EMT #1 Surprising Minimum-Wage Job

[VentMedic]

While I agree that more education should lead to higher salaries, I remind you there are plenty of doctors, lawyers, and other highly educated professionals out there not making all that much more than Joe Paramedic, who has two years, maybe, of post-secondary education, as opposed to seven or eight or more years.

But, they do have a choice. A lawyer could choose to work for a law firm representing wealthy drug dealers and make serious money or they could work for a nonprofit. Paramedics rarely have that choice. Even with just a two year degree many are limited in their choices in a lot of professions and not just health care. It doesn't have to be about the money but rather about the opportunities. Why do you think most of us start planning at an early age to see that our kids get at least a 4 year college education?

People who work in education are also a great example. The Masters degree is highly sort after even when some know their salary may not increase significantly. However, if the opportunity arises for a job in some other area of education, they are prepared as well as having the satisfaction of being better prepared to teach in their current position. What amazes me is there are many Paramedics who still don't understand how a college level A&P or pharmacology class could benefit them. Some would rather just believe "lido numbs the heart" and "CPAP pushes lung water" as there can't possibly be any more than that to it.

The education scheme in healthcare doesn't make all that much sense sometimes. You need a master's degree to be an athletic trainer, and an associate's degree (maybe, if your state doesn't still have diploma schools) to be a nurse. Although maybe nursing is an outlier, because the shortage has kept the base credential from going to BSN, at least in my state, despite the fact that NY went to BSN-required almost twenty years ago, IIRC. Heck, my local community college has a five-year waiting list for ASN programs - in that time, you could go undergrad and be most of the way to an MSN.

The higher education has allowed Athletic Trainers to expand their opportunities for employment when inturn gave them a chance to earn more and be more mobile.

Even though the states have not made the BSN the standard for minimum education, that doesn't mean employers can't. In fact, the way many of the health professions started advancing was due to employers requiring higher education for entry since they realized there was a need for more than just a grad from a tech school mill. For some professions, like Respirartory Therapy, well over 3/4 of those in the profession had a two year degree long before it became the standard.

Nursing is now becoming very competitive. Employers are looking not only at your years of education but also where you obtained it. Mail-order RNs from places like Excelsior are rarely at the time of the line for a decent job regardless of whether you state allows them to be licensed or not. Their clinical experience is shoddy at best even when they do take the additional hours.

Anyway, the point of all this is - more education for prehospital care providers is a good thing. Higher salaries are also a good thing. Merely increasing the educational requirements may not necessarily lead to higher salaries, however.

Again, have you not seen what higher education has done for the other health care professions? Do you understand what it means to petition the insurances for reimbursement based on patient benefit?

I personally like the advancement and reimbursement model Physical Therapy has created within their prefession. Even RNs are envious of the wages and perks this group is commanding largely due to their expertise with the reimbursement legislation. I also said "commanding" and not "demanding". This has NOTHING to do with unions which in fact many professional health care providers are rarely part of as it hampers their own upward mobility in a rapidly advancing field of medicine.

OT, SLP, and RT are other professions that must take an active look at the business model to gain reimbursement and make their fields worthy of notice. If you don't have a quality product (educated people) to see the insurances, don't expect them to recognize the service you provide as "professional" and with that reimbursment scale. RT is also petitioning for another level of reimbursement in another area outside of the hospital world for those with a Bachelors or Masters degree.

Also when professional associations (again NOT unions) support each other, their effect is felt when it comes to legislation within the insurance world. NPs and PAs are excellent examples as they found the opportunities could be plentiful if they worked together on certain issues rather than against each other as in the past with a few turf wars. Now, if you read on their websites what they have accomplished, you would be amazed as they are moving forward to help with ED overcrowding. They, as other healthcare professions (RT, nursing, PT, OT etc) have also been careful to choose their wording as "what we can do for patient care". Unfortunately, the tone with those in EMS (and the FD) it has been what the people and patients should be doing for us. EMS has not changed much for education minimums in 40 years and yet they still believe they are worth more while some are offering even less care to the patient than what was offered 40 years ago.

