EMS/Nursing vs. Firefighting

[Veneficus]

I was trying really hard not to get involved in this thread

But I would like everyone to consider:

Well said, I guess there are more people out there that question where all the money to pay for these changes is going to come from. You can also factor in the hundreds of smaller departments that would love to be able to staff a full time ALS rig with a paid crew but even at today's wages its not happening for many.

I see your point, and I agree largely, but I ask you to consider the side I see it from, which is basically the opposite side.

Because the healthcare system funding is unsustainable. There most certainly will be major retraction. No political party will be able to stop that. You cannot create money that doesn't exist and get away with it for long.

When that retraction comes, budgets will go down and people will lose their jobs. Especially in my opinion, low and midlevel providers. In any industry in contraction they are always first to go.

At that point in addition to competition for jobs, a provider who can demonstrate versatility or value above the average will be the prime choice.

Because this provider will actually be replacing several providers or operating in a capacity that saves money in the long run, they will be paid higher.

$150K/year I doubt very much.

But if you pay on average $24K/4 years for a degree that gets you a job making ~75K a year when you figure in benefits, that is a hell of a good investment if your alternative is 24K a year at the local burger joint without benefits. Infact it pays for itself in 1 year. 2 if you add in your time at minimum wage.

As I am sure you know, there aren't a lot of high paying union positions open. I figure many of those will soon be going the way of the UAW positions as the economy worsens or the healthcare bubble pops.

I saw on monday that the average unemployment numbers. (you know the reported ones) are 10.4% for people without a degree and 4.9% for those with a bachelors or above.

$24K/ 4 years to have a job is even better than no job at all, not competative, or competing with 10,000 people for 1 position.

For those hoping to make a future in EMS, even for a short time, I think it is only responsible for those already established to encourage not only a degree, but a change in thinking about the system.

 

[SerumK]

Veneficus, I agree 100% with everything you said except that there is some i[YOUTUBE][/YOUTUBE]nevitable mass firing in EMS... now if you said in Fire, Id believe it.

 

[Veneficus]

Veneficus, I agree 100% with everything you said except that there is some i[YOUTUBE][/YOUTUBE]nevitable mass firing in EMS... now if you said in Fire, Id believe it.

When medicare/medicade is cut, I very much doubt it will be physicians that take a major hit.

However, I can see a significant decrease in both the reimbursement for IFT as well as the required level of providers and equipment.

Let's face it, most routine IFT really is nothing more than a really overpriced taxi. Nowhere in EMS education outside of critical care transport is there focus on it.

Other than spending the trip taking 2 sets of completely unnecessary vitals that will change nothing in the patient management at destination, and figuring out how to fill out the paperwork so it gets automatically paid, what special skills or medical training/equipment is really required?

A stretcher and 2 guys to lift it?

Oxygen that the same patients manage on their own?

looks like a prime place to be cut to me.

 

[RunnerD1987]

Sort of in the same boat. Just about finishing up college and not satisfied with directions can take me. So trying to branch out with taking an EMT-B course to help find where to go. Not great at math, but still considering going towards an area in the medical field. If it is what you want go for it and apply yourself. Just make sure it is what you want before you put in the hard work. Best of luck.

 

[Shishkabob]

Good luck with organizing. Most employers across the board want to keep EMS salaries as low as possible. Who's going to advocate degrees if it'll mean a pay increase? Meanwhile, many in the profession are transient as it is.

Meh, as Gen Y gets more in to the leadership roles, and the baby boomers move on out, it should get a bit better (hopefully...) but then again when I see my generation I wonder how we're ever going to avoid blowing the Earth up.

Let's face it, most routine IFT really is nothing more than a really overpriced taxi.

A stretcher and 2 guys to lift it?

Oxygen that the same patients manage on their own?

looks like a prime place to be cut to me.

Vast majority of BLS IFT needs to be gotten rid of, plain and simple. The only BLS IFTs I can see as legit are the paralyzed / comatose, psychiatric, MAYBE the overweight. Pretty much every other transfer should be ALS in nature.

That would save the government, and insurance companies, a crap load of money right there.

Think of a single dialysis patient. Last I read, $100 per treatment, was the norm, plus $300 ambulance ride. Many need dialysis 3ish times a week. That's $1200 a week. That's nearly $60,000 per year, just in dialysis. Let's face it, they aren't the healthiest people, so they visit the hospital quite a bit as well, also picked up by Medicare. That's just a single person. Think of all the money that could be saved by stopping ambulance transports (3/4 of the cost)

Granted I've oversimplified it a bit, AND not all patients are like that, but food for though.

I don't know about you, but I've met just as many fallible and idiotic nurses as I have Paramedics. Just having the title "RN" does not make you better than someone with NREMT-P. You may disagree with me, you are free to do so, but I've made my point abundantly clear whilst you have yet to answer my one simple question I've asked multiple times in this thread alone.

