Greatest Contributor to Burnout in EMS

[FourLoko]

Biggest pet peeve ever! During my medic ride along time I worked with a company where the majority of the medics would complain complain complain if they had 3 or 4 calls in a 12 hour shift. We'd sit and watch tv all night then maybe get a call and the whole way there would be "darn it all I won't know what happened at the end of the show!"

Once, after a call the two of them were chatting it up with people at the hospital (probably been there 20 minutes after dropping off a pt) when we were dispatched to a multi MVC with roll over at like 4am. They never copied the call, dispatch called us again, I went into the ER to try and find them and couldn't, finally on the third call from dispatch they appeared and we got going. People with piss poor work ethic really annoy me.

We only work 10s and average 6 calls a day. You can think about how long calls take where you are and do the math. In three work days I might get one lunch break that might be 30 min if I'm lucky.

I didn't blame the dispatchers because I know they're under pressure from the owner who likes to show up too often. Then again I'm sure they can learn to say "No, I'm sorry we don't have a crew this time."

Sorry you only made 5 Million this year Mr. Owner guy, I can't even afford rent.

 

[ATrain]

It's true. I've worked for places where many of the employees were constantly putting the place down, acting like working there was beneath them, or were just apathetic to the whole situation. As a new person, seeing the average employee act that way, I lose respect for the organization and begin looking for another place to work.

You just hit the nail on the head as to why I ended up quitting the first place I worked, and much more eloquently than I could have phrased it.

Both of my medic partners that I'd had during the home stretch of my employment there were just miserable, hateful people. They never had anything good to say about work, and it's like making a run was a chore.

It really starts to wear on you when, for 36+ hours a week you're stuck in a truck with someone who is so negative.

 

[Basermedic159]

I don't understand why our pay is so crappy. We are basically pre hospital ER docs. The only difference is we dont write prescriptions. I have seen many Paramedics smarter than the doctors we transfer our care to.

 

[systemet]

I don't understand why our pay is so crappy. We are basically pre hospital ER docs. The only difference is we dont write prescriptions. I have seen many Paramedics smarter than the doctors we transfer our care to.

EM physician : 4 year undergraduate degree, 4 year MD program, 5 year fellowship.

Paramedic : 6 month EMT program, 2 year paramedic diploma.

 

[abckidsmom]

I don't understand why our pay is so crappy. We are basically pre hospital ER docs. The only difference is we dont write prescriptions. I have seen many Paramedics smarter than the doctors we transfer our care to.

I would venture that this thought process is another reason to add to the list o factors that contribute to burnout in EMS. Paramedics as a class have a really high self esteem and view of what our role actually is.

Experienced, thinking medics are really valuable resources, but they are not the same as er physicians. We function as the physician's eyes, ears and hands in the field, but by design, we are extremely limited in what we can do, the areas in which we are educated, and the impact we can have in our roles.

I get a lot of satisfaction out of sleuthing out a good diagnosis, but I don't consider it certain a lot of times without confirmation. Like with the ABG discussion in the CPAP thread, without he diagnostic testing in the hospital, some things ate just shots in the dark.

Challenges our assessment skills, but keeps us humble, if we're smart.

Anyway, my two cents is that ego is a big contributor to burnout.

 

[firecoins]

I will contribute a little about what burns me out.

I was working at a crappy transport company. While loading a vent patient into the rig, a supervisor certified as an EMT-B wrote me up for not wearing a company issed tie. I was never issued a company issued tie but that was not important. The fact that I was loading a vented patient into a rig was not important. The fact is this could have been handled when I came into work not wearing the said tie when I sign out my equipment from an office with supervisors in it. They could have given me a tie and written me up when a patient was not at risk. :glare: Event like this make me speak negative about the company which I see people here have complained about.

We as medics are not ER docs but considerings some of the stupid things non ER docs have done makes me believe I should go to med school. (those non ER docs are indeed bright people just not very good at EM) I like my ER docs and get along with them very well. I guess I am a bit biased.

