# Thoughts on this? (Re: current wage topic)



## GirevikMedic (Jun 3, 2015)

Link:
http://uniformstories.com/articles/...l&utm_source=facebook.com&utm_campaign=buffer

With this being a bit of current hot button issue of sorts I'd be curious to hear what some others have to say about the above linked article. I know there's already a thread on the issue but this seems to take things from a different perspective and I also didn't want to hijack that thread.

Personally, I found it interesting with some valid points. Some people may not like it but that's why it's called "opinion". Point 4 is probably the biggest/most important but it seems to go over so many heads which is sad.


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## TF Medic (Jun 3, 2015)

There are obviously a lot of factors at play, but in the end an open market will always dictate cost/price based on supply and demand. As long as there is a supply of certified paramedics willing to accept a job paying $xx,xxx per year (insert your personal "that's too low!" figure here), that is what services will offer to new medics.

EMS is so widely varied throughout the country that it is difficult to create standardization of billing, shifts, services, and payroll. There are a handful of places in my state where one can make a comfortable middle-class living being a medic, but there are a lot more smaller communities using volunteer or paid-on-call services that are almost always part time employees doing EMS on the side of their full time gig. They do not (usually) demand high wages, and therefore the services will continue to pay them as little as they will accept. It is basic economics.

So far, I've come across two main types of people in EMS: Those who say it is a "calling," and those who are using it as a stepping stone into something else. Neither consider it a career, and both are willing to accept lower wages. One accepts it based on emotion, one accepts it because it is only temporary.

I don't see much changing unless it becomes a college degree type certification and standardization of organization nation-wide. I don't think either of those are likely.


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## 281mustang (Jun 3, 2015)

The article likely won't do anything to silence the voices of people on the other side of the issue, but it was a well composed rebuke nonetheless.


> We need new and innovative ways to generate revenue, like community paramedicine, subscription services, and more comprehensive medical care that extends past the limited scope of emergency medicine that we are used to. But once again, that requires education.


 This is the end-all point to the wage argument.

Regardless of what people blindly say about increased education standards increasing our salary, our reimbursement rates/wages won't increase simply by requiring an associates degree. It requires education advanced enough to break through our "you call, we haul" role that we currently serve. We need something of a "Paramedic Practitioner", someone that bridges the gap between Paramedics and Physicians just as Nurse Practitioners do so between Nurses and Physicians. Someone that could prevent many of the unnecessary transports we performed, effectively reducing the burden placed on overpopulated ERs while simultaneously funneling the extra funds saved by the hospital visit to the pre-hospital system. 

Ideally it would require a Masters degree to be truly effective. One wouldn't be needed on every ambulance as that would simply be unrealistic, the system could simply work with just having multiple providers in a given area that EMS providers could request during appropriate calls.

Just my two pennies...


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## GirevikMedic (Jun 3, 2015)

TF Medic said:


> There are obviously a lot of factors at play, but in the end an open market will always dictate cost/price based on supply and demand. As long as there is a supply of certified paramedics willing to accept a job paying $xx,xxx per year (insert your personal "that's too low!" figure here), that is what services will offer to new medics.
> 
> EMS is so widely varied throughout the country that it is difficult to create standardization of billing, shifts, services, and payroll. There are a handful of places in my state where one can make a comfortable middle-class living being a medic, but there are a lot more smaller communities using volunteer or paid-on-call services that are almost always part time employees doing EMS on the side of their full time gig. They do not (usually) demand high wages, and therefore the services will continue to pay them as little as they will accept. It is basic economics.
> 
> ...



I totally agree about the supply-demand factor. Actually, I'm a little surprised that one didn't make on the list. This is something that makes me wonder just how much EMS is really invested in itself. The wage issue is not a secret and phrases like "EMT's are dime a dozen, medics a quarter" aren't exactly news either. Gross over saturation of talent is known too. Still, the schools that supply our industry just keep pumpin' 'em out which drives down pay scales by simple economics 101. These schools are literally square 1 for our field. Yet tuition fees (which I'm sure the NREMT appreciates once cert time rolls around) appear to be more important than quality of turn out and/or preserving a more positive job market. I'm lucky to work for a solid company that pays well (like ol' Jack Burton, though, I've paid my dues) but that doesn't mean I'm blind to the issues we face as a whole. Sadly, it seems many are - or worse they just don't care.


