Why are Paramedics paid so little?

crashh

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Why, with the advanced skill level, are paramedics paid so little?
 

STXmedic

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Because we're a dime a dozen. However, there are some extremely well paying companies out there. You just have to work to get them.
 

ffemt8978

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Variety of reasons.

Skill sets are not hard to teach, education and knowledge is lacking, market saturation, Medicare/Medicaid reimbursement rates, FD's, vollies, and the list goes on. Pick your poison for the week and it will be a correct answer.
 

JPINFV

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Why, with the advanced skill level, are paramedics paid so little?

Because the barrier to entry is so low that Tyrion Lannister can use it for pull-ups.

Because of the SUPPLY vs demand issue.

Because Medicare views EMS as a medical taxi service and EMS is fragmented to the point that no one can stand up and say, "No, we're better than taxi drivers."

Because there's a sizable portion of EMS providers who are happy being medical taxi drivers, because being a medical professional is hard.
 
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crashh

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I just finished my EMT (actually waiting on the results - it's been 4 weeks!). I know i passed, just waiting for confirmation.

Anyway, I am planning to go to nursing school. Which will actually be a 3 year program, since I need some pre-requisites...so, pre-nursing into nursing.

Well, my company has just offered me, after some interest by myself, to pay for me to go to paramedic school. This program is a 1 year school. I would sign a contract to stay with my company for 3 years after completion of the course. In that time I plan to do the pre-nursing>nursing.

I'm not thinking about doing the paramedic for the money ( we are a volunteer dept), but i feel the field trauma experience will be good for me. My ultimate goal is to do travel nursing and eventually do national/international aide, so i thought the paramedic would help.

any thoughts?
 

Christopher

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Who said Paramedics were paid so little?

Pay is commensurate with education, experience, and responsibility.

If it takes 1500 hours to become a Paramedic (this includes EMT-B time) the barrier to entry is pretty low. Expect low pay for vocational positions. As an example of how low the barrier to entry is for a Paramedic, in North Carolina many folks going to school to become a hair dresser (I may have just called them the EMS equivalent of an "Ambulance Driver", apologies in advance) have longer educational requirements!

While we may know we have a large responsibility, as a profession we've not accepted that. This is most evident in that people still believe protocols are The Word of God for the People of God. Standing orders are merely a vehicle to shift responsibility onto medical directors. It also shows we're still technicians rather than clinicians.

My view is that paramedics are currently being paid slightly under their market value, but that this is consistent with almost all vocational positions in the US. Wages for these types of jobs has lagged, and I doubt we'll see anything different to come. Even as a software engineer for a Fortune 5 company, in our group we've not seen our wages track with those in "softer" positions such as management, HR, or finance/sourcing. Welcome to the world of being an Individual Contributor.

A reasonable starting wage for a certified paramedic should be 2-3 times the minimum wage multiplied by a cost-of-living adjustment for the given area. This represents the relative difficulty in obtaining a certification as a paramedic and the responsibility on the employee. (Interestingly enough the current mean wages in the US are around 2x the minimum wage.)

A reasonable starting wage for a licensed paramedic, with an AS or BS and an additional 1-2 years of paramedic school, should be 4-5 times the minimum wage multiplied by a cost-of-living adjustment for the given area. This represents the relative difficulty in obtaining the post-secondary education and the additional responsibilities associated with licensure.

Considering the potential harm we're able to cause as providers it is pretty crazy how little education we're given. Complaints about getting paid less are not terribly well founded.

Given that hair dressers and HVAC technicians (4,000 hours of experience prior to licensure*) spend more time in school and apprenticeship than your average Paramedic, your question should be: "Why are Paramedics** so poorly educated?"

*I think the only program in the US that comes close to this is Seattle Medic One's paramedic program.
**I'm included in this group.
 

NYMedic828

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I just finished my EMT (actually waiting on the results - it's been 4 weeks!). I know i passed, just waiting for confirmation.

Anyway, I am planning to go to nursing school. Which will actually be a 3 year program, since I need some pre-requisites...so, pre-nursing into nursing.