Now you are resorting to the use of personal attacks or experiences to drag down professions based on a few incidents involving individuals you have seen. You have also stated to being a very new Paramedic and it seems like very little experience applying your newly acquired skillset or knowledge based on some of your posts.

I don't know you, I don't know your qualifications. To me, you're a brand new poster. You can be an MD, you can be an RN, you could be a medic, you could be a first responder, or you could be one of the many phonies we have running around this site claiming they know stuff. Don't question my professionalism and don't question my knowledge base just because you disagree with one of my views. You don't know me personally, therefor you do not have any room to stand on with those views. There are a few people on this site who DO know me personally, and I haven't seen a one go the route you have.

I not once stated our education was more than adequate, or that we know too much, or that we should stop learning, or that we're Gods gift to the world, or any variation thereof. Quit making it seem as such. I not once said we shouldn't get an associates minimum. Quit making it seem as such. I not once belittled entire professions. Quit making it seem as such.

 

[Aidey]

Think of a single dialysis patient. Last I read, $100 per treatment, was the norm, plus $300 ambulance ride. Many need dialysis 3ish times a week. That's $1200 a week. That's nearly $60,000 per year, just in dialysis. Let's face it, they aren't the healthiest people, so they visit the hospital quite a bit as well, also picked up by Medicare. That's just a single person. Think of all the money that could be saved by stopping ambulance transports (3/4 of the cost)

Just a quick correction, dialysis patients cost around $25,000* a month for the dialysis and directly associated costs. That is about $2,000 per treatment, with the average patient doing 3 treatments a week. Kidney failure is an automatically qualifying condition under Medicare, meaning expenses are easy to track. When you start looking at the equipment, medication and staff costs it adds up quick.

Sidenote - If this country can't reduce the levels of kidney failure due to type II diabetes and HTN the cost of paying for dialysis for all of those people will sink this country faster than any other health condition.


*That was the number given to me 2 years ago when I was working at the dialysis clinic.

 

[JPINFV]

Sidenote - If this country can't reduce the levels of kidney failure due to type II diabetes and HTN the cost of paying for dialysis for all of those people will sink this country faster than any other health condition.

Alternatively, I would be interested to see how much peritoneal dialysis costs compared to dialysis. This study ended up looking at 100 patients (50 HD matched to 50 PD) and found that PD was a little over 40k cheaper on average. Granted, not all HD patients are eligible for PD, but it would be interesting to see what could be done, especially if a system can be found for PD to be done with continuously cycling throughout the day instead of the current 3-5 cycling sessions.

 

[Aidey]

Not only is it cheaper, it is healthier for the patient, and for the most part has lower complications. It also allows people to continue to work, go to school etc because of the more flexible schedule. There are the people who continually cycle during the night, and then exchange fewer times during the day too. Home hemo has a lot of the same benefits, but the learning curve is steeper, and complications can be more emergent.

/hijack

 

[Aidey]

When medicare/medicade is cut, I very much doubt it will be physicians that take a major hit.

However, I can see a significant decrease in both the reimbursement for IFT as well as the required level of providers and equipment.

Let's face it, most routine IFT really is nothing more than a really overpriced taxi. Nowhere in EMS education outside of critical care transport is there focus on it.

Other than spending the trip taking 2 sets of completely unnecessary vitals that will change nothing in the patient management at destination, and figuring out how to fill out the paperwork so it gets automatically paid, what special skills or medical training/equipment is really required?

A stretcher and 2 guys to lift it?

Oxygen that the same patients manage on their own?

looks like a prime place to be cut to me.

I would guess that fully 50% of the transfers I do could have been dealt with other ways. Hospitals calling us because they don't want to wait for the WC van, only the Medicaid WC van running at night (which they still don't call). SNFs sending out palliative care patients with fevers (who then also have to be sent back by amb). I could go on.

Something I always ask myself when looking at transfer paperwork is "How does this patient normally travel?". Way too often the answer is WC van or as a passenger in a private vehicle.

To combine my last post with this one, we had a lady at the dialysis clinic who was normally AOx2 due to a stroke, she broke her hip and went on to have at least one more stroke while in the hospital from that. When she came back she was AOx1 and nearly completely aphasic. She almost needed 1:1 attention to keep her from pulling her needles. She was being sent back and forth via WC van. The little old lady who can't remember if it is the 24th or the 25th does NOT need "medical supervision" for her dementia.

There are so many places they could save money if they made the system more efficient and cut down on the insane amounts of unnecessary transports being done.


Edit: Also to combine my last post and this one, if it hasn't happened already, when are we going to start putting dialysis units in SNFs? Less transports, the patients could receive longer dialysis treatments, better continuity of care, less trauma to the patients etc.

