureau of Labor Statistics and NREMT data), I can't make an evidence-based conclusion. That said, I would agree that we have likely had some change since then, insofar as that there is a general consensus among state EMS officials that, as stated in the, the 2011 National EMS Assessment, "it appears that purely volunteer EMS services are declining" and being replaced by "mixed, paid volunteer, and/or call pay services" (which I would, collectively, deem a type of career/volunteer mixed staffing).
> 
> Also, similarly to earlier studies, the 2011 National EMS Assessment found that:
> 
> ...



From what I've seen, they could definitely expand the EMT-B program a couple months to include many interventions that would decrease the need for calling ALS assistance such as starting IVs, Cardiac Monitoring, etc.

Put those that are getting the EMR in the driver seat of the ambulance and use the resources one has better.

In our area, ALS is called out for many things a BLS crew can handle.


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## VentMonkey (Feb 15, 2017)

MikeC said:


> From what I've seen, they could definitely expand the EMT-B program a couple months to include many interventions that would decrease the need for calling ALS assistance such as starting IVs, Cardiac Monitoring, etc.


What good do you do anyone having a monitor with a "couple of months" training and nothing to treat the patient with after your primary dx?Even a lot paramedic programs are lacking on how in depth cardiology modules should be.

I have no qualms with an EMT starting IV's, but again what good are you doing gam-gam with a lock in place and a hip fx? To me you need more rhyme and reason (and experience).

All of these ideas may sound well and good, but the goal for all of us (including experienced providers) is increasing educational standards. This often dictates an increase in critical thinking abilities, which in turn may decrease (the need for) multiple providers with similar skillsets, rightfully so.


MikeC said:


> In our area, ALS is called out for many things a BLS crew can handle.


This is hardly endemical. I do agree major tweaks need to be made, as well as a nationally recognized standardized approach. 

I could care less who the sanctioning body is---if there is one at all---over it so long as from one coast to the other we're all held to the same uniform standards and policies.


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## EpiEMS (Feb 15, 2017)

MikeC said:


> From what I've seen, they could definitely expand the EMT-B program a couple months to include many interventions that would decrease the need for calling ALS assistance such as starting IVs, Cardiac Monitoring, etc.
> 
> Put those that are getting the EMR in the driver seat of the ambulance and use the resources one has better.
> 
> In our area, ALS is called out for many things a BLS crew can handle.



So what you've suggested is basically AEMT (less the cardiac monitoring). This level exists, but it is not the base level for (911) EMS responses in most of the country (excluding Georgia, I believe?). Many of us on these forums would agree with increasing baseline educational standards (i.e. make a new EMT standard that is equivalent to AEMT, or perhaps make AEMT the base level for 911 response). That said, to add too many skills to the undereducated provider (I include myself in this) is liability ridden and worse - possibly harmful to patients (or just more costly without any benefits). Many of us have discussed problems with the EMT-I '99 or the EMT-CC that NYS had to make this point.


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## NomadicMedic (Feb 15, 2017)

MikeC said:


> From what I've seen, they could definitely expand the EMT-B program a couple months to include many interventions that would decrease the need for calling ALS assistance such as starting IVs, Cardiac Monitoring, etc.
> 
> Put those that are getting the EMR in the driver seat of the ambulance and use the resources one has better.
> 
> In our area, ALS is called out for many things a BLS crew can handle.



The problem is, by expanding the EMT program a few months, you'd only teach the skills and wouldn't provide enough education to actually do anything with them. (This is my biggest problem with AEMT.)

For example, starting an IV by itself is usually pointless, unless you're working as an assistant to a paramedic. Obtaining a cardiac rhythm is pointless unless you have the education to actually interpret a rhythm and have drugs (or other modalities) to treat what you see.

In my dream world, the entry point for staffing a 911 truck would be a crew of 2 AEMTs with an expanded education model, equiped with some standard medications, like Narcan, Benadryl, Zofran, D50/Glucagon and Albuterol and CPAP and SGA and with the caveat that anytime an 'advanced' procedure is initiated, a paramedic in a fly car is dispatched to evaluate and, if needed, assume care. 

Also, the EMT basic level should be retooled to focus on inter-facility and non emergency transports, borrowing pieces of the CNA curriculum. To reflect this, the name should be changed to ATT, Ambulance Transport Technician.


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## EpiEMS (Feb 15, 2017)

@NomadicMedic, this is basically what other Anglophone countries have - I think. Their first level of paramedics are our AEMTs (as far as scope, but have much more education) and EMT-equivalents (if they exist at all) focus on IFT, supporting paramedics, or are volunteers.

That said, @NomadicMedic, wouldn't you agree that AEMT as it exists today, would be better for baseline 911 providers than EMT is?


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## ExpatMedic0 (Feb 15, 2017)

First and Foremost, we need to be masters of acute emergency situations requiring interventions and recognizing potentially urgent cases that need immediate transport. This concept is the whole reason we were invented and exist; it's our bread and butter. The problem is, this is like 10% of our calls (at least in my experience). The other 90% get responses and/or transports to the ED. If the patient wants to go to the ED, you HAVE to take them. "You call, we haul."  This concept is an incredibly outdated and inefficient method.  The problem is we need more education and training for things that are not acute emergencies, and the system is set up against us. Additional entry level training to make a proper transport decision and follow-up care plan for the patient is needed. Transporting everyone to the ED is a huge waste of time, money, and resources.  Community paramedic training has the right idea in a way, but some of those concepts and ideas need to be passed down for every day paramedics. This knowledge is not something a merit badge NAEMT or AHA course can provide; only higher education can. We also need better phone triage and an entirely re-worked reimbursement and billing plan which is not transport based. We are still being treated like a transport service along the lines of Uber or Dominos delivery. Stakeholders care about response times and billing/reimbursement based on transport, not patient attention and the grand scheme of what's best for the patient's health and the system's sustainability. The whole system needs to move away from looking at this as a transport service or public safety and start looking at it as part of the regular health care system. There is potential even to make EMS the gatekeeper of the entire healthcare system if changes were implemented.


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## VentMonkey (Feb 15, 2017)

I vote changing the name from _Emergency_ Medical Services to something along the lines of _Prehospital_ Medical Services.

It's all encompassing and sounds so much less appealing to those duped so easily by buzzwords.


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## NomadicMedic (Feb 15, 2017)

EpiEMS said:


> @NomadicMedic, this is basically what other Anglophone countries have - I think. Their first level of paramedics are our AEMTs (as far as scope, but have much more education) and EMT-equivalents (if they exist at all) focus on IFT, supporting paramedics, or are volunteers.
> 
> That said, @NomadicMedic, wouldn't you agree that AEMT as it exists today, would be better for baseline 911 providers than EMT is?



