How much should EMS make?

[Bullets]

I know that pay is a hot topic in EMS, and i see people comment on Facebook job postings all the time "I aint working for $XX/hr"

So what is a realistic expectation for hourly pay in EMS? EMTs bring a 140ish hour technical cert and no HS requirement to the table. ALS may or may not have an Associates Degree.

The comparison seems to be in vs out of hospital staff, but our EMTs and ER techs are generally around the same wage. ALS does usually make less than an RN but RNs need a bachelors degree.

 

[DesertMedic66]

One hundred trillion million dollars.

In reality you can’t really set a single amount. $11 an hour is considered low in my area and is pretty much impossible to live on but in another area you might be able to live ok off of $11/hr.

For my area I would like to see EMTs at $20/hr starting and medics at $30/hr starting.

$20/hr in my system will be yearly of around 51k and $30/hr is 76k. It is slightly less than nursing but nurses here are all BSNs.

 

[NysEms2117]

This is a good question, I have a counter-proposal. Lets say we're talking about a "minimally educated" EMT- High school education, no college. Having just recently made a career change to technology, I have people under my management that are making well over 100k with a high school diploma and that's it. I am not saying they should be equal, but I do believe pay should be raised. Part of the big question is, for whom are we talking about? You will probably not be able to change pay by a county or city run EMS system by that much, because the budget is the budget. I think if there was some uniformity in EMS that would help with the wages argument. EMT's for where I was in New York (Albany) were 15-17, and could live a moderate lifestyle. Medics were 23-25, Firefighter medics were 25-27 if I remember properly. I feel that for 60-70% of America, those are acceptable living wages(excluding places like NYC, LA, ect ect.). I'm a firm believer in Education is an investment, so I Personally feel that a paramedic with a high school education should have a salary grade of 1. A.A.S is 2, B.S 3, and so on. In saying that I also feel that ALL employers should offer some educational incentives.

 

[DrParasite]

I know that pay is a hot topic in EMS, and i see people comment on Facebook job postings all the time "I aint working for $XX/hr"

It's a fair statement; I will be totally honest, I don't get out of bed for job that pays me less than $12 an hour, either full time or part time.

So what is a realistic expectation for hourly pay in EMS? EMTs bring a 140ish hour technical cert and no HS requirement to the table. ALS may or may not have an Associates Degree.

there are so many different factors, with the most important one being supply and demand. Because the 18 year old EMT who gets to run 911 calls, and accepts $9 an hour, is hurting his entire profession, and makes it harder for me to ask for more money.

I get recruiters who contact me daily about jobs..... if I'm interested in the position, I asked two questions: whose the end client, and how much is the salary. if I don't like either answer, I tell them, so I don't waste my time or their time. how many EMS agencies won't post their salary rates in job postings? have you ever known people to interview for a job, or even accept a job without knowing how much they are going to be paid?

The comparison seems to be in vs out of hospital staff, but our EMTs and ER techs are generally around the same wage. ALS does usually make less than an RN but RNs need a bachelors degree.

ER techs (at least in NJ) require NO formal training, NO certification, and NO experience. They also work harder than almost every EMT I know (they aren't known as the nurses ***** no nothing, and there are typically several nurses to every 1 tech).

But it boils down to supply and demand... is it easier to get someone off the street, give them two to four weeks of intense training on skills, and the rest be OJT, or have someone complete a 3 month class that lasts about 240 hours, give or take, require a formal state recognized exam, and then find a job?

Lets say we're talking about a "minimally educated" EMT- High school education, no college. Having just recently made a career change to technology, I have people under my management that are making well over 100k with a high school diploma and that's it. I am not saying they should be equal, but I do believe pay should be raised.

Back to supply and demand, and how much value does the employer (or prospective employer) place on the applicant or employee? If I have three equally qualified people who will perform the same job identically, it is in my best interest to chose the cheapest one (who can make me the most revenue for the least cost).