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## GirevikMedic (Jun 3, 2015)

281mustang said:


> The article likely won't do anything to silence the voices of people on the other side of the issue, but it was a well composed rebuke nonetheless.
> This is the end-all point to the wage argument.
> 
> Regardless of what people blindly say about increased education standards increasing our salary, our reimbursement rates/wages won't increase simply by requiring an associates degree. It requires education advanced enough to break through our "you call, we haul" role that we currently serve. We need something of a "Paramedic Practitioner", someone that bridges the gap between Paramedics and Physicians just as Nurse Practitioners do so between Nurses and Physicians. Someone that could prevent many of the unnecessary transports we performed, effectively reducing the burden placed on overpopulated ERs while simultaneously funneling the extra funds saved by the hospital visit to the pre-hospital system.
> ...



Yeah, #4 was the big one IMO. Sadly, I see too many people who fail to see the forest for the trees while making sure everyone sees the big H (for hero) emblazoned on their puffed out chest with their only other argument being "F*** you, pay me!"

My thoughts...

EMT 
College level basic A+P, pathophysiology and biology, didactic portion akin to what medics now see (perhaps without ACLS and PALS but keeping ITLS and whatever hands-on skills and pharmacology is appropriate for that level), a clinical rotation that's more comprehensive - maybe X shifts in an ER and X shifts on an ambulance (FD or EMS, whatever so long as it's a transporting provider) that includes 911 and IFT time while being paired with an FTO. That part may prove difficult with liability/insurance issues and/or professional agreements when mixing a school, a student and at least 1 outside provider. Somehow bringing this equivalent, or comparable to, an Associate's Degree would be good. 

Medic
More in depth A+P/patho/bio, microbio?, didactic portion that's part refresher while also applying the more advanced material, ACLS and PALS, appropriate pharmacology and skills, clinical rotations that are more in-depth and hospital based (EMTs would be, ideally, ambulance based), internship. Ideally, equivalent or comparable to a Bachelor's.

Paramedic Practioner 
Master's Degree equivalent/comparable. Larger basis in the higher level critical care, community paramedicine, etc/whatever. Obviously there's several possibilities for this one. 

These are all just rough ideas tossed out there. But combined with a proper PR push of the proper pubic/media re-education of what EMS is (and isn't) and the value, or potential value, held by EMS... we could actually see some big steps forward. Unfortunately, this will not happen within on licensing renewal cycle. Instead it would take years and too many are too impatient.


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## cruiseforever (Jun 5, 2015)

As with with any other job, if you are not happy with your situation:

1- Move, there are services that do pay well.
2- Go to school and change careers.
3- Stay were you are at.  But please stop pissing and moaning how bad it is.


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## triemal04 (Jun 5, 2015)

Just as an aside, for those of you talking about "paramedic practitioners," I hope you understand how laughable that is, and how much it shows the lack of awareness about EMS, medicine, and the healthcare system in this country.  

First off, do you actually understand what a PA is?  What a PA can do?  If you do, why bother trying to reinvent the wheel?
Do you understand how difficult it would be to create a provider at that level that was actually accepted by the healthcare community AND the insurance companies AND the federal gov't (holds the medicare purse strings)?
Do you understand how pathetic it is to talk about creating a much higher level of provider when the current providers are so ****ed up, uneducated, unstandardized and *******ized across the country?  Maybe...I don'tknow...fix, REALLY FIX the current problems first.

Carry on with the original topic, but keep this in mind.


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## triemal04 (Jun 5, 2015)

cruiseforever said:


> As with with any other job, if you are not happy with your situation:
> 
> 1- Move, there are services that do pay well.
> 2- Go to school and change careers.
> 3- Stay were you are at* and do something to improve the situation.*


Better idea.