 

[EMSLaw]

VentMedic, thank you for an interesting post. I agree with basically all of what you've said.

The education minimums for EMS should go up. But not because of higher pay, or at least not solely for that reason. They should go up because that's what better patient care requires. Otherwise, we might as well go back to the days of sending an ambulance attendant and MD intern out in a cadillac ambulance, or calling the local funeral home to do transports.

Medicine as a whole seems to have gotten away from the tech school approach and towards higher levels of academic training. Respiratory therapists, nurses, and a lot of other patient care providers have moved from diploma training or on-the-job experience to an Associates Degree or more. Maybe we should be looking for the day when an Associate's Degree in Paramedicine is the entry-level EMS credential. But to do that, and get the higher pay and greater respect that EMS professionals seek, you'd need to be able to point to specific ways in which patient care is improved by having a more educated pre-hospital provider.

 

[DV_EMT]

That little loophole was closed in 2005, and now becoming a pharm tech requires a degree or completion of a pharm tech program.

Actually... that's incorrect. your thinking of the grandfather clause... yes its been done away with. I received my pharm tech licence in 2007. All it requires is a HS diploma (or GED) and passing the PTCB exam.. followed by a background check and payment to the state. Thats how i got mine

There are some ways to get a Pharm Tech in the state of CA that say you have to complete the course... however it is not mandatory that you take a ACPE course.

 

[46Young]

Vent, it's about time someone spoke about how the different healthcare professions actually further the profession and it's compensation after raising the bar on education. I've asked RidRyder and others several times here how they expect higher educational standards to change slaries, benefits, scope, etc without organization (not necessarily unions, I understand what you're saying). I've received no response until now.

So, how would you recommend EMS as a profession work to further the field and it's ensuing compensation after raising the educational requirements? What should we all be doing to help?

 

[Aerin-Sol]

Nursing does have a low-education position: Certified Nursing Assistant. They take a course that's even shorter than an EMT class.

I'm not an EMT professional and I haven't even started the class so my opinion may not be worth much, but I currently like the way the career is handled. I am glad that there is a relatively short, basic course that I can take to get an entry-level job. If I want to make a decent amount of money in the field, I'll become a paramedic or a flight nurse, positions that *do* require more education. It seems to me that that's the expectation of employeers as well. Why would someone who wants pre-hospital care to be their career just stay at the EMT-B level?

 

[VentMedic]

Nursing does have a low-education position: Certified Nursing Assistant. They take a course that's even shorter than an EMT class.

Actually some states require many more hours than an EMT. In addition, their foundation makes them very flexible within a hospital system to add skills or to be used in many different areas.

Also, do you know how their worth is figured into the budget of a healthcare system? Healthcare is a very complex business. Once can not just say "I can take a BP" and expect the various insurances and funding sources to throw money at them.

I'm not an EMT professional and I haven't even started the class so my opinion may not be worth much, but I currently like the way the career is handled. I am glad that there is a relatively short, basic course that I can take to get an entry-level job. If I want to make a decent amount of money in the field, I'll become a paramedic or a flight nurse, positions that *do* require more education. It seems to me that that's the expectation of employeers as well. Why would someone who wants pre-hospital care to be their career just stay at the EMT-B level?

That is not always true especially for the Paramedic. Often, like in the state of CA, as well as others, the RN is there for the complex patients and usually that position does require more experience and education. However, for the Paramedic you may find the ads still say
*High School diploma or equivalent
*Paramedic Cert or license for that state
*ACLS with PALS recommended
*2 to 3 years of experience

As well, some Flight companies often little more than a faster trip to a hospital.

But you are correct it is usually left to the employer to make the requirements.

Florida has also changed the wording in the statutes for some of its transport agency, medical director and personnel requirements. It will now want the receiving hospital of higher care to determine the appropriate level of transport for certain populations such as infants and babies. It will no longer let the EMS agency just say "We'll get them there by a real fast ride with inadequate staffing." Too many have taken patients they had no business touching.