Do you need a college education to have value? absolutely not. there are plenty of smart people, experienced people, and well paid people who never went to college. And to be honest, many jobs don't need a college degree, despite the push from the industry for everyone to have a bachelors (heck, just look at nursing, does anyone really think a BSN is more qualified than an ADN, considering both take the same NCLEX exam to become an RN? And no, you don't need a bachelors to be a nurse, but the nursing union and lobbyists have convinced hospitals to only hire BSNs; there are plenty of RNs and even LPNs who are working as nurses in SNF and other nursing and clinical positions)

 

[RocketMedic]

I think 40k and 55k are good starting points.

 

[Peak]

It is all about what the market will bear. As long as you have programs cranking out EMTs and they are willing to work for 10ish an hour they that is what they are going to get paid. I don't think it is right but without something else intervening like a union it will just be that way.

In our hospital system the same holds true, and education/position often has little to do with it. I make more than my director, but I also have several differentials and specialty pay incentives. Many of our critical care nurses make more than our PAs and NPs. All of our critical care nurses make more than our flight nurses, our ED medics make FAR more than our flight medics. Right or wrong we live in a capitalist society, its all supply versus demand.

 

[NysEms2117]

Back to supply and demand, and how much value does the employer (or prospective employer) place on the applicant or employee? If I have three equally qualified people who will perform the same job identically, it is in my best interest to chose the cheapest one (who can make me the most revenue for the least cost).

Very true. I tend to think rather "old school" and think an employer should invest in an employee, both fiscally and on the company/professional advancement side. In my opinion there's not enough "pegs" for promotions in EMS, UNLESS your FD. Because in the very very limited about of time I worked in EMS it was: EMT-B-> AEMT-> Medic->CC-P. There were little titles like crew chief, or squad leader, but they did minimal if anything for pay or seniority. In corperate land, you have analyst, associate, Sr analyst, Sr associate, specialist, Sr Specialist, and they do the same job basics, but going from analyst to associate is a pay raise, so on and so forth. On top of that most companies will then offer to send you back to school for a business or finance degree, so you can become management, and then you have manager, Sr manager, director, Sr director, and a plethora of different titles/salaries in between. Basically it incentivizes people to stay, and continue working hard, because that is why we go to work, right? We want to make money and provide for ourselves and others outside of our job. I know that's why I don't mind staying a few hours extra where I work now, because I know it gets noticed, and come bonus time or promotion time, I know it won't be overthought. From my experience in EMS people wouldn't mind doing the extra 2 hours of paper work if they know it was something that gets noticed, not something that is expected of them. I think EMS has a hard time keeping people, since there is such a strict budget, and often times they can't offer the same things PD's or FD's do (Pension mostly). If somebody can figure out a way to do that, I think EMS would be better suited, however that's going to take an academic curriculum re-work which already needs to happen, but most likely still wont

 

[DrParasite]

Because in the very very limited about of time I worked in EMS it was: EMT-B-> AEMT-> Medic->CC-P.

That's not really a fair comparison, because all those titles were education based, not role based. It's no different than saying the role are AS->BS->MS-> PhD; each increase in level is due to external schooling, compared to the job they do. If I'm a hard work, who stays late every day, I am not going to be "promoted" from EMT to AEMT. But If i'm lazy, and don't do what i'm told, I can still go to medic school and go from EMT to medic once i pass my NREMT.

At my college, we have EMS instructor I, II, III, and IV, with each progressive level requiring additional training (usually an additional instructor certification), additional experience, or classes taught or other stuff. clear objectives, achievable goals.

in my corner of quasi corporate america, we have 4 staff roles: "title trainee, title I, title II, Sr. title," substituting title for that particular job, and in theory they are all staff positions who do the same thing, but the higher the title the more experienced the person is at their job. each promotion comes with a pay raise, and a person with more experience can start with a higher title. but it still gives employees something to strive for.

our manager track goes "Team Lead / non-IS manager, IS Manager I, IS Manager II, VP, SVP, EVP, C level executive", with each level rising in the organization.