Absolutely, but really the education needs to be ramped up and the protocols across the country need to be standardized. Also, we'd need to totally eliminate the EMT-B position as an option for a "emergency response".


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## TransportJockey (Feb 15, 2017)

VentMonkey said:


> I vote changing the name from _Emergency_ Medical Services to something along the lines of _Prehospital_ Emergency Services.
> 
> It's all encompassing and sounds so much less appealing to those duped so easily by buzzwords.


Prehospital medical services. Take emergency out of the title altogether. We can still do 911, but it would more wholly encompass future rolls. And get some of the adrenaline junkie tools from even getting a start

Sent from my SM-N920P using Tapatalk


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## NomadicMedic (Feb 15, 2017)

VentMonkey said:


> I vote changing the name from _Emergency_ Medical Services to something along the lines of _Prehospital_ Emergency Services.
> 
> It's all encompassing and sounds so much less appealing to those duped so easily by buzzwords.



How about "City Name" Medical Services, or "Prehospital Medical Service"? I think we should take the word emergency out of it. Police and Fire don't use the word "emergency' anywhere in their name.


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## MikeC (Feb 15, 2017)

VentMonkey said:


> What good do you do anyone having a monitor with a "couple of months" training and nothing to treat the patient with after your primary dx?Even a lot paramedic programs are lacking on how in depth cardiology modules should be.
> 
> I have no qualms with an EMT starting IV's, but again what good are you doing gam-gam with a lock in place and a hip fx? To me you need more rhyme and reason (and experience).
> 
> ...



Very interesting perspective from a cardiologist..

"EMS is on the scene minutes later. Yes, the cavalry has arrived. I tell the EMS personnel that I’m a cardiologist and I think this guy is having a heart attack. “We need a 12 lead ECG now.” The EMS personnel respond:* “We can’t do an ECG because we are a basic life support ambulance.”* Are you kidding me? I think to myself.

An abnormal ECG is the portal to entry for heart attack care and the key to unleashing the fury of modern day medicine to save this guys life. Once the ECG is abnormal, a cath lab team can be activated.

EMS in my county—an urban area–is great and they do a wonderful job. *But it turns out there is up to a 50% chance that when an ambulance pulls up on a scene they can’t provide even an ECG.* It’s the same in many areas in my state and throughout the country. If a paramedic is on board then an ECG is done at the scene and it is transmitted to the PCI center. However, for a variety of reasons, in most locales, basic EMTs are not allowed to perform ECGs. This means the diagnosis of heart attack has to wait until arrival in the ER. That’s a significant delay–and it makes no sense.

*ECGs are cheap to do, easy to perform and confer no risk to the patient. The accompanying computer software correctly recognizes a heart attack the vast majority of the time.* The recently released heart attack guidelines for the US have as the second recommendation “performance of a 12-lead ECG by EMS personnel at the site of first medical contact (FMC) is recommended in patients with symptoms consistent with STEMI.” Furthermore, just last month in _JACC Intervention_ a study was published showing a greater than 50% reduction in mortality with pre-hospital activation of the cath lab during STEMI care."

for the whole story.. http://www.kevinmd.com/blog/2013/01/allowing-emts-perform-ecg-controversial.html

I disagree that EMT-B can't learn how to apply and interpret the 12 lead. Technology also allows for faxing the results to medical command.  I think it would be wise to add it to the EMT-B curriculum.

As for the A-EMT, they should just move the basic level up to that and eliminate it entirely. 

It's a vast waste of resources to reduce a NREMT-B to a ambulance driver IMO.  Sadly this is what many people believe the capabilities of an EMT-B are limited to.


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## VentMonkey (Feb 15, 2017)

TransportJockey said:


> Prehospital medical services. Take emergency out of the title altogether. We can still do 911, but it would more wholly encompass future rolls. And get some of the adrenaline junkie tools from even getting a start


Thanks, TJ. That's what I had meant, and the rest as you've elaborated. I edited it.


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## MikeC (Feb 15, 2017)

EpiEMS said:


> So what you've suggested is basically AEMT (less the cardiac monitoring). This level exists, but it is not the base level for (911) EMS responses in most of the country (excluding Georgia, I believe?). Many of us on these forums would agree with increasing baseline educational standards (i.e. make a new EMT standard that is equivalent to AEMT, or perhaps make AEMT the base level for 911 response). That said, to add too many skills to the undereducated provider (I include myself in this) is liability ridden and worse - possibly harmful to patients (or just more costly without any benefits). Many of us have discussed problems with the EMT-I '99 or the EMT-CC that NYS had to make this point.



The level exists but is not widely practiced, at least in our area. BLS is BLS. If an ALS call is required, they still have to be dispatch to the scene.

In our area, there really isn't a market for the A-EMT. Many think it will be phased out eventually.  People looking to advance from basic are encouraged to pursue the Paramedic.


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## VentMonkey (Feb 15, 2017)

MikeC said:


> The level exists but is not widely practiced. BLS is BLS. If an ALS call is required, they still have to be dispatch to the scene.
> 
> In our area, there really isn't a market for the A-EMT. Many think it will be phased out eventually.  People looking to advance from basic are encouraged to pursue the Paramedic.


You really need to quit reiterating what the veterans on here already know too well, and/ or have lived. You don't have a dog in the fight, do us all a favor and eat a little humble pie.


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## EpiEMS (Feb 15, 2017)

@VentMonkey @NomadicMedic Along with changing the nomenclature, may as well change the titles, too:
 First Responder - Today's EMT + undergraduate certificate
 Paramedic Technician - Today's AEMT + associates degree in EMS (or bachelors in another discipline + certificate)
 Paramedic - Today's Paramedic scope + bachelors degree (option for accelerated bachelors like ABSNs for those with a degree in another field)
 Critical Care Paramedic/Community Paramedic/Tactical Paramedic/[Insert Specialty] Paramedic - Masters' degree

I wish I could get on the National Scope of Practice dealio.


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## MikeC (Feb 15, 2017)

ExpatMedic0 said:


> First and Foremost, we need to be masters of acute emergency situations requiring interventions and recognizing potentially urgent cases that need immediate transport. This concept is the whole reason we were invented and exist; it's our bread and butter. The problem is, this is like 10% of our calls (at least in my experience). The other 90% get responses and/or transports to the ED. If the patient wants to go to the ED, you HAVE to take them. "You call, we haul."  This concept is an incredibly outdated and inefficient method.  The problem is we need more education and training for things that are not acute emergencies, and the system is set up against us. Additional entry level training to make a proper transport decision and follow-up care plan for the patient is needed. Transporting everyone to the ED is a huge waste of time, money, and resources.  Community paramedic training has the right idea in a way, but some of those concepts and ideas need to be passed down for every day paramedics. This knowledge is not something a merit badge NAEMT or AHA course can provide; only higher education can. We also need better phone triage and an entirely re-worked reimbursement and billing plan which is not transport based. We are still being treated like a transport service along the lines of Uber or Dominos delivery. Stakeholders care about response times and billing/reimbursement based on transport, not patient attention and the grand scheme of what's best for the patient's health and the system's sustainability. The whole system needs to move away from looking at this as a transport service or public safety and start looking at it as part of the regular health care system. There is potential even to make EMS the gatekeeper of the entire healthcare system if changes were implemented.