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## GirevikMedic (Jun 6, 2015)

cruiseforever said:


> As with with any other job, if you are not happy with your situation:
> 
> 1- Move, there are services that do pay well.
> 2- Go to school and change careers.
> 3- Stay were you are at.  But please stop pissing and moaning how bad it is.



Not gonna argue with this one. I've been there... pulling 3 jobs to make it work and at different points in time seriously considering military/military reserve, truck driving, personal training, MRI tech and law enforcement. I'm lucky that things have worked out to where they have now and I know that. But this is always an option and it does come off as some kind of weird entitlement that some of our peers feel like we/they deserve a lucrative career in EMS because "it's a passion". Unfortunately, passion doesn't pay the bills. Do sanitation workers do the job out of passion?



triemal04 said:


> Just as an aside, for those of you talking about "paramedic practitioners," I hope you understand how laughable that is, and how much it shows the lack of awareness about EMS, medicine, and the healthcare system in this country.
> 
> First off, do you actually understand what a PA is?  What a PA can do?  If you do, why bother trying to reinvent the wheel?
> Do you understand how difficult it would be to create a provider at that level that was actually accepted by the healthcare community AND the insurance companies AND the federal gov't (holds the medicare purse strings)?
> ...



Oh, I agree. I'm not saying that the PP is the answer or the most feasible. That was more spitballing ideas based on the concept. I think the EMT/medic ideas are plenty sufficient and would be a step in addressing current fixes. I don't have the answers and I don't know what they are - but I do know that alot of these arguments people are spewing appearing to be poorly thought out and/or presented. I wonder why the NREMT couldn't be used as a better vehicle to standardization, barrier to entry, etc. (or do I really want to know the answer to that? LOL).


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## GirevikMedic (Jun 6, 2015)

And... a recent "rebuttal"...

http://www.highperformanceems.com/2015/06/05/5-reasons-ems-does-deserve-higher-pay/


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## 281mustang (Jun 6, 2015)

triemal04 said:


> Do you understand how pathetic it is to talk about creating a much higher level of provider when the current providers are so ****ed up, uneducated, unstandardized and *******ized across the country?  Maybe...I don'tknow...fix, REALLY FIX the current problems first.
> 
> Carry on with the original topic, but keep this in mind.


 And exactly how would the problem be fixed in a way that raises wages proportional to the increased education standards?


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## cruiseforever (Jun 6, 2015)

triemal04 said:


> Better idea.


 
Thanks for the addition.


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## triemal04 (Jun 10, 2015)

281mustang said:


> And exactly how would the problem be fixed in a way that raises wages proportional to the increased education standards?


What increased educational standards?

The way it works is FIRST you add value to your service, FIRST you make it more difficult to attain the required certification, FIRST you make the job more marketable, and only THEN do you increase wages.

So far none of the above has been done.


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## gonefishing (Jun 11, 2015)

triemal04 said:


> What increased educational standards?
> 
> The way it works is FIRST you add value to your service, FIRST you make it more difficult to attain the required certification, FIRST you make the job more marketable, and only THEN do you increase wages.
> 
> So far none of the above has been done.


What more required education do you need when were with patients for so little time? In San Diego, LA county,SF your major hubs we are with our patients for 15minutes at most times.  Do I need the education of a nurse when im not spending days attending to my patients every needs and taking orders from a Doc? I think weve proven ourselves.  Weve come a long way since Johnny and Roy and frankly fireman don't fight fires every day and the education is a bare minimum requirement of an academy and a high school diploma yet they get alot of pay in big hub citys where cost of living out weighs wages in ems.  What it comes down to really is they are organized and we are not.  Alot of people piss and moan on the net but are too damn afraid to organize.


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## Clare (Jun 11, 2015)

gonefishing said:


> What more required education do you need when were with patients for so little time? In San Diego, LA county,SF your major hubs we are with our patients for 15minutes at most times.  Do I need the education of a nurse when im not spending days attending to my patients every needs and taking orders from a Doc? I think weve proven ourselves.  Weve come a long way since Johnny and Roy and frankly fireman don't fight fires every day and the education is a bare minimum requirement of an academy and a high school diploma yet they get alot of pay in big hub citys where cost of living out weighs wages in ems.  What it comes down to really is they are organized and we are not.  Alot of people piss and moan on the net but are too damn afraid to organize.