 

[RocketMedic]

I had an EMT-I supervisor lecture me that it was unacceptable that I didn't drop two 14s into a patient with a humorus fracture, nor did I use narcs. Completely ignored tat the patient was two and that the splint+icepack worked perfectly.

"For trauma, 18s are unacceptable" = low pay.

 

[46Young]

I don't understand why our pay is so crappy. We are basically pre hospital ER docs. The only difference is we dont write prescriptions. I have seen many Paramedics smarter than the doctors we transfer our care to.

http://sandmansprogress.blogspot.com/2006/07/rise-of-noctor.html

Ever heard of the term "noctor?"

 

[the_negro_puppy]

I had an EMT-I supervisor lecture me that it was unacceptable that I didn't drop two 14s into a patient with a humorus fracture, nor did I use narcs. Completely ignored tat the patient was two and that the splint+icepack worked perfectly.

"For trauma, 18s are unacceptable" = low pay.

 

[Tigger]

I don't understand why our pay is so crappy. We are basically pre hospital ER docs. The only difference is we dont write prescriptions. I have seen many Paramedics smarter than the doctors we transfer our care to.

Skills do not necessarily equate to knowledge, as others have pointed out.

 

[Melclin]

Neggro....I know what you mean. I've been working for a year and I can feel the seeds of burn out growing in me.

Things that contribute to my future Falling down style massacre of people that grind my gears:

1. Ramping. I found it soul destroying working in the city when you would spend 3 hrs waiting with a pt on stretcher and know full well that because every other ambulance was waiting behind you in line, when you clear you instantly pick up one of the many waiting BS jobs waiting for ambulances, and join the back of the line you left 45 mins ago. Especially at 4am. Sometimes you'd be lucky and get a pt sick enough to go straight through or well enough to put in the waiting room, but mostly not.

2. Fatigue. The roster structure we have at the moment is simply not sustainable. Its difficult at best and murderous at worst.

3. A lack of high acuity work. Now, no one expects to have every job be super involved and interesting. None the less, I find it very frustrating debriefing after a big job and looking at what I could have done better and thinking, yep in 3yrs when I do another job like it, I'll try and remember to do x better.

4. Politics. I don't think I need to explain this one.

 

[MediMike]

I don't understand why our pay is so crappy. We are basically pre hospital ER docs. The only difference is we dont write prescriptions. I have seen many Paramedics smarter than the doctors we transfer our care to.

I've been gone for a long time, so I don't know if we've got people trolling on here now, but this comment is absolutely retarded. (Poor adjective I know, but whatever)

We are so incredibly far removed from being doctors that it's not even funny. Not even an urgent care PA. Hell, an MA can probably tell you the proper ABx to prescribe for various infections better than many on here.

Skills wise we are a combination of an ICU RN with standing orders and a doc in regards to RSI/Intubation. That's about it. I will agree that depending on which system you work in, there is some degree of "practicing medicine", but its not common in the U.S.

I'm curious to know how you can qualify yourself or your buddies as "smarter than the doctors" you transfer care to.

 

[Handsome Robb]

I don't understand why our pay is so crappy. We are basically pre hospital ER docs. The only difference is we dont write prescriptions. I have seen many Paramedics smarter than the doctors we transfer our care to.

Wait really? If these medics are so much smarter why do they settle for crappy pay and long work hours rather than going to med school and getting better hours (for the most part) with exorbitantly better pay.

Yea we can do some skills that are exclusive to MDs and certain mid-level providers in certain circumstances but that in no way shape or form makes us "prehospital ER docs."

Lack of education and oversaturation of qualified employees are two reasons for "crappy pay", among other things.

If you get a job offer and don't take it because of the salary it's no skin off their back, there are probably 100 more people behind you that will gladly accept it.

 

[the_negro_puppy]

Neggro....I know what you mean. I've been working for a year and I can feel the seeds of burn out growing in me.