I think it's a great idea.  EMS could actually play a HUGE part in preventative services, education, etc. Especially how much they deal with cardiology, diabetes, enter other chronic conditions. Hopefully any new healthcare reform concepts actually take in feeback from healthcare providers and not simply be dictated by special interest groups. Not holding my breath on that one.


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## MikeC (Feb 15, 2017)

VentMonkey said:


> You really need to quit reiterating what the veterans on here already know too well, and/ or have lived. You don't have a dog in the fight, do us all a favor and eat a little humble pie.



I'm just discussing. You seem to have a problem with that. The discussion was involving advancing the course training of EMT-B to include that of the A-EMT and do away with it. Others suggest making the EMT-B curriculum is sufficient only for an EMR. I disagree with that.  It's a vast waste of resources to make an EMT-B a transport technician capable of driving an ambulance with little to no patient contact. The current curriculum is more advanced than that.


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## STXmedic (Feb 15, 2017)

MikeC said:


> I disagree that EMT-B can't learn how to apply and interpret the 12 lead. Technology also allows for faxing the results to medical command.  I think it would be wise to add it to the EMT-B curriculum.


And then when the monitor is wrong, the MI doesn't get recognized, and the patient dies. Or theres no MI, but another condition that may indicate something serious or life-threatening, but since the monitor does not say "STEMI", the condition doesn't get recognized, and the patient dies (or is much worse off if you're not a fan of hyperbole). 12 leads are for much more than just STEMI's, and many paramedics have difficulty being proficient with 12 lead interpretation.

You need to familiarize yourself with the phrase "You don't know what you don't know." Especially since you seem to constantly fall victim to the phrase.

You also seem like a smart guy (edit, corrected, apparently I can't read). One of the things that took me forever to realize is to not expect others to be at the same level as you from an intelligence perspective. While you may very well be capable of learning 12 lead interpretation without much time or difficulty, most of the people you work with will barely be able to spell PCR. The entry requirements and educational standards basically ensure that this field will be inundated with idiots. Don't expect them to be at the same level as you. That won't change until the system changes its standards.


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## TransportJockey (Feb 15, 2017)

MikeC said:


> The level exists but is not widely practiced, at least in our area. BLS is BLS. If an ALS call is required, they still have to be dispatch to the scene.
> 
> In our area, there really isn't a market for the A-EMT. Many think it will be phased out eventually.  People looking to advance from basic are encouraged to pursue the Paramedic.


ILS is widely used in New Mexico and Texas, along with a few other rural States. 

Sent from my SM-N920P using Tapatalk


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## VentMonkey (Feb 15, 2017)

MikeC said:


> I'm just discussing. You seem to have a problem with that. The discussion was involving advancing the course training of EMT-B to include that of the A-EMT and do away with it. Others suggest making the EMT-B curriculum is sufficient only for an EMR. I disagree with that.  It's a vast waste of resources to make an EMT-B a transport technician capable of driving an ambulance with little to no patient contact. The current curriculum is more advanced than that.


Nope, discussions are relevant, it's your arrogantly "know it all" demeanor. Plus the fact you're pointing things out we're all pretty much well aware of. Again, do some digging on this forum some more, and you'll find much of this stuff is hardly new, just because it's new to you.

Perhaps pursue higher education if you don't already possess any. You do articulate yourself well, I'll give you that, but trying and pointing  things out in the manner that you do usually doesn't yield results in a way conducive to effect change.

@STXmedic his profile pic says the dude is 35.


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## NysEms2117 (Feb 15, 2017)

EpiEMS said:


> First Responder - Today's EMT + undergraduate certificate
> Paramedic Technician - Today's AEMT + associates degree in EMS (or bachelors in another discipline + certificate)
> Paramedic - Today's Paramedic scope + bachelors degree (option for accelerated bachelors like ABSNs for those with a degree in another field)
> Critical Care Paramedic/Community Paramedic/Tactical Paramedic/[Insert Specialty] Paramedic - Masters' degree


would there be any spot for folks like me? Bachelors in non EMS, but educated(ish) in EMS, or emergency ops in general? Also would you count relevant nursing topics such as A&P and pharmacology at one of them?

My personal 2 cents would be this. Educate everybody. It's my same motto for LE(day job). If you mandate lets say CPR to be learned and certified for each and every high school senior, In a few years time, i'd venture to say that you would see survival rates for cardiac arrests increase due to CPR being started within the first 5 minutes(obviously good). Now i can agree with EPI and most of you out there EMT-B right now isn't all that useful. I think it needs to be a mix of DE... wait @NomadicMedic and @EpiEMS .I fully agree that AEMT is kind of a "we are throwing you to the sharks" category, you know just enough to do some damage. I think ER docs need to get together and say the top 5 things they need done past a BLS scope and list them. Cater to those needs(yes i know they will vary between city life, and country life), Make an EMT-CC or intermediate or whatever name you want to call them. have the BLS and those 5 skills. Then have the paramedics(raise the bar for a B.S in EMS/Paramedicine) have the all encompassing scope saying you can do whatever to those rare patients. At the same time, i think the minimum requirements need to change, I do not think an EMT-B course should be able to be completed in a month-2 months. I understand why it currently is, but i don't think it is helping anybody. To this day i still don't agree with most of the alphabet soup (TCCC and all that stuff),but thats a story for a different day. If they continue to offer the alphabet soup, there should be incentives for providers to get said certifications. For example you get a geriatric specialty cert(whatever it's called GEMS?) you should get a +.75$/hr pay-raise, or whatever they deem that to be.
I completely agree, Emergency should be removed, i'm pretty sure everybody can see the emergency by the obnoxious red blue and white lights, and sirens blaring(which debatably should also be limited/taken away for certain things).
@VentMonkey @ExpatMedic0 @NomadicMedic @STXmedic (or any paramedic+)- Would you guys consider the idea of changing EMR- to paramedic assistant, and teaching them how to set up the paramedics equipment, while your off getting the patient/prelim asses?


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## NomadicMedic (Feb 15, 2017)

I think we do a fair portion of this now. EMTs that work with a paramedic usually do a really good job of providing support to the medic. But I don't believe they should be left alone to provide patient care. Unless, it's a very benign nonemergency transport.