I don't know about you but certainly many of my patients get more than fifteen minutes of my attention.  It is difficult to properly assess somebody holistically and decide what treatment they need (if any), if they require referral to a medical facility and if so, which one, and how they are going to get there in fifteen minutes.  If you are able to do that in fifteen minutes, please, share your secret!

Whilst I have great  respect for the Fire Service (and lets face it, I am just a little attracted to well-built people in a big red truck!) the clinical decisions that are made by Ambulance personnel are far more complex than putting out a fire or cutting up a car so your comparison is invalid.  

Education is not in and of itself a direct link to salary, you must also look at what is required of the person with the education.


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## gonefishing (Jun 11, 2015)

Clare said:


> I don't know about you but certainly many of my patients get more than fifteen minutes of my attention.  It is difficult to properly assess somebody holistically and decide what treatment they need (if any), if they require referral to a medical facility and if so, which one, and how they are going to get there in fifteen minutes.  If you are able to do that in fifteen minutes, please, share your secret!
> 
> Whilst I have great  respect for the Fire Service (and lets face it, I am just a little attracted to well-built people in a big red truck!) the clinical decisions that are made by Ambulance personnel are far more complex than putting out a fire or cutting up a car so your comparison is invalid.
> 
> Education is not in and of itself a direct link to salary, you must also look at what is required of the person with the education.


My secret is there is a hospital on practically every corner and in school was drilled on doing a full trauma assessment load and go in under 2 minutes.  I've had GSW's where the closest accepting was literally 5 minutes away.  When I was an emt I had a pediatric still alarm once that kid had full treatment in 2 minutes and at the closest pediatric accepting 8 minutes away.  Theres no secret.


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## Carlos Danger (Jun 11, 2015)

gonefishing said:


> What more required education do you need when were with patients for so little time? In San Diego, LA county,SF your major hubs we are with our patients for 15minutes at most times.  Do I need the education of a nurse when im not spending days attending to my patients every needs and taking orders from a Doc? I think weve proven ourselves.  Weve come a long way since Johnny and Roy and frankly fireman don't fight fires every day and the education is a bare minimum requirement of an academy and a high school diploma yet they get alot of pay in big hub citys where cost of living out weighs wages in ems.  What it comes down to really is they are organized and we are not.  Alot of people piss and moan on the net but are too damn afraid to organize.



I think you make a point here that is often overlooked.

Maybe, the reason why EMS education hasn't changed significantly over the past decades is the simple fact that there is no pressing reason to make those changes. As much as the administrators and educators like to talk about being "progressive" and "looking to the future", in reality sweeping changes (at least ones that cost a lot of money and take a lot of work) are typically reactionary; something has to force them to happen. And even though we've got plenty of room for improvement, and I'd personally really like to see a more academic, college-based 2-year degree education with less a little emphasis on emergencies and more on basic primary care become the entry-level standard for paramedics, the reality is that for the most part, paramedics do a pretty good job with the education that we already have.

So why fix what aint broke? Especially when the proposed fix (increased educational standards) is expensive and results in a lot of whining and pushback from many of the stakeholders? 

And also - I know I've beaten this horse hard on this forum many times - it's really important to understand that increased education does not automatically translate to increased compensation. If that were the case, then every paramedic with a 4 year degree would make way more money than their colleagues without a college degree, and that isn't the case.


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## Clare (Jun 11, 2015)

gonefishing said:


> My secret is there is a hospital on practically every corner and in school was drilled on doing a full trauma assessment load and go in under 2 minutes.  I've had GSW's where the closest accepting was literally 5 minutes away.  When I was an emt I had a pediatric still alarm once that kid had full treatment in 2 minutes and at the closest pediatric accepting 8 minutes away.  Theres no secret.



I have no idea what most of that means. 

If your attitude is that the role of the modern Ambulance Service to just pick people and take them to the hospital then don't be surprised if you pay is equally as low.