I know that's why I don't mind staying a few hours extra where I work now, because I know it gets noticed, and come bonus time or promotion time, I know it won't be overthought. From my experience in EMS people wouldn't mind doing the extra 2 hours of paper work if they know it was something that gets noticed, not something that is expected of them.

While that is true, when I worked in EMS, I have stayed late, came in on my off hours, attended meetings, participated in special operations trainings, and helped out when needed, and got absolutely nothing for it. I know of people who will come in on their days off to do work, or help out, and the union guy inside me hates to see that. I don't mind working extra once in a while, when it's crunch time, but the more hours I work, the less I made per hour, and if it's happening on a regular basis, than it's up to management to hire more people to handle the workload.

You're doing it because you know it gets noticed, and you get a return come bonus or promotion time; in EMS, that often translates into you being the sucker who will work for free, and results in you being taken advantage of by managers who play favorites or want to surround themselves with yes men.

In the case of EMS, if I'm spending an extra 2 hours after my shift ends doing paperwork, and it's a result of a poor implementation of the charting system, or a lack of proper relief that would have avoided this issue, than I better get paid for my time. I've spent enough hours helping out the organization that didn't benefit me at all, so now if I'm doing something that will only help the organization, I expect to be compensated appropriately.

 

[Summit]

Compensation is just one variable interdependent on many market variables.

SUPPLY:
How hard is it to meet requirements?

• Barriers to Entry: Length, difficulty, and cost of earning qualification
• Disqualifiers: physical, mental/social/personality, legal

How much do people want to do the job?

• Status/glamour/respect/pride associated with job
• Intrinsic reward of job
• Risk/stressors of job*
• Schedule*
• Work environment*
• Compensation (pay, vacation, education, retirement, insurance etc)
• Fringe benefits (e.g. frequent discounts, special treatment, special license plates)
• Reliability of pay (Guaranteed shifts? Overtime available?)

* = same variable may initially attract and later repel workers

VS.

DEMAND:

• What is the need?
• What are the alternatives for this service or employees?
• Who is paying?
• Who is the employer?

Very low barriers to entry + high status/glamour, intrinsic reward (at least initially), frequently desirable schedule, fringe benefits, guaranteed work, and frequent OT availability all conspire to increase supply to the point where there are adequate workers willing to accept low compensation.

 

[NysEms2117]

That's not really a fair comparison, because all those titles were education based, not role based. It's no different than saying the role are AS->BS->MS-> PhD; each increase in level is due to external schooling, compared to the job they do.

I am currently in charge of Senior Managers with High school diplomas. They have had anywhere between 5-9 promotions in their career at my employer.

I am not going to be "promoted" from EMT to AEMT.

Internally I personally feel, there should be EMT I, EMT II, EMT III, EMT IV, ect. to give some incentive on working hard and staying late. no Caregiving responsibilities, just Fiscal benefits(not even just salary each time, EMT1->2 gets an extra 3% match on 401k, 2->3 gets bonus of X) things of that nature.

each promotion comes with a pay raise, and a person with more experience can start with a higher title. but it still gives employees something to strive for.

This makes sense, IMO. The minutia of naming conventions will vary everywhere, but its still the same principal. Only thing that should be taken into account is workload of the individual. (ex: A Sr. Manager at a fortune 20 company, may be equivalent to a EVP of a small company, and should be treated equal(ish).

You're doing it because you know it gets noticed, and you get a return come bonus or promotion time; in EMS, that often translates into you being the sucker who will work for free, and results in you being taken advantage of by managers who play favorites or want to surround themselves with yes men.

100% correct. You sir, just brought one of the major problems right into center stage under the spotlight. (you also found why EMS isn't a primary gig for me.)

In the case of EMS, if I'm spending an extra 2 hours after my shift ends doing paperwork, and it's a result of a poor implementation of the charting system, or a lack of proper relief that would have avoided this issue, than I better get paid for my time. I've spent enough hours helping out the organization that didn't benefit me at all, so now if I'm doing something that will only help the organization, I expect to be compensated appropriately.