 And I also think if you polled emergency room physicians, they would tell you that the top five things that we need to do pre-hospital would be; transmit 12 leads, provide dextrose to hypoglycemics, beta agonists to reactive airways, Narcan to opiate overdose and Epi to anaphylaxis. Most of the rest of it is nice to have but not necessary. 5 items may not be enough. there are a few others that i can think of that would have immediate benefit. 

 And as far as education goes, I believe it needs to be specialized. Having a doctorate in medieval literature doesn't equal "medical doctor.".  And just because you have a doctorate, that doesn't mean you can challenge the test.


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## Handsome Robb (Feb 15, 2017)

@NysEms2117 you'd fall into the "Paramedic Technician" category. That being BS in something other than EMS plus a certificate. 

Or you could follow the fancy route with the accelerated Paramedic degree by using your nursing classes. 

To go back to the core question of this thread, while supply and demand play a roll as well as low entry requirements, without a restructuring of reimbursement rates/practices it doesn't matter if we all have Master's degrees. 

Someone may have said this already, I just skimmed the thread. 


Sent from my iPhone using Tapatalk


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## Giant81 (Feb 15, 2017)

I think there is nothing wrong with a Basic applying a 12-lead then transmitting the telemetry to the ED and allow the on call DR to look it over while we're en-route.  As a basic rig, we don't need to interpret considering there is little we can do in the field aside from O2, ASA, assist with nitro, rapid transport, making interpretation less important.  And, most of our medication interventions require online med control approval.


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## EpiEMS (Feb 15, 2017)

MikeC said:


> It's a vast waste of resources to make an EMT-B a transport technician capable of driving an ambulance with little to no patient contact. The current curriculum is more advanced than that.



That's what EMTs (more or less) do, we show up, treat immediate life threats (which is a rare thing to have to deal with), and (almost always) transport...sounds more or less like patient transfer/IFT to me.



NysEms2117 said:


> would there be any spot for folks like me?



In my model, absolutely - I don't see why it couldn't help with the certificate or secondary bachelors (like an ABSN type of thing, where if you have a non-science degree, you would need to take some prerequisites).



NysEms2117 said:


> In a few years time, i'd venture to say that you would see survival rates for cardiac arrests increase due to CPR being started within the first 5 minutes(obviously good).



Totally - and it's cheap!



NysEms2117 said:


> Would you guys consider the idea of changing EMR- to paramedic assistant



I mean, in an ALS-heavy system like mine, that's basically what I am - I run the BLS side of things (vitals and set up for medic procedures) while they get venous access or get a more detailed history/exam going, then I drive. No reason to not make EMTs --> "EMR" in name.



Handsome Robb said:


> To go back to the core question of this thread, while supply and demand play a roll as well as low entry requirements, without a restructuring of reimbursement rates/practices it doesn't matter if we all have Master's degrees.
> 
> Sent from my iPhone using Tapatalk



Absolutely - from the reimbursement side, if we have more education, we can justify charging like a physician or midlevel. That said, the "fee for service" model is going away in many areas, and being replaced by bundled/capitation payments (which, frankly, is kinda like ambulance transport, but aligned to conditions, sometimes).


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## VentMonkey (Feb 15, 2017)

Giant81 said:


> I think there is nothing wrong with a Basic applying a 12-lead then transmitting the telemetry to the ED and allow the on call DR to look it over while we're en-route. * As a basic rig, we don't need to interpret considering there is little we can do in the field aside from O2, ASA, assist with nitro, rapid transport, making interpretation less important*.  And, most of our medication interventions require online med control approval.


Here's a perfect example why, as of now, you (EMT's in general) have no business carrying cardiac monitors. If anything it makes interpretation that much more crucial with a time-sensitivite injury/ infarct, yikes.

This post is one big contradiction, IMO.


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## NysEms2117 (Feb 15, 2017)

EpiEMS said:


> I mean, in an ALS-heavy system like mine, that's basically what I am - I run the BLS side of things (vitals and set up for medic procedures) while they get venous access or get a more detailed history/exam going, then I drive. No reason to not make EMTs --> "EMR" in name.


I get that, i'm a Basic on a CCT rig, so my job is to literally try and read my medics mind, and get what he will need + call in whatever he needs/sees ect. I'm also not a fan of EMR's, because they technically can work on an ambulance, but have no place being there a rename to driver only, or paramedic assistant is necessary IMO. I feel that a paramedic should be having most of the patient contact, just as a PCP has most of the patient contact when you see them. I(as well as most people, I would assume) want the highest trained person available providing care to me, or my loved one. 
To me i don't understand why people would want to be given the tools to do something, but not why. Personally if i was a CC-EMT, i'd be petrified to intubate, sure they taught me how, but i dont want to end up being a "well i'll figure it out as i go" kinda thing. I also learn better knowing why i'm doing something, but hey i'm a weird person i guess? 

I also think a thing we would need to watch out for and this is more of @EpiEMS field then mine, but if we do all of these educational requirements, how are the patients going to pay, if they can't already? Sure we bump up paramedics salary and EMT(paramedic assistant i think you called it), but if the patients can't pay, it does nobody any good.


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## Giant81 (Feb 15, 2017)

so is there no value at all in allowing a provider to apply, acquire, and transmit a 12-lead to the ED ahead of their arrival?  Especially when considering a 20min transport time in a rural area, and the additional lead time needed to call in the needed personnel for the Cath-lab if required.  

I'm certainly not trying to start a fight or anything, I'm just trying to figure out how providing the ED with more information about the PT's before arrival is a bad thing.   Unless the Basic acquired 12-lead is looked at as inaccurate.


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## EpiEMS (Feb 15, 2017)

NysEms2117 said:


> how are the patients going to pay, if they can't already?


Well, in some sense, we've answered that question forever - they won't/don't.
The reimbursement model for EMS is such a mess - and dependent on cross-subsidization from those who can pay.

We all need to be very aware of the following:
 - Not everybody needs the highest level of care.
 - Providing the highest level of care to everybody is expensive, and not everybody needs it (or can afford it).

@Giant81, on the subject of BLS 12-lead acquisition...sure, it's fine and dandy to transmit, but the inability to interpret could lead to gross overtriage (or, perhaps worse for your patients, undertriage).


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## VentMonkey (Feb 15, 2017)

Giant81 said:


> Unless the Basic acquired 12-lead is looked at as inaccurate.


This right here. So again, even many paramedics interpretation of properly and accurately identifying NSTEMI's, for example (think NOS LBBB in the face of several co-morbid factors absent "classic" ACS/ AMI s/s) are faultered.

Even at the ALS-level in an urban/ suburban environment with fairly short transport times to PCI capable hospitals you have folks down playing the severity of the NSTEMI who oftentimes may have sat on it just as long as the "classic tombstone" STEMI with crushing chest pain, but because it isn't slapping Mongo the Medic directly in the face, the patient can be under triaged only to find out their cardiac markers are just as, if not more so, through the roof than the acute MI.