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## triemal04 (Jun 11, 2015)

gonefishing said:


> What more required education do you need when were with patients for so little time? In San Diego, LA county,SF your major hubs we are with our patients for 15minutes at most times.  Do I need the education of a nurse when im not spending days attending to my patients every needs and taking orders from a Doc?


You're right.  All people in your area need is a driver.  


> What it comes down to really is they are organized and we are not.  Alot of people piss and moan on the net but are too damn afraid to organize.


Very, very true unfortunately.  While simply unionizing is not an automatic, or gaurenteed fix for a group it definitely can help, and can also, if the union exists in either large enough numbers, or just has enough clout, help push various agendas forward (for good or bad).

Of course, creating (and then running, sustaining, and doing all those pesky union related activities like negotiating, advocating at the city/county/state/national level of gov't, standing up for members, researching and keeping up on current labor laws, OSHA laws, keeping up on what is happening at the city/county/state/national level as it relates to the local, and on and on and on and on (if it's a good local anyway)) is not easy, pain free, or simple.  And so the standard EMS mantra comes out:

Ain't nobody got time fo' dat!


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## chaz90 (Jun 11, 2015)

gonefishing said:


> What more required education do you need when were with patients for so little time? In San Diego, LA county,SF your major hubs we are with our patients for 15minutes at most times.  Do I need the education of a nurse when im not spending days attending to my patients every needs and taking orders from a Doc? I think weve proven ourselves.  Weve come a long way since Johnny and Roy and frankly fireman don't fight fires every day and the education is a bare minimum requirement of an academy and a high school diploma yet they get alot of pay in big hub citys where cost of living out weighs wages in ems.  What it comes down to really is they are organized and we are not.  Alot of people piss and moan on the net but are too damn afraid to organize.




This is the reality in big city, urban EMS. In my world, I am often the only medical provider for close to an hour for someone who is in chronically very poor health and hasn't seen a doctor for months or years. 

Managing acute exacerbations of multiple chronic conditions and hoping to create a field diagnosis and treat them effectively while transporting to the appropriate facility for them is a challenge outside of the big city where there is a large hospital on every corner. There's more to the country, and the world, than any of our individual experiences. Each medical system and EMS system works with its own particular set of circumstances and one generalization simply doesn't apply across the board. 

Perhaps it's time we recognize that and apply different levels of paramedicine across differing service areas. In San Diego, perhaps an AEMT that defibrillates, starts IVs, uses CPAP, places SGA in cardiac arrests, transmits 12 leads, and is able to administer fentanyl, D50, narcan, and albuterol is all that is necessary. Perhaps the expanded scope paramedics shouldn't be the ones working in a high volume system of 20+ 5 minute transports in a 10 hour shift. 

In other parts of the world though, our more advanced skills are used, and are often indicated. In these cases, a smaller cadre of higher level practitioners with the education and capability to treat patients and effect transport decisions might be smart.


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## gonefishing (Jun 11, 2015)

Remi said:


> I think you make a point here that is often overlooked.
> 
> Maybe, the reason why EMS education hasn't changed significantly over the past decades is the simple fact that there is no pressing reason to make those changes. As much as the administrators and educators like to talk about being "progressive" and "looking to the future", in reality sweeping changes (at least ones that cost a lot of money and take a lot of work) are typically reactionary; something has to force them to happen. And even though we've got plenty of room for improvement, and I'd personally really like to see a more academic, college-based 2-year degree education with less a little emphasis on emergencies and more on basic primary care become the entry-level standard for paramedics, the reality is that for the most part, paramedics do a pretty good job with the education that we already have.
> 
> ...


Very true.  I have a college education but am paid just the same as anybody else.


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## fatkid (Jun 30, 2015)

Watch how many companies leave LA City if they go to a 15 dollar an hour minimum wage


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## gonefishing (Jun 30, 2015)

fatkid said:


> Watch how many companies leave LA City if they go to a 15 dollar an hour minimum wage


Well heres the thing, in the city laws if you work 2 hours or more any time of the day in LA city limits, you have to abide by city wage rules.
You could do an hour there go back an hour later and you would have to pay $15 an hour for the whole work day.


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