So, how would you recommend EMS as a profession work to further the field and it's ensuing compensation after raising the educational requirements? What should we all be doing to help?

Since you are a union person this might be difficult to discuss with you. Unions do NOT promote a profession. A good insurance plan might provide peace of mind but it doesn't do much for you as a profesional Paramedic. My father was union while working the mines and had great insurance/paid etc but most of his co-workers barely had an eighth grade education. (Although I will say their first-aid education was by far superior to anything in the EMT-B courses today and it was just part of the job.)

It is the professional associations that have rallied for better professional recognition and reimbursement. They are also the ones who provide the data to hospitals when RTs, PTs and SLPs want a raise. Those unlucky enough to be covered by a union must wait for the contract to renegotiate. If RTs get their desired bills for higher education and reimbursement passed tomorrow, they will start working on implementing it instead of waiting 3 years for another contract to add an additional level.

Examples:

RT
http://www.aarc.org/

Advocacy
http://www.aarc.org/advocacy/

PT
http://www.apta.org//AM/Template.cfm?Section=Home

Advocacy
http://www.apta.org/AM/Template.cfm...ggedPageDisplay.cfm&TPLID=181&ContentID=57962

http://www.apta.org/AM/Template.cfm...aggedPageDisplay.cfm&TPLID=57&ContentID=12727

NP

http://www.aanp.org/AANPCMS2

PA

http://www.aapa.org/

OT

http://www.aota.org/

Radiology
https://www.asrt.org/

The things that all of these associations have in common:

* Their membership is promoted from the beginning of education by a student membership either included in tuition or offered at the dicount price.

* Employers may also offer membership as a "perk" or expect one the have it.

* Each state has a chapter and often with local chapters.

* People are members regardless of their union status and they do NOT mix up what each can do and what the association can do when it comes to worth or value.

* Hospitals take pride in sponsoring someone to run for a position within the association at whatever level.

* Gives opportunities for research to be presented with grants available.

* The research can also be used to show proof of worth when it comes to reimbursement. "See, what we do works".


I was a Paramedic long before I became as RT. During the 1970s Florida was a leader in 2 year college programs for the Paramedic and they were encouraged even by the FDs. Nursing was a late bloomer and was just getting around to establishing the 2 year degree and telling the diploma programs to join forces with a college for some classes. At that time it was actually thought that the Paramedic would become a leader and example amongst the health care professions. RT was still OJT or a 1 year cert program. Radiology Technicians were sailing in the same boat as Respiratory. PT was just solidifying their Bachelors programs and looking towards a Masters in the future. SLP was still and infant. But along came this profession that has gotten a boost from a TV show and was the pearl of everyone's eyes including the public.

But, along came greed and since the education foundation was not fully laid out, medic mills sprung up in the FDs and ambulance services. Everyone wanted to become part of this cool profession and FDs/ambulance owners saw they could capitalize on an abundance of labor with ease of entry. It was also when the 3 month medic grads came about who had little interest in medicine that the Paramedics like myself with a degree starting looking where we could grow as medical professionals.

I also find the thread "how many have done this" rather amusing as the early Paramedics (includes Rid, myself and a few others here) did a lot more invasive procedures and were considered good at them or were at least well prepared by our education and training. There was also a different relationship with trust from the medical directors at that time. Now it seems the attitude is "here's some generic protocols and try not to kill anyone". The other thing about better educated Paramedics and other professionals is that when an "advanced skill" or some medication is no longer advocated because of evidence based findings, they don't whine "they took away our MAST" and consider it a punishment. They look at what is in the literature that works better.

Watching other professions that have only been licensed for 20 years or less just sprint past the Paramedic has been disheartening. But, they learned from the mistakes nursing made and when they were challenged by nursing, they enlisted them as partners in healthcare rather than the enemy. When you only have a few thousand members and they have probably a million, you form a better plan of action.

 

[Aerin-Sol]

Actually some states require many more hours than an EMT. In addition, their foundation makes them very flexible within a hospital system to add skills or to be used in many different areas.