Things that contribute to my future Falling down style massacre of people that grind my gears:

1. Ramping. I found it soul destroying working in the city when you would spend 3 hrs waiting with a pt on stretcher and know full well that because every other ambulance was waiting behind you in line, when you clear you instantly pick up one of the many waiting BS jobs waiting for ambulances, and join the back of the line you left 45 mins ago. Especially at 4am. Sometimes you'd be lucky and get a pt sick enough to go straight through or well enough to put in the waiting room, but mostly not.

2. Fatigue. The roster structure we have at the moment is simply not sustainable. Its difficult at best and murderous at worst.

3. A lack of high acuity work. Now, no one expects to have every job be super involved and interesting. None the less, I find it very frustrating debriefing after a big job and looking at what I could have done better and thinking, yep in 3yrs when I do another job like it, I'll try and remember to do x better.

4. Politics. I don't think I need to explain this one.

I feel your pain Broseph. I find that the intensity for burnout is directly proportional to time from your last holidays. Thankfully im about to go on 2 weeks annual, been nearly 8 months since last hols. Ramping is the most soul destroying for me.

 

[bw2529]

For myself, as a relatively new volunteer, I consider the abuse of the EMS system as well as the incorrect prioritization of calls my biggest complaints.

 

[MediMike]

Ahhh the abuse of the EMS system...yeah it sucks, but face it, we, along with the ED are the new gateway to primary care. It's one of those things that people are just going to have to get on board with, hell use it as part of the effort to increase education for EMS so we can do nice neat non-transports with a decreased litigation rate/danger.

Wake County rocks their APP's, think it's a great model for suggesting alternative transport destinations, we can do this people!

 

[46Young]

Ahhh the abuse of the EMS system...yeah it sucks, but face it, we, along with the ED are the new gateway to primary care. It's one of those things that people are just going to have to get on board with, hell use it as part of the effort to increase education for EMS so we can do nice neat non-transports with a decreased litigation rate/danger.

Wake County rocks their APP's, think it's a great model for suggesting alternative transport destinations, we can do this people!

A few Chiefs at my department were looking at the APP program, but there's a problem. They fail to see how it's financially beneficial to not transport as many people who use 911 as they can. The hospitals are not interested either, since the vast majority of the county's residents have commercial insurance, and there are relatively few that are uninsured or on Medicaid. So, the hospitals make out by taking in everyone that wants to use the ED, and run the whole battery of CYA tests to boost their revenue.

So, both the hospitals and the county's 911 service stand to lose revenue by directing patients to destinations other than 911 receiving hospitals. They fail to see the financial incentive. Sure, the healthcare system in general saves money, but the county and the hospitals aren't getting any of the benefit.

Edit: If the residents were relatively poor, with a large percentage either uninsured or on Medicaid, it would be a different story altogether.

 

[MediMike]

I feel ya buddy. We've hit the same issues over here. The ED docs are all considered contractors who are paid on a production basis, so there isn't a chance in hell of it getting off the ground. I'd feel morally deficient if I didn't at least make an effort.

It always comes down to turning a profit rather than fixing the broken system

 

[MasterIntubator]

My source of burnout = upper management.

Otherwise, the hours, the pay, the late night "my knee hurts now" calls, etc... are all what makes me smile and enjoy my job. I would not change a thing on the provider side. Well... maybe the pay. Would be nice to be financially comfortable and no bills.

 

[Basermedic159]

Wait really? If these medics are so much smarter why do they settle for crappy pay and long work hours rather than going to med school and getting better hours (for the most part) with exorbitantly better pay.

Yea we can do some skills that are exclusive to MDs and certain mid-level providers in certain circumstances but that in no way shape or form makes us "prehospital ER docs."

Lack of education and oversaturation of qualified employees are two reasons for "crappy pay", among other things.

If you get a job offer and don't take it because of the salary it's no skin off their back, there are probably 100 more people behind you that will gladly accept it.

Everyone dosn't have the money to just pick up and go to med school...