Which is where the supply demand comes in, because i'm sure other people will come in and gladly work those 2 hours for free. As aforementioned.

If I have three equally qualified people who will perform the same job identically, it is in my best interest to chose the cheapest one (who can make me the most revenue for the least cost).

 

[Tigger]

This is not meant disparagingly, but EMTs will always be underpaid. It is a nominal investment into oneself that comes with a lot of fringe perks (schedule, self worth, etc) and as such it seems likely that there will always be an oversaturation outside of the most rural areas. And even then, those EMTs in Colorado aren't doing any better than their urban brethren as there still really isn't a shortage. Furthermore, it's an entry level position that is not hard to climb up from. As far as higher education goes, paramedic school is a pretty good deal. Even decent employers often have tuition assistance or an internal program. If you want to be an EMT for life, awesome. There are places that can facilitate that (I work for one) and in the scheme of career progression, paramedic school is not an enourmous burden.

I have no idea what paramedics should make. The BSN really pushed nursing wages up, and paramedics will not have that for a long time. I am not sure how paramedics can compare to that with our lackluster education standards, which right or wrong is the preeminent benchmark for compensation in healthcare. Paramedics have a relatively unique role in that they autonomously manage patients in much of this country, but what is that worth exactly?

And never mind the non-clinical aspect. How many folks here have significant, non-clinical responsibilities? Does your pay match that, or do you do because that's what's needed to keep the place running?

 

[EpiEMS]

Paramedics have a relatively unique role in that they autonomously manage patients in much of this country, but what is that worth exactly?

Not to mention that it is a collateral duty in many places - not necessarily the full time occupation of many providers.

 

[DrParasite]

The BSN really pushed nursing wages up

did it really? or were nurses paid well, and the BSN just made it better? Or was it just another bargaining chip that unions were about to use to leverage more money from management?

Also, is there any research that correlate that increased entry level requirements increased patient care? or patient outcomes? or did it simply allow the educational facilities to make more money by requiring 4 years of schooling vs 2, and hospitals to say "well, we require bachelors degrees, and you know, more education is better because it only makes sense...", and the students came out in more debt due to more schooling, and ended up learning from preceptors who only has an ADN?

And never mind the non-clinical aspect. How many folks here have significant, non-clinical responsibilities? Does your pay match that, or do you do because that's what's needed to keep the place running?

We call those people supervisors, or administrators. many EMS works are constantly on the trucks, and don't have time to do non-clinical stuff. so if you are running for your entire shift, and can't handle your administrative stuff, is that a failure on your part, or the employer for not giving you the proper time to do the administrative stuff?

Too many places want to give field staff additional responsibilities, but don't want to compensate the staff for the additional work, or want to put the supervisor on the ambulance, preventing them from actually supervising (if you are on the ambulance, you aren't going to be able to do the field supervisor job for anyone other than that single ambulance)

Not to mention that it is a collateral duty in many places - not necessarily the full time occupation of many providers.

ehhh, taking the whole "volunteer" component out of the picture....

I can think of several careers have people working other jobs. I don't know of a single adjunct college professor that has only one job. every career firefighter I know has a second, and often a third job. I know nurses that work FT at one hospital, and PT at another. And doctors will work for one entity, and moonlight elsewhere, especially when they are first starting out (apparently residents get paid pretty poorly).

It also boils down to the old "you get what you pay for." if you pay above the market wage (whatever that is), you get more applicants, you can be selective, and hold your staff to higher standards, and if they fail to maintain them, thank them for their service and replace them with someone else. If you pay poorly, you might still have a lot of applicants, but the quality applicants will go elsewhere, or you will have a higher than expected turnover when staff leave for better paying positions.

 

[Tigger]

did it really? or were nurses paid well, and the BSN just made it better? Or was it just another bargaining chip that unions were about to use to leverage more money from management?