 

[Shishkabob]

Correction noted, Aidey. I had just quickly looked up what Medicare reimbursed a while back and guess I got the wrong source


There was SO much that this past healthcare "reform" could have done to actually fix the problems instead of just making more people pay for said waste, yet obviously the people we have making policy can't even tie their own damn shoes correctly, let alone use brain cells to solve a problem.

Here's a hint: Ask the people who work in healthcare everyday what needs to be changed, not some pencil pusher who hasn't seen a patient in 30 years.

 

[Aidey]

Part of the goals of the reform are cutting waste, but I agree that they need to ask the people currently working in healthcare.

That may be what Medicare reimburses for one specific aspect of the treatment. Like I said, the different costs add up quick. There are the staff costs for the techs, nurses, dietitian and others; medication costs*, labs done twice a month minimum, heparin, tubing, needles, dialyzers, saline**, gloves***, biohazard waste****, disinfectants, the dialysate solutions. So Medicare might reimburse $100 for the treatment, but all the stuff needed for the treatment is another $1900.

* Look up the cost of one dose of Epogen - holy crap.
** Yes, saline is cheap, but my 32 chair clinic went through a couple cases day.
*** About one box per tech, per 12 hour shift.
**** Another thing that adds up REALLY fast.

 

[Veneficus]

Alternatively, I would be interested to see how much peritoneal dialysis costs compared to dialysis. This study ended up looking at 100 patients (50 HD matched to 50 PD) and found that PD was a little over 40k cheaper on average. Granted, not all HD patients are eligible for PD, but it would be interesting to see what could be done, especially if a system can be found for PD to be done with continuously cycling throughout the day instead of the current 3-5 cycling sessions.

There was a study done in Britian that shows there is no change in outcome between peritoneal and hemodialysis however there was tremendous cost savings, I will try to look it up later for you, on a quick break at hospital.

 

[Veneficus]

Correction noted, Aidey. I had just quickly looked up what Medicare reimbursed a while back and guess I got the wrong source


There was SO much that this past healthcare "reform" could have done to actually fix the problems instead of just making more people pay for said waste, yet obviously the people we have making policy can't even tie their own damn shoes correctly, let alone use brain cells to solve a problem.

Here's a hint: Ask the people who work in healthcare everyday what needs to be changed, not some pencil pusher who hasn't seen a patient in 30 years.

THe problem isn't not knowing what needs to be done, the problem is not having the guts to do it.

If you are a politician with stocks invested in a pharm company, it hurts you to reduce pharm costs.

If you are a medical university, you don't want to hear that student loans won't be available to fund your outrageous tuition.

If you are a doctor, you don't want to hear you are not making enough to pay the $1400 a month school loan you got.

If you are a specialist you don't want to hear they are doubling residency spots meaning the wait list to see you goes down and you can't demand outrageous sums of money for only being able to perform an extremely limited medical practice and sending the patients to 10 other doctors none of whom commnicate.

the list goes on.

 

[8jimi8]

There was a study done in Britian that shows there is no change in outcome between peritoneal and hemodialysis however there was tremendous cost savings, I will try to look it up later for you, on a quick break at hospital.

My experience is biased by a year of working out our level 1 county hospital. If you look at people that I've served that required hemodialysis, the vast majority of those are complications non-compliance and /or other bad habits. You cannot tell people who skip dialysis to go drinking that they need to be managing a peritoneal dialysis rig several times a day. This is the same for home hemodialysis. These are management routines for only the most conscientious and compliant of patients.

 

[usalsfyre]

My experience is biased by a year of working out our level 1 county hospital. If you look at people that I've served that required hemodialysis, the vast majority of those are complications non-compliance and /or other bad habits. You cannot tell people who skip dialysis to go drinking that they need to be managing a peritoneal dialysis rig several times a day. This is the same for home hemodialysis. These are management routines for only the most conscientious and compliant of patients.

Quite frankly, these folks need to take responsibility for their health, or they will die. We can give people the tools to take care of themselves, and if they don't, tough feces....

What would happen to the hemodyalisis industry however, I do not know.

 

[Minnick27]

Another thing you have to think of is that not all patients are able to do peritoneal dialysis. There needs to be enough room for them to be able to infuse the fluid every day. And the previous poster is correct about cost, it costs alot of money to do a dialysis treatment. And you have to have a nurse present. You could do what they do in hospitals and bring a portable machine in the room, but then you can only do one at a time. I've never been into a nh that has the room to build a dedicated area along with a water system which takes up alot of room

 

[Aerin-Sol]

Vast majority of BLS IFT needs to be gotten rid of, plain and simple. The only BLS IFTs I can see as legit are the paralyzed / comatose, psychiatric, MAYBE the overweight. Pretty much every other transfer should be ALS in nature.

I'd also throw in some post-orthopedic surgery patients, but yeah, most BLS transfers are people really need a wheelchair van or a regular taxi. Why is it that they get sent on ambulances? Does medicare not pay for wheelchair vans?