Again, this all falls back on better education at every level in order to take the seriousness of the more vague complaints with a bit more than a grain of salt. I just don't realistically see an future EMT curriculum being afforded that kind of luxury. 

Now, if they did, I would argue that they need a full understanding of basic A&P as well as in depth cardiology module review that mimics some of the better paramedic programs, or surpasses them entirely, which would also call for the same if not more with future paramedic education.

Again, it all circles back to more education. Along those same lines, and while many provider in the streets may not care, what is the cost-burden for an over-triaged falsely identified STEMI alert patient? 

This too effects even prehospital providers, but again without an all encompassing approach to EMS there's no room for this when we as a whole continue to call for more "tools in the toolbox" sans proper understanding and education, let alone actual EBM, which collectively, EMS sucks at.


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## MikeC (Feb 15, 2017)

https://www.ems.gov/pdf/education/N...l-Guidelines/EMR_Instructional_Guidelines.pdf

Interesting read. Definitely the EMR looks to be sufficient for the role of Ambulance Driver/Patient Transport tech to help with transfers.


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## EpiEMS (Feb 15, 2017)

VentMonkey said:


> what is the cost-burden for an over-triaged falsely identified STEMI alert patient?


It's yuuuge. We're talking in the 5-figures, and that's even before we talk about societal burdens (like lost productivity).









MikeC said:


> https://www.ems.gov/pdf/education/N...l-Guidelines/EMR_Instructional_Guidelines.pdf
> 
> Interesting read. Definitely the EMR looks to be sufficient for the role of Ambulance Driver/Patient Transport tech to help with transfers.



As is a taxi, generally speaking.


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## MikeC (Feb 15, 2017)

EpiEMS said:


> That's what EMTs (more or less) do, we show up, treat immediate life threats (which is a rare thing to have to deal with), and (almost always) transport...sounds more or less like patient transfer/IFT to me.



There is a list of things that the EMT-B is trained on currently in addition to transporting and identifying/ treating life threats to ABCs. 

EMT-B teaches how to assess diabetic emergencies, which are extremely common it seems, and provide appropriate treatment for hypoglycemia . Local protocols look to implement the use of Glucometers for BLS crews.  So in the event of a hypoglycemic diabetic emergency, the EMT-B can assess the various s/s, history taking, obtain a glucometer reading, and administer oral glucose / food or drink allowed via local protocols.  If the pt is conscious with a gag reflex, no ALS would be required unless there was no response within 15 minutes of administering treatment. If unconscious, ALS could be dispatched to provide D-50/ Glucagon.

The NREMT-B is trained on assessing for potential stroke via the Cincinnati stroke scale and GCS. In the event of a wnl glucometer reading, the crew would suspect potential stroke and load and go to the most appropriate trauma center to receive treatment via thrombolytics. Medical command could be contacted for any further instructions or advise.

I think many services could greatly expand the role of the EMT-B, especially the NREMT trained in my opinion.

Also when I stated "transfers", I was referring to the various transfers from nursing home to hospital, hospital to hospital, etc


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## EpiEMS (Feb 15, 2017)

MikeC said:


> I think many services could greatly expand the role of the EMT-B, especially the NREMT trained in my opinion.



Sure, and they do. But that doesn't really add very much value to the discussion.


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## VentMonkey (Feb 15, 2017)

EpiEMS said:


> It's yuuuge. We're talking in the 5-figures, and that's even before we talk about societal burdens (like lost productivity).


Sorry, again, my vague attempt at rhetoric fails.


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## Eden (Feb 15, 2017)

In Israel, we face quite the same difficulties. We are in the process of turning the profession to acdamia-based. Currently 66℅ of the paramedics working in the field have a degree (b.ems or other relevant degree).
But the problem still exists, the job is hard and medics are overworked. The last research showed that 50℅ of the medics leave the field after 5years.
So yea you guys are not alone lol.


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## Eden (Feb 15, 2017)

Eden said:


> In Israel, we face quite the same difficulties. We are in the process of turning the profession to acdamia-based. Currently 66℅ of the paramedics working in the field have a degree (b.ems or other relevant degree).
> But the problem still exists, the job is hard and medics are overworked. The last research showed that 50℅ of the medics leave the field after 5years.
> So yea you guys are not alone lol.


And now academic paramedics with 5 years of experience can go on and become PA's. So tons of good medics leave.


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## EpiEMS (Feb 15, 2017)

VentMonkey said:


> Sorry, again, my vague attempt at rhetoric fails.


No, no - I understood your rhetorical point, I just wanted to add some color on the literal statement.


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## Giant81 (Feb 15, 2017)

VentMonkey said:


> This right here. So again, even many paramedics interpretation of properly and accurately identifying NSTEMI's, for example (think NOS LBBB in the face of several co-morbid factors absent "classic" ACS/ AMI s/s) are faultered.



I feel like we're getting bogged down with the possibility of over or under triaging a cardiac emergency based on a 12-lead.  This can't happen.  I can't triage anything using a 12-lead.  I don't obtain a 12-lead until after I've traiged the PT.  Once I've made my transport decision and possible diagnosis based on evidence I'm allowed to interpret, and treated as appropriate per my protocols, THEN I apply, acquire, and transmit a 12-lead.  

There is no way I can interpret a 12-lead incorrectly, since I cannot and do not interpret them at all.  They are only a tool the local hospitals would like us to obtain and send them while enroute to give them a better picture of the PT's condition before we arrive at the ED.  

I can completely understand where you're coming from and how even a paramedic can end up mis-interpreting a 12-lead.  They are not simple to read.  There's quite a bit of information on them, and I can understand how some things may not be straight forward.  I've done a bit of research on trying to identify what I'm looking at.  Not so I can interpret, but so it can hopefully help identify artifacting and ways to minimize it so I can obtain the best information possible for the ED to treat the PT. 

I guess there may be some argument on whether or not a Basic is competent enough to obtain a 12-lead, but it's not that difficult to apply the proper electrodes to the right places, and acquire the strip.  Reading it is the hard part, and that is left to someone with a lot more knowledge and time in doing that sort of thing than I am.  

As far as why paramedics make so little, I can't say.  On the one hand, I believe a paramedic degree is an associates or the equivalent of a 2-year college degree.  While the initial entry requirements are not large, and may not facilitate a higher salary, the fast-paced OP tempo, constant requirement for ongoing education, responsibility for PT's lives, and high burnout rates would (I feel) tend to possibly suggest a higher pay than your normal 2 year degree trained tradesman.  Though, public service isn't known to be a terribly lucrative industry.  Sure, the equipment makers can make bank, but the EMS companies and providers don't tend to make much.  Some are municipality based systems funded partly with tax money.  These systems aren't going to pay much either.  