Well, my company has just offered me, after some interest by myself, to pay for me to go to paramedic school. This program is a 1 year school. I would sign a contract to stay with my company for 3 years after completion of the course. In that time I plan to do the pre-nursing>nursing.

I'm not thinking about doing the paramedic for the money ( we are a volunteer dept), but i feel the field trauma experience will be good for me. My ultimate goal is to do travel nursing and eventually do national/international aide, so i thought the paramedic would help.

any thoughts?

They want you to be a medic to make THEM money. Work as an EMT, go to nursing school. Secure a better future for yourself.

If you are just finishing EMT, you probably haven't been with the company long enough to know you wanna work there for 4 more years.
 

sir.shocksalot

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Who said Paramedics were paid so little?

Pay is commensurate with education, experience, and responsibility.
Bravo! Every time I hear a paramedic complain about their wage (or EMT for that matter) I have a good laugh.
If it takes 1500 hours to become a Paramedic (this includes EMT-B time) the barrier to entry is pretty low.
This is the problem, anyone, and I mean ANYONE can do my job. When all it takes to become a paramedic is an EMT card (aka. First-Aid for firefighters) and 4-6 months of your time, then employers are going to have serious reservations about paying you reasonable wages.

Many in EMS like to point fingers at nurses and say "Hey, I do all the same stuff they do, I should get paid as much!". If that is they case then it should be a simple task to get through nursing school... except that it isn't, most nursing programs require a year of A+P, chem, pathophys, basic english composition. Each class is one more filter so that only those with the drive to do well make it. In many places (there are always exceptions) there is absolutely no filter before paramedic school other than your EMT card.
Given that hair dressers and HVAC technicians (4,000 hours of experience prior to licensure*) spend more time in school and apprenticeship than your average Paramedic, your question should be: "Why are Paramedics** so poorly educated?"
I totally agree! I am not sure what it is that makes most EMS providers feel they are entitled to a higher wage simply because we have large responsibilities (relatively). Almost every worker on this planet thinks they deserve a higher wage, but few are willing to work hard to earn it.

If the minimum for Paramedic certification was an AAS you would see and increase in wages as the number of people able to obtain an AAS would decrease the supply of Paramedics. This will never happen so long as EMS agencies are happy with the status quo and EMS providers remain too lazy to change it.

If paramedics weren't allowed to leave EMS I'm sure this career would be much better. As it stands the best paramedics we have go to nursing school or PA school or leave health care entirely, which leaves EMS in a sad state of talent-deprivation.
 

Tigger

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Many in EMS like to point fingers at nurses and say "Hey, I do all the same stuff they do, I should get paid as much!". If that is they case then it should be a simple task to get through nursing school... except that it isn't, most nursing programs require a year of A+P, chem, pathophys, basic english composition. Each class is one more filter so that only those with the drive to do well make it. In many places (there are always exceptions) there is absolutely no filter before paramedic school other than your EMT card.

And now cue the "I work on the streets, I don't need to take all of those college classes!" So few in EMS seem to understand that the point of taking these classes is to have a solid basis for trying to understand the human body. With this knowledge you can treat so many more patients efficiently and correctly. Just because you can practice as a paramedic without that knowledge does not mean you should, what happens when a patient fall between two pages of the protocol book?
 

JPINFV

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And now cue the "I work on the streets, I don't need to take all of those college classes!" So few in EMS seem to understand that the point of taking these classes is to have a solid basis for trying to understand the human body. With this knowledge you can treat so many more patients efficiently and correctly. Just because you can practice as a paramedic without that knowledge does not mean you should, what happens when a patient fall between two pages of the protocol book?
ems_60mph_mousepad-p144957923623903279envq7_400.jpg

I throw up a little in my mouth every time I see that meme.
 
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My grandparents, who were both general surgeons in Scotland, England, and Iran would laugh uncontrollably at that picture.
 