Oh, sorry. I was just thinking of my state.

Also, do you know how their worth is figured into the budget of a healthcare system? Healthcare is a very complex business. Once can not just say "I can take a BP" and expect the various insurances and funding sources to throw money at them.

I'm not sure what you mean by this. Are you saying that CNAs are valued more than EMS personnel?

That is not always true especially for the Paramedic. Often, like in the state of CA, as well as others, the RN is there for the complex patients and usually that position does require more experience and education. However, for the Paramedic you may find the ads still say
*High School diploma or equivalent
*Paramedic Cert or license for that state
*ACLS with PALS recommended
*2 to 3 years of experience

Yeah, but don't you need to go to several hundred hours of class to get a paramedic license?

 

[JPINFV]

In the grand scheme of things, 'several hundred hours' really isn't all that amount of time.

 

[VentMedic]

I'm not sure what you mean by this. Are you saying that CNAs are valued more than EMS personnel?

When you compare what the EMT and the CNA each bring to patient care, the CNA could actually have more patient benefit in a broader sense and they also see more patients per shift than some EMTs seen in one or two months. CNAs also do many of the "skills" that EMTs do as well as having the opportunity to do more. If one just looked at some of the services provided in the back of a truck by EMTs, insurances might wonder why they are even reimbursing the ambulance service as much as they do. The serivces of the CNA and other ancillary staff that don't get direct professional reimbursement is calculated based on total care and needs is covered by the charges for that unit or service. This is similar to how some ambulances are also reimbursed when there is not a specific professional fee attached. Specialty services are the exception.

Yeah, but don't you need to go to several hundred hours of class to get a paramedic license?

This is the problem. Paramedic education is measured in hours rather than college credit and degrees. Several hundred or even a 1000 hours is not much considering nursing and RT may get that many hours or more in just their clinicals. PTs do post graduate internships with 1000s of hours.

 

[subliminal1284]

Again the excuse that there are just so many EMT's as the reason why wages are so low falls apart. Yeah no one may WANT the janitor job or the garbage man job but with the way things are right now with a high unemployment rate there are hundreds if not thousands of people who would be more than happy to work either one of those jobs just to have a job. Yet the wages for those jobs have not lowered.

 

[Aerin-Sol]

When you compare what the EMT and the CNA each bring to patient care, the CNA could actually have more patient benefit in a broader sense and they also see more patients per shift than some EMTs seen in one or two months. CNAs also do many of the "skills" that EMTs do as well as having the opportunity to do more. If one just looked at some of the services provided in the back of a truck by EMTs, insurances might wonder why they are even reimbursing the ambulance service as much as they do. The serivces of the CNA and other ancillary staff that don't get direct professional reimbursement is calculated based on total care and needs is covered by the charges for that unit or service. This is similar to how some ambulances are also reimbursed when there is not a specific professional fee attached. Specialty services are the exception.

Hmm. I was going to sign up for CNA classes but everyone on the student doctor forums derided it as "wiping old people's butts" and said EMT would be more interesting.

This is the problem. Paramedic education is measured in hours rather than college credit and degrees. Several hundred or even a 1000 hours is not much considering nursing and RT may get that many hours or more in just their clinicals. PTs do post graduate internships with 1000s of hours.

I see what you're saying there.

 

[VentMedic]

Hmm. I was going to sign up for CNA classes but everyone on the student doctor forums derided it as "wiping old people's butts" and said EMT would be more interesting.

CNAs definitely have their worth and those who make remarks such as that really have NO comprehension of patient care.

You do realize that many of those on the "student doctor" forums are EMTs who believe they are now in medical school even though they haven't enrolled in college yet?


Healthcare is a business. College classes in a well designed degree program also help the students to see this. Healthcare is a very competitive business. Each profession must be flexible to fill new roles as medicine is constantly changing. The care the CNA gives if fundamental to any patient setting. They also have had to become very flexible as budget issues have placed them in various expanded duty roles or have moved them from one areas to another as reimbursement for services change. This is also why healthcare professions constantly monitor insurance and healthcare reform so they can assume or even let go of a few tradtionan "skills" or roles to assume others. Sometimes, the CNA may even be asked to take up the slack.