I guess there are some places that pay pretty well don't they?  Wasn't Denver, CO and a couple other markets pretty well paid in comparison to national averages?  I guess it's like anything police/fire/ems related.  You do it because you like to help people and be a part of the community, if you're doing it to try and get rich, you'll be sadly disappointed very quickly.


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## SandpitMedic (Feb 15, 2017)

VentMonkey said:


> I vote changing the name from _Emergency_ Medical Services to something along the lines of _Prehospital_ Medical Services.


You want to be PMS?!


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## EpiEMS (Feb 15, 2017)

Giant81 said:


> You do it because you like to help people and be a part of the community, if you're doing it to try and get rich, you'll be sadly disappointed very quickly.


Nurses don't have this problem. Physicians don't have this problem. (Why? They have more education and more professional unity, which circles back to the education - they raise the barriers to entry, magically cutting down on the possible supply.)


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## SandpitMedic (Feb 15, 2017)

Enough with the cardiac calls. That's nothing to do with why we are paid minimally, and nothing to do with increasing the educational standards  at the Paramedic level.

Let's be realistic, if these changes are going to occur at all, they are going to be minimal. The least common denominator is an Associate of Science degree. If we can move from a certificate based model to an AS model we'd be taking the smallest largest step forward.

Jumping straight into the Bachelor of Science arena is biting off more than EMS can chew. It also is not feasible. Starting with the AS allows the market to catch up, and allows the physicians who devise our protocols a chance to catch up...

The implementation is to be in steps not in leaps. Eventually, I hope to see the top field Paramedic level being, at _baseline_, equivalent to a CCT  Medic with a Bachelor of Science Degree... in several years.... for now, the minimum barrier being an AS will self correct a lot of the problems we face, and better EMS providers. We will always be a hands on, first line, skill set driven employee; supplemental education in CCT skills and academia are what we need as a baseline.


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## SandpitMedic (Feb 15, 2017)

EpiEMS said:


> Nurses don't have this problem. Physicians don't have this problem. (Why? They have more education and more professional unity, which circles back to the education - they raise the barriers to entry, magically cutting down on the possible supply.)


Exactly, as I said the answers to most of our issues has been staring us in the face for years. You want to be like them? Act like them? Follow suit. Raise the education standards.


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## VentMonkey (Feb 15, 2017)

It was merely an example as someone suggested that EMT scope should include cardiac monitoring with _limited educational_ _backgrounds.

That _was my relevance to the thread topic regarding education, pay, and lack there of.

You all know how us (EMS) folk are easily side tracked...oh! A penny!!...


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## agregularguy (Feb 15, 2017)

While I agree on the bumping up of education, standards and all that- I think we're missing something right now. I believe EpiEMS brought it up earlier in the thread. 

Where is the money for our pay raise coming from?
If you're in a smart, publicly funded third service/municipal/fire based EMS, you're paid through taxes supporting your agency as well as reimbursements for care.
But if you're with an agency like AMR, or other private services which cover a vast, if not majority of America at this point, where is that increase in money going to come from? How about volunteer agencies, who remain volunteer out of either stubborness or complete inability to actually pay for providers?
AMR for example, literally pays the cities near me to be the 911 (and hospital) coverage provider. They make the most money off of IFT's near me, as I'm in a poverty stricken area and Medicare is what's paying most of our 911 bills. Medicare doesn't cover the full amount for services though. They can only reimburse up to X number of dollars. Exceed that amount in providing good patient care, and you're taking a loss for that extra amount of $. I don't have the exact figures off hand, but if you're bringing in a complicated ALS patient with multiple medications, cardiac monitoring, intubation, there's no way that they reimburse the full amount. 

So we can talk all we want about increasing our standards, our education, and what we can provide for our patients all day. But the fact is that as of right now, where is that money going to come from?


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## epipusher (Feb 15, 2017)

Finally someone stating the obvious.


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## NysEms2117 (Feb 15, 2017)

SandpitMedic said:


> Enough with the cardiac calls. That's nothing to do with why we are paid minimally, and nothing to do with increasing the educational standards  at the Paramedic level.
> 
> Let's be realistic, if these changes are going to occur at all, they are going to be minimal. The least common denominator is an Associate of Science degree. If we can move from a certificate based model to an AS model we'd be taking the smallest largest step forward.
> 
> ...


I feel the most feasible thing would be to get a real national standard, IMO. Don't let states deviate much, set a EMT, Pre-medic, medic, or whatever you want to call them. Don't let a state like NYS, North Dakota, or Pennsylvania do what they do and have 6 different types of Emergency medical responder "ranks"/titles. However advancing EMS in anyway I would like, whether thats with degree's, mandated national standards(higher), or hell even more practical hours.


agregularguy said:


> So we can talk all we want about increasing our standards, our education, and what we can provide for our patients all day. But the fact is that as of right now, where is that money going to come from?


I refer you to @EpiEMS post earlier in this thread, maybe on the previous page.
In my dumb simple answer, Less medics due to educational requirements= more money between the ones that are left. 
Money comes with professionalism, which EMS doesn't have much of if im completely honest. Education is key for most problems the US is currently facing in all fields(not just EMS)


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## agregularguy (Feb 15, 2017)

NysEms2117 said:


> I feel the most feasible thing would be to get a real national standard, IMO. Don't let states deviate much, set a EMT, Pre-medic, medic, or whatever you want to call them. Don't let a state like NYS, North Dakota, or Pennsylvania do what they do and have 6 different types of Emergency medical responder "ranks"/titles. However advancing EMS in anyway I would like, whether thats with degree's, mandated national standards(higher), or hell even more practical hours.
> 
> I refer you to @EpiEMS post earlier in this thread, maybe on the previous page.
> In my dumb simple answer, Less medics due to educational requirements= more money between the ones that are left.
> Money comes with professionalism, which EMS doesn't have much of if im completely honest. Education is key for most problems the US is currently facing in all fields(not just EMS)



You'll always have to have medics. If you can't get enough medics, then you replace them with something cheaper. Look at Delaware for example. Sure, they could spend the money and put a lot more medics on the road at one time. Instead, they choose to put medics in fly cars, and send them only to what they triage as the most critical calls. The rest of the time, they fill in with BLS trucks. (That being said, I LOVE the concept of sending ALS fly cars to only higher priority calls..) Or look at other, more rural areas. They can't always afford or attract higher educated providers in paramedics. So what do they do? Staff with intermediates. Similar care, at less education, and most importantly less money. Same with my city. Down medics for the night? Send out a few pages with incentive shift offers looking for medics, but ultimately they end up loading up on BLS units.
Cheaper for the agency. Does it provide the same level of care? No. But with a lack of medics, they have to do something.

Again, I really do believe we should raise our standards in education. Medics SHOULD have a bachelor's. We should hold ourselves to higher educational, and professional standards. Our patients deserve that. It's just a matter of where the money is going to come from for the changes.