Akulahawk

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Many in EMS like to point fingers at nurses and say "Hey, I do all the same stuff they do, I should get paid as much!". If that is they case then it should be a simple task to get through nursing school... except that it isn't, most nursing programs require a year of A+P, chem, pathophys, basic English composition. Each class is one more filter so that only those with the drive to do well make it. In many places (there are always exceptions) there is absolutely no filter before paramedic school other than your EMT card.
There are LVN programs that teach a minimum of A&P and the like for the scientific background for their program and those "classes" may not be acceptable by other colleges for their programs. This is not too much unlike some Paramedic programs that teach the minimum scientific stuff also. It's the "teach only what they need to pass" mentality. RN (thankfully) generally requires a much more rigorous set of coursework for entry to that program. So far, I have found that my education has been quite sufficient for understanding the nursing theory without having to crack the books much for that.
If the minimum for Paramedic certification was an AAS you would see and increase in wages as the number of people able to obtain an AAS would decrease the supply of Paramedics. This will never happen so long as EMS agencies are happy with the status quo and EMS providers remain too lazy to change it.
Too true. I would completely support the AAS requirement, even if it was a general science AS degree with specific coursework for entry to a Paramedic program, though a ADP (Associate Degree in Paramedicine) would be more ideal, with similar prerequisites so that an ADP grad could transition to an ADN program or BSN program (or any other healthcare program) and meet most of the typical entry science requirements for those without too much difficulty.
If paramedics weren't allowed to leave EMS I'm sure this career would be much better. As it stands the best paramedics we have go to nursing school or PA school or leave health care entirely, which leaves EMS in a sad state of talent-deprivation.

And now cue the "I work on the streets, I don't need to take all of those college classes!" So few in EMS seem to understand that the point of taking these classes is to have a solid basis for trying to understand the human body. With this knowledge you can treat so many more patients efficiently and correctly. Just because you can practice as a paramedic without that knowledge does not mean you should, what happens when a patient fall between two pages of the protocol book?
When the patient doesn't fit a given protocol, many would just say "call OLMC" and go from there... Of course, I prefer to call OLMC, advise what I've got and what I'd like to do. But that's just me... unfortunately...
 

DrParasite

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Respectfully disagreeing with almost everyone here, but WE don't give each other credit.

I can't speak for anyone else, but in my EMT class (in New York State and New Jersey, I took them both), there were people who didn't pass. I know people who were in the paramedic program (in both NJ and NY), who didn't pass. You know what? not everyone can do this job, not everyone can pass the classes. Yes, maybe our entrance prerequisites are too low (or non-existent), but like other educational programs, people who enroll do not always pass.

why are we paid so little? well, to start, many EMS agencies are for-profit, so the lower they pay their paramedics, the more profit for the company. we can also go with the idea that most EMS systems aren't tax funded (unlike fire and police) so they generate most of their revenue from what they make transporting people. With medicare and medicaid abuse and declining returns, you have less money to spend on salaries.

And then there is the big one. no, it's not supply and demand (although that does play a large role in many areas). Paramedics are WILLING to work for those low wages. EMTs are WILLING to work for lower wages. if a paramedic will work for $12 an hour, why should any company pay more? if an EMT will work for $9 an hour, why should any company pay more?

Education does come into play, but it all boils down to the simple fact that people are willing to work for those sucky wages. and if they won't, employers will find some new hires who will.
 

EpiEMS

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There are ~200,000 EMTs, ~15,000 AEMT/EMT-Is, and ~60,000 medics (http://www.ems.gov/pdf/EMSWorkforceReport_June2008.pdf). You can fairly estimate that half of the workforce is volunteer (pg. 46 of the above cited report). These numbers are growing quite rapidly (http://www.bls.gov/ooh/Healthcare/EMTs-and-paramedics.htm).

Since the barriers to entry are quite low, you'd expect low wages. Considering the danger of the field and the (often?) odd hours, wages should be elevated. We observe, quite clearly, that wages are much lower for EMTs and medics than for similar fields (i.e. police, fire, RTs, RNs, etc.).