Now, the EMT hasn't changed too much in 40 years. In fact their statutes were written to where they lack in flexibility. The same for the Paramedic. For this reason hospitals change the titles to ER Tech so that they can expand the roles of the EMT to suit the purpose if needed.

Organizations, such as the FD, have taken on EMS with only a limited interest in expanding what most already deem to be "adequate" to get a patient to the hospital. In the 1960s that was okay but even at that, the systems first established in the FDs such as Miami were very different where intent of patient care was concerned when compared to a system like the Freedom House Ambulance Service.

 

[Sasha]

Hmm. I was going to sign up for CNA classes but everyone on the student doctor forums derided it as "wiping old people's butts" and said EMT would be more interesting.

I really hate reading stuff like this. "Wiping old people's butts" is part of the job, and no one is above doing that. I hate when people treat it with such contempt. I don't look forward to changing diapers (And yes, as an EMT I have changed diapers with a nurse or a CNA to help get the patient ready for transport.) but I don't bat an eyelash at it either. It's part of the job. It might even be you some day that requires changing.

 

[Aerin-Sol]

I really hate reading stuff like this. "Wiping old people's butts" is part of the job, and no one is above doing that. I hate when people treat it with such contempt. I don't look forward to changing diapers (And yes, as an EMT I have changed diapers with a nurse or a CNA to help get the patient ready for transport.) but I don't bat an eyelash at it either. It's part of the job. It might even be you some day that requires changing.

I hope that was directed at the posters who said that and not at me specifically. =)

I don't have a problem with doing "gross" things but if *all* I am doing is changing dirty sheets and cleaning up body fluids (which is how those forums characterized it) I don't think that would help me as much as the things that EMTs do.

 

[VentMedic]

I hope that was directed at the posters who said that and not at me specifically. =)

I don't have a problem with doing "gross" things but if *all* I am doing is changing dirty sheets and cleaning up body fluids (which is how those forums characterized it) I don't think that would help me as much as the things that EMTs do.

Do you even know what a CNA does or is capable of doing? Do you know how much patient contact they get on a daily basis?

Now, do you know what an EMT does or doesn't do even when they do work for a 911 EMS company?

 

[Sasha]

I hope that was directed at the posters who said that and not at me specifically. =)

I don't have a problem with doing "gross" things but if *all* I am doing is changing dirty sheets and cleaning up body fluids (which is how those forums characterized it) I don't think that would help me as much as the things that EMTs do.

It would help you more than driving an ambulance would.

 

[JPINFV]

If you visit SDN, my advice is don't spend too much time in Pre-Allo.

 

[Aerin-Sol]

Do you even know what a CNA does or is capable of doing? Do you know how much patient contact they get on a daily basis?

Now, do you know what an EMT does or doesn't do even when they do work for a 911 EMS company?

Yep, I looked up all of the low level (CNA, EMT-B, Phlebotomy, EKG tech) health care jobs.

I don't want to work for a 911 company; I want to be an ER Tech.

 

[Sasha]

Yep, I looked up all of the low level (CNA, EMT-B, Phlebotomy, EKG tech) health care jobs.

I don't want to work for a 911 company; I want to be an ER Tech.

A CNA cert will better prepare you to become an ER tech than being an EMT would, also it would be easier for you to find a job as a CNA in an ER than an EMT.

 

[Aerin-Sol]

A CNA cert will better prepare you to become an ER tech than being an EMT would, also it would be easier for you to find a job as a CNA in an ER than an EMT.

Most of the info I saw said that either EMT-B is preferred or having both is preferred and that CNAs are not wanted in the ER.

And I don't really want to work as a CNA. I think EMT work would at least be interesting. If not, I'm only out $450 and a bunch of Saturdays I would have just spent paying videogames.