Also, is there any research that correlate that increased entry level requirements increased patient care? or patient outcomes? or did it simply allow the educational facilities to make more money by requiring 4 years of schooling vs 2, and hospitals to say "well, we require bachelors degrees, and you know, more education is better because it only makes sense...", and the students came out in more debt due to more schooling, and ended up learning from preceptors who only has an ADN?

I have no idea if it improves any outcomes. It might not at all, but it did assist with the continual increase in RN pay if you believe nursing. Right, wrong, or indifferent to patient care, improved outcomes don't necessary correlate with wages.

We call those people supervisors, or administrators. many EMS works are constantly on the trucks, and don't have time to do non-clinical stuff. so if you are running for your entire shift, and can't handle your administrative stuff, is that a failure on your part, or the employer for not giving you the proper time to do the administrative stuff?

Too many places want to give field staff additional responsibilities, but don't want to compensate the staff for the additional work, or want to put the supervisor on the ambulance, preventing them from actually supervising (if you are on the ambulance, you aren't going to be able to do the field supervisor job for anyone other than that single ambulance)

I am fine with my workload. I can run my calls, write my grants, spec our trucks, and handle my PIO responsibilities. I don't get much downtime, which is not the end of the world. What does suck is only getting a moderate pay bump over our base paramedic wages to do these things

 

[Summit]

did it really? or were nurses paid well, and the BSN just made it better? Or was it just another bargaining chip that unions were about to use to leverage more money from management?

Also, is there any research that correlate that increased entry level requirements increased patient care? or patient outcomes? or did it simply allow the educational facilities to make more money by requiring 4 years of schooling vs 2, and hospitals to say "well, we require bachelors degrees, and you know, more education is better because it only makes sense...", and the students came out in more debt due to more schooling, and ended up learning from preceptors who only has an ADN?

It's all of the above... except unions. I think about 15% of RNs are union.

There is some evidence for BSN improving outcomes.

BSN definitely opens career pathways for RNs to move beyond the bedside, whether up or sideways, because BSN provides the generalist education to allow serial respecialization and basic QI/leadership.

 

[DrParasite]

It might not at all, but it did assist with the continual increase in RN pay if you believe nursing.

I underlined the important part. The nursing lobbyists have done a lot to help get more money for nurses, and to get certain regulations passed. They are like unions though, always looking out for their own best interests (and when they line up with the public's best interest, that's even better). I do question that belief that a Bachelors in EMS will lead to a rise in wages, especially since so many paramedics have been successful for decades without said degree.

There is some evidence for BSN improving outcomes.

can you please provide a link to a study that has this evidence? I haven't seen any, and many of my nursing friends (who have been nurses for years and don't have their BSNs) didn't know of any.

BSN definitely opens career pathways for RNs to move beyond the bedside, whether up or sideways, because BSN provides the generalist education to allow serial respecialization and basic QI/leadership.

no arguments that a BSN increases the career pathways besides bedside care; but historically, how many nursing leaders didn't have BSNs? how many did QI without a bachelors? how many respecialized in a different area of nursing without even going back to college?

 

[Ridryder911]

Oh no... here we go again...

EMS cannot even decide within itself of what it is.. are we Safety, Public Service .. etc? Then if that is the case, this is the pay is what you have.

Is EMS medical? Then if compare yourself with others within the medical community the reason many other of those changed the education requirements is because of pay, professional roles, increase job security. It was not that long ago most RN's was hospital trained, Physician Assistant was an associate degree. Physical Therapist and a Pharmacist was a bachelors degree (now most require doctorate level). Their wages didn't automatically go up because they felt like they deserved it. They mandated increased education which meant stricter and tighter entry requirements... hence supply & demand. As well a demand reimbursement was asked to ensure that they were able to obtain the money to make the pay grade.

Now, unfortunately the EMT course has been watered down to an Advanced First Aid level with some very basic allowances placed within the guidelines. It is what it should be; a starting point. Alike other medical professions that have a stair-step ability to grow hopefully; the program delivers a good foundation to grow upon and at the same time requires some requisites to round out the required basics.