"Supply and demand" expresses, on a larger level, why wages are where they are. People look for jobs and weigh the costs and benefits for one job over another, etc.
Simple as Econ 101.
 

jjesusfreak01

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I can't speak for anyone else, but in my EMT class (in New York State and New Jersey, I took them both), there were people who didn't pass. I know people who were in the paramedic program (in both NJ and NY), who didn't pass. You know what? not everyone can do this job, not everyone can pass the classes. Yes, maybe our entrance prerequisites are too low (or non-existent), but like other educational programs, people who enroll do not always pass.

In my basic class I believe they told us to expect something like 60% attrition by the end of the class. Most of us stuck through it, which they said was very unusual. In my EMT-I class, only 75% of the class ended up passing the class final, though all those who passed the final passed the state test. What is the standard attrition rate for nursing school?
 

sir.shocksalot

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I can't speak for anyone else, but in my EMT class (in New York State and New Jersey, I took them both), there were people who didn't pass. I know people who were in the paramedic program (in both NJ and NY), who didn't pass. You know what? not everyone can do this job, not everyone can pass the classes. Yes, maybe our entrance prerequisites are too low (or non-existent), but like other educational programs, people who enroll do not always pass.
Just because people do not pass EMT/Medic school does not mean that the course is difficult. There are a large number of reasons people do not do well in school; personal problems, lack of time to study, lack of drive to study, et cetera will cause someone to fail a course, this does not mean that the course is good at weeding out people that are incapable of doing the job.
And then there is the big one. no, it's not supply and demand (although that does play a large role in many areas). Paramedics are WILLING to work for those low wages. EMTs are WILLING to work for lower wages. if a paramedic will work for $12 an hour, why should any company pay more? if an EMT will work for $9 an hour, why should any company pay more?

Education does come into play, but it all boils down to the simple fact that people are willing to work for those sucky wages. and if they won't, employers will find some new hires who will.
Actually your last paragraph highlights why wages are low... there is always someone else to do your job.

It is a fallacy that employees dictate wages. I personally detest working for $11/hr to $19/hr depending on the shift. However my choices are the wages I was offered and unemployment. I cannot walk into an employer and say "I am worth $24/hr and will work for no less", I will get laughed out of the office and over to the unemployment line.

When looking at hiring paramedics 99.9% of companies simply say "Can s/he fulfill the job description?" and "Will s/he be a good fit for company culture?". The first question is answered by background checks, certification checks, and a physical ability test. The second question is usually answered by an interview. When pretty much every paramedic that applies meets the requirements it is hard to justify paying more because you offer nothing special to employers.

Contrast this with hiring in the IT/Computer software/Engineering world. Companies in this world instead ask "What skills/abilities/knowledge does this individual bring to the table that we can use here at Blahblah Industries?". These companies are looking for the best and the brightest who are creative and intelligent and will pay lots of money and benefits to recruit and retain these people. Thats why places like Google and Microsoft pay $100,000+/yr and have long paid vacations, at work nap times, on site childcare, on site healthcare, free cafeterias, and many more benefits.

Now we will never see those benefits in EMS, ever really (Heck MD/DO don't even get those kinds of benefits). However as long as paramedic school is quick and easy to finish with minimal investment in school time, employers will have a glut of paramedics to choose from to fill holes in the schedule. And as long as EMS is a job where we drive patients to the hospital (or are viewed as such) then employers have no interest in hiring and retaining talented and dedicated healthcare providers.
 

sir.shocksalot

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What is the standard attrition rate for nursing school?
This is a poor argument for wages. We know that physicians command a very high wage, yet less than 2% of students in medical school drop out for academic reasons. If we use the argument that high attrition should = high wages then we would expect to see attrition in medical school at a much higher rate.

In fact I would argue that high attrition is actually an indicator of poor instruction or poor screening of applicants to the program.



source for medical school graduation rates: https://www.aamc.org/download/102346/data/aibvol7no2.pdf
 

JPINFV

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That's what I was expecting. The general estimate is med school attrition rates is generally in the 10-15% range, but that counts attrition rates as "not graduated in your initial class" and not "not graduates at all." Of course that's a confounding variable when looking at a program that takes 4 years minimum vs a program that can be completed in less than a month for EMTs or less than a year for paramedics.
 
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