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## VFlutter (Feb 15, 2017)

agregularguy said:


> Again, I really do believe we should raise our standards in education. Medics SHOULD have a bachelor's. We should hold ourselves to higher educational, and professional standards. Our patients deserve that. It's just a matter of where the money is going to come from for the changes.



If you (profession in general) are looking for a guaranteed return on your investment before taking the plunge then you are out of luck. As with RNs moving towards Bachelors and OT/PT moving towards Masters and even Doctorates the increase in pay and privilege didn't come until years after. PTs whom are now getting doctorates are spending susbtainaly more on their education then they will recoup with current salaries. However they are using their increased education to advocate for more billable services, outpatient practice, etc in hopes that the profession advances as a whole and eventually the rewards will be worth the work. Not saying everyone in these professions are selfless but it seems like a much harder concept for many in EMS to buy into.


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## TransportJockey (Feb 15, 2017)

But chase, all medics want everything handed to them before they are willing to work hard for it. 

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## SpecialK (Feb 15, 2017)

I can't really follow all of what people are on about, it's a bit over my head so here's what I can say:

In about 1999/2000, the Australian services (led by Ambulance Victoria) sat down and decided they wanted to move from the old two-year Diploma to a three-year BHSc degree as the base qualification.  The first to do this was Ambulance Victoria and over the next decade or so all of the ambulance services in Australia moved to a degree being required for employment.  There is now an oversupply of graduates in Australia.  New Zealand has done so as well but only more recently perhaps maybe over the past five years? 

in Australasia, Paramedics now require a three-year degree and ICPs require a post-graduate qualification on top of the degree.  This means it takes somebody between 3.5 to 4 years to become a Paramedic (degree plus the internship once employed) and about seven years for ICP (degree + approximately two years experience as a Paramedic + one year PG qualification + internship).  You can literally become a doctor faster than you can become an ICP!

I can't speak to whatever situation those outside of Australasia have; but in my experience if you want to do something; *just do it.
*
If you want, for example like Australasia, your Paramedics to have a degree and your ICPs to have a post-graduate qualification ontop (or whatever you call them) then *just do it.  *You get nowhere with little steps and piss-arseing about.  Your professional regulator or body (for example the College of Paramedics or Health Professions Council or Paramedic Board or whatever it is called) just needs to do it and say, right, in five years' time we will not register anybody who doesn't have the required qualification X, and that's it.  Put a line in the sand and do not look back.  Otherwise you will get nowhere.


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## VentMonkey (Feb 15, 2017)

Like I'd stated in another thread, it seems as though I, or anyone, can effect change on a grander scale so much more with a degree, and behind a desk than in the field. 

I think @Chase makes a great point, most field providers have no desire, nor do they see themselves capable of this sort of position. To me, it's sad and keeps us where we are even to this day, chasing our tails. 

Before we start going on and on about where the money will come from, we need willing and able minded people to take on such roles so that the masses are given these (debatably) deserving increases in pay. Again, this defines nobility and heroism, not to mention selflessness, but hey let's keep focusing on gadgets, "life saves", and whine about our pay rut...


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## VFlutter (Feb 15, 2017)

SpecialK said:


> but in my experience if you want to do something; *just do it.*.


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## NomadicMedic (Feb 15, 2017)

Just a quick sidebar, Delaware's ALS system isn't based on cost savings, it's a VERY expensive program to run. It's designed to put medics where they're needed, when they're needed. A small number of medics running high acuity calls prevents skill dilution and "rust out". But saving money with it? Not even a little. 




agregularguy said:


> You'll always have to have medics. If you can't get enough medics, then you replace them with something cheaper. Look at Delaware for example. Sure, they could spend the money and put a lot more medics on the road at one time. Instead, they choose to put medics in fly cars, and send them only to what they triage as the most critical calls. The rest of the time, they fill in with BLS trucks. (That being said, I LOVE the concept of sending ALS fly cars to only higher priority calls..) Or look at other, more rural areas. They can't always afford or attract higher educated providers in paramedics. So what do they do? Staff with intermediates. Similar care, at less education, and most importantly less money. Same with my city. Down medics for the night? Send out a few pages with incentive shift offers looking for medics, but ultimately they end up loading up on BLS units.
> Cheaper for the agency. Does it provide the same level of care? No. But with a lack of medics, they have to do something.
> 
> Again, I really do believe we should raise our standards in education. Medics SHOULD have a bachelor's. We should hold ourselves to higher educational, and professional standards. Our patients deserve that. It's just a matter of where the money is going to come from for the changes.


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## DrParasite (Feb 17, 2017)

agregularguy said:


> Where is the money for our pay raise coming from?
> If you're in a smart, publicly funded third service/municipal/fire based EMS, you're paid through taxes supporting your agency as well as reimbursements for care.
> But if you're with an agency like AMR, or other private services which cover a vast, if not majority of America at this point, where is that increase in money going to come from? How about volunteer agencies, who remain volunteer out of either stubborness or complete inability to actually pay for providers?
> AMR for example, literally pays the cities near me to be the 911 (and hospital) coverage provider. They make the most money off of IFT's near me, as I'm in a poverty stricken area and Medicare is what's paying most of our 911 bills. Medicare doesn't cover the full amount for services though. They can only reimburse up to X number of dollars. Exceed that amount in providing good patient care, and you're taking a loss for that extra amount of $. I don't have the exact figures off hand, but if you're bringing in a complicated ALS patient with multiple medications, cardiac monitoring, intubation, there's no way that they reimburse the full amount.
> ...


I think you just answered your own question:  transition EMS from all those private services to a taxpayer funded system.  911/EMS is a money losing system, especially in the inner cities. I'm sure EMS in the rural areas are also money losing, because you don't have the call volume to make it profitable.  

Volunteer EMS can work, but they need to bill for services.  Volunteers in the 60s, 70s, 80s, and 90s, did EMS a huge disservice, by doing the job for free, and relying on donations.  Now that EMS is advancing, and the donations are drying up, people everywhere are saying "wait, now I have to pay for this?  lets see how we can get this service now and still avoid paying for it."  

I agree, EMS needs a stable funding source, and like most of the public sector, if you want  service you will need to pay for it.  ditto healthcare, if you want medical care, you are expected to pay for it.


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## TransportJockey (Feb 17, 2017)

My service does a decent job paying for itself. We are a county EMS system that does rural and suburban 911 and we have a NET division that does non emergent transfers separately from 911. Plus those trucks can double up and backup the 911 system if things get busy. We also will occasionally send a 911 truck on an als or CCT run. This has made it so we have a budget surplus of several million and we have just put up two new trucks without any additional funding from the communities we serve. There are ways to do it. But it's not easy and what may work for one place will not work for all. 