As one EMS employer told me .. "As long as I can get an EMT for basically free, why should I pay much more? There's a new crop every 16 weeks, I can choose from" . Can an EMS provider justify the salaries, can they get reimbursed to pay such salaries and is there a shortage to raise salaries?

Paramedic level... We are so fragmented within our own system, it is ridiculous! I may have a Paramedic that only has the very minimum NHTSA training but able to pass the test. We are unlike those in the health profession that perform on an some autonomy level; where basic general medicine is taught first; then one specializes afterwards. EMS are specialized then specializes later in general medicine (community Paramedic).

Although, I am definitely for advancing the pay grade of those in EMS. It can be a very slippery slope. Does every EMS need more than one Paramedic on a response? How much are you going to pay for salaries? How much is the consumer willing to pay? It is hard to justify higher salaries as long as there is no demand and payment structure is low to EMS services. Again, supply & demand. Quit flooding the market and you will see a demand, you will see reimbursements rates go up, and then you a response in salaries.

R/r 911

 

[VFlutter]

can you please provide a link to a study that has this evidence? I haven't seen any, and many of my nursing friends (who have been nurses for years and don't have their BSNs) didn't know of any.no arguments that a BSN increases the career pathways besides bedside care; but historically, how many nursing leaders didn't have BSNs? how many did QI without a bachelors? how many respecialized in a different area of nursing without even going back to college?

A study from Europe. Looks at staffing ratios and education.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62631-8/abstract

More examples.
https://www.registerednursing.org/answers/do-bsn-educated-nurses-provide-better-patient-care/

If you look at Magnet hospitals, whom are required to have a high percentage of BSN nurses, they usually far exceed the average when it comes to patient care metrics such as inpatient days, infection rates, re-admission, etc. Hard to know if that is a result of having more BSN nurses or all of the other factors that go into achieving magnet status such as the quality improvement programs, emplyoee engagement and satisfaction, staffing etc. Correlation does not equal causation however when a lot of high-level nursing units and hospitals tend to have a high percentage of BSNs it tends to lend to the argument.

In many hospital it is becoming impossible to get a manager level RN job without a BSN or even MSN. Even those who have been in management for years are being forced to advance or leave. Just because people have done these roles in the past without a BSN does not mean that there is no benefit to requiring it.

How many Paramedics function as a QI/QA person with minimal college education and likely no formal statistics or research course? Would requiring such improve their understanding or performance of the job?

Evolve or die. Good, bad, or indifferent every medical profession except EMS is advancing educational requirements.

 

[Tigger]

I underlined the important part. The nursing lobbyists have done a lot to help get more money for nurses, and to get certain regulations passed. They are like unions though, always looking out for their own best interests (and when they line up with the public's best interest, that's even better). I do question that belief that a Bachelors in EMS will lead to a rise in wages, especially since so many paramedics have been successful for decades without said degree

Successful how? Making average wages in the face of generally below average working conditions? Ok...

And again, I have no interest in arguing about whether BSNs improve patient care outcomes. The advent of the BSN has positively affected nursing wages and that is what is germane to this discussion. Not to be callous, but I don't particularly care if it improves care. It got them the wages they deserve.

 

[DrParasite]

Successful how? Making average wages in the face of generally below average working conditions? Ok...

I don't equate success with how much money one makes. I agree that paramedics makes averages wages in below average working conditions

By successful, I mean they have performed as paramedics, saving lives, raising the dead, shocking people,giving medications, you name it, they have did it. They have done the job for years before there was a push for paramedics without any college education. What has changed about the job that now requires a paramedic to have a bachelors degree? and is that change enough to say that a 10 year paramedic is no longer qualified to be a paramedic until they get said degree?

I will agree that the changes in paramedicine (such as community paramedic, EMS based research, and some new roles that are being filled by paramedics) do warrant a degree, particularly a bachelors. Which can be used to justify the increased wages for those who are holding those positions.

Or are you saying that EMS should require bachelors degrees, and the money that previously wasn't used will just magically appear?