I have worked for a transport service since October as a second job, and my guess is that the driving factors here are service, tied closely to money. Hospital contracts are the bread and butter of any private provider and the competition is cutthroat. If you have the contract you will do anything to keep it, and if you want it, you will do anything to get it. We have the contract with the local hospital and a short response commitment. Our competition will literally sit at the doors of the ER in the hope they can catch us with everything committed, forcing us to the far end of the response time while an ER room remains occupied with a D/Ced patient. Thus, a reputation for availability is acquired and will certainly be mentioned when the next contract time rolls around. FWIW, I really enjoy my job (though I do get some 911 stuff with the FD I work at) and we do get a fair number of critical transports to the next larger city with my PT gig. For me it's the perfect mix, and I can never get to work quick enough (I've been an EMT since 1985, BTW, so the honeymoon is long over...lol). Delivering pt care to my older neighbors can be challenging, and I believe there is room to make a difference. In addition, it is an excellent training ground for vitals, report writing, and really getting a good history. My only advice is that if you don't like it and it makes you miserable, start cruising those classifieds. There are plenty of opportunites out there, no matter what your certification. Hope this helps...