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## SandpitMedic (Feb 17, 2017)

TransportJockey said:


> My service does a decent job paying for itself. We are a county EMS system that does rural and suburban 911 and we have a NET division that does non emergent transfers separately from 911. Plus those trucks can double up and backup the 911 system if things get busy. We also will occasionally send a 911 truck on an als or CCT run. This has made it so we have a budget surplus of several million and we have just put up two new trucks without any additional funding from the communities we serve. There are ways to do it. But it's not easy and what may work for one place will not work for all.
> 
> Sent from my SM-N920P using Tapatalk


Can I borrow a cool million?


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## agregularguy (Feb 17, 2017)

DrParasite said:


> I think you just answered your own question:  transition EMS from all those private services to a taxpayer funded system.  911/EMS is a money losing system, especially in the inner cities. I'm sure EMS in the rural areas are also money losing, because you don't have the call volume to make it profitable.
> 
> Volunteer EMS can work, but they need to bill for services.  Volunteers in the 60s, 70s, 80s, and 90s, did EMS a huge disservice, by doing the job for free, and relying on donations.  Now that EMS is advancing, and the donations are drying up, people everywhere are saying "wait, now I have to pay for this?  lets see how we can get this service now and still avoid paying for it."
> 
> I agree, EMS needs a stable funding source, and like most of the public sector, if you want  service you will need to pay for it.  ditto healthcare, if you want medical care, you are expected to pay for it.



I would love that. I think our healthcare system needs an overhaul.
I think it'll just be interesting to see how they (and by they I mean people smarter than I)do it. What works in the south, may not work for the midwest, and vice versa.


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## Handsome Robb (Feb 18, 2017)

TransportJockey said:


> My service does a decent job paying for itself. We are a county EMS system that does rural and suburban 911 and we have a NET division that does non emergent transfers separately from 911. Plus those trucks can double up and backup the 911 system if things get busy. We also will occasionally send a 911 truck on an als or CCT run. This has made it so we have a budget surplus of several million and we have just put up two new trucks without any additional funding from the communities we serve. There are ways to do it. But it's not easy and what may work for one place will not work for all.
> 
> Sent from my SM-N920P using Tapatalk



We just recently did a cost analysis and found that we only cost ~$12 per person in the county. There are ways of making EMS cost effective. 


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## TransportJockey (Feb 18, 2017)

It's called separating it from the hose monkeys

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## EpiEMS (Feb 19, 2017)

Handsome Robb said:


> We just recently did a cost analysis and found that we only cost ~$12 per person in the county. There are ways of making EMS cost effective.
> 
> 
> Sent from my iPhone using Tapatalk



Do you guys bill for transport? (Is that net of transport revenue?)


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## Handsome Robb (Feb 19, 2017)

EpiEMS said:


> Do you guys bill for transport? (Is that net of transport revenue?)



Yes we do, but county residents pay far less for our bills than out of county residents do. Out of approximately a 15 million dollar budget (IIRC) we are able to recoup ~10 million through billing and only have to cover the other 5 million with county tax money. 

Those are very rough numbers, I'm going off of memory. It's all publicly accessible on our county website. 


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## VentMonkey (Feb 28, 2017)

Because even though this topic is always being brought up...

Because even though the piece is two years old, and it will never lose its relevance...

And, because every new "reaper-racing-Nightwatch-loving-adrenaline-junkie" should read this, I'll copy and paste this as the blog (I'm sure many of you are already aware of) was referred to me by a good online buddy:

http://www.lifeunderthelights.com/2...more-money-a-guest-post/#sthash.TcyfSpqv.dpbs


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## GMCmedic (Mar 1, 2017)

I guess my definition of little is different from everyone else, but I may be one of the select few. I started out at a terrible AMR shop and spent many nights getting ran into the dirt, off the streets 3 hours late and down 12 reports. I worked my butt off building a reputation as a competent provider and reliable employee. The last two years at my current job i made 50k and 52k. Thats 8k-10k more a year. This year im on pace to make 60k and havent worked overtime beyond my regular schedule (kelly schedule). 



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## DrParasite (Mar 2, 2017)

VentMonkey said:


> Because even though this topic is always being brought up...
> 
> Because even though the piece is two years old, and it will never lose its relevance...
> 
> ...


not for nothing, but there are numerous things wrong about the piece you posted...

To start with, EMTs IS a skilled profession.  there ARE requirements for entry.  It might be a low skilled profession, but its not like you can hop on an ambulance with 0 education and 0 experience and do anything when faced with a sick patient (we will assume the volunteers who do this are doing so under a more experienced and educated provider).  there are entry level requirements, but they are just entry level requirements, not the end all goal.

I'm not going to say it's a difficult class, but most decent classes do have students fail out or get dropped due to poor performance.  the fast food industry has 0 requirements to get hired.... you might need a HS diploma.  the EMT class I run is around 240 hours, with tests that you need to pass or else you get booted from the program.  The two week boot camps and super condensed programs are an embarrassment, but that's what happens when you add for profit entities and the fire service (do whatever you can to get them certified the quickest, regardless  of if they know what they are doing afterwards) to the list of EMS training entities.... lets do the bare minimum and get it done as quickly as legally possible to maximize revenue and minimize work time.

I will agree that the supply outweighs the demand; but that's what happens when you have training programs pumping out more EMTs and paramedics than their are jobs.  the other question is how many of graduates are working full time in EMS following graduation; I would imagine the number isn't as high as you would believe.



> In some areas the police and members of the public can administer medications that you are not allowed to.Â  And even if you were truly the heroes you believe yourselves to be, so what?


oddly enough, I agree with the statement; if the general public can give meds, or a non-medical person working in another field, why can't the "medical professional?"  But it's irrelevant to the topic at hand.

The bottom line is, EMS is a profession to some..... and if you are working in a profession, you should get paid a living wage.  If you don't like what you are being paid, and you think you are worth more, than either explore other opportunities with other companies, go to school to make yourself more valuable to your employer, or leave the field altogether, and enter a different field where you will be paid more.  When enough people leave, and agencies can't get people to accept piss poor wages, than wages will increase (remember the whole supply and demand principle?)

BTW, there are plenty of "certifications" in the real world that are shorter than EMT class..... just go to any community college and see what "test prep" classes they offer.  Many are not in healthcare, and many will result in getting paid more than you will make in EMS.


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## EpiEMS (Mar 2, 2017)

DrParasite said:


> I will agree that the supply outweighs the demand; but that's what happens when you have training programs pumping out more EMTs and paramedics than their are jobs.



Certainly a valid point, but unless there is some sort of cartel controlling things (like for medical schools or nursing schools), it's far from individually rational for a school to go out and say "hey, I'm gonna cut enrollment because it'll boost wages". This is a tough problem to solve.


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