Why are Paramedics paid so little?

MikeC said:
The PD is carrying the .1mg intranasal atomizer spray as BLS crews are using. IM are available but expensive. From what I've heard, some ALS crews may or may not have it available.
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may want to learn the fact that narcan is also IV. ALS has narcan IV, which is more effective- narcan up a damaged nose? or narcan direct into a a vein?
 
EpiEMS said:
Bank tellers make circa minimum wage, too. They don't ask to get robbed at gunpoint.

The key reason why EMS providers don't make very much money (in most places) are pretty simple, and align pretty nicely to a very simple supply/demand framework. This reason is low barriers to entry for EMS providers (i.e. relatively high supply/low price at any quantity demanded). It doesn't take much to get into EMS, and lots of people will do it (because, say, they like the woo-woos). Compare EMS initial entry criteria to similar fields (from the same source, the Bureau of Labor Statistics' Occupational Outlook Handbook) and you'll see that EMS barriers to entry are (relatively) low.

Also, don't forget - if I own an ambulance company, I can't bill Medicaid for more money if I have better providers (ceteris paribus). For example, if I have a transport from Hospital A to Hospital B for Elderly Patient A, I can only expect reimbursement for the transport of $X dollars, regardless of whether my personnel are paramedics with college degrees or paramedics with a non-degree certificate. Obviously, I'm oversimplifying the issue - but the core point is that there is no explicit link between things like provider quality and revenue, so what reason does a provider have to pay more for more education (beyond the statutory minimum)?

You should read this document. It provides a lot of insight.
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Very good post. Thanks for posting.
 
NysEms2117 said:
may want to learn the fact that narcan is also IV. ALS has narcan IV, which is more effective- narcan up a damaged nose? or narcan direct into a a vein?
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Thank you yes .4mg IV naloxone via PA state protocol can be administered by ALS. The local PD are carrying the intranasal spray at .1mg/dose which is what the article is referring to in requiring multiple doses.
 
So to bring the topic back on track of the original thread concerning the factors that influence pay for EMS providers, the influencing factors are mostly supply of workers, demand for services, and reimbursement capabilities through Medicare and Medicaid. Are there any other major factors to consider?

I don't know how grants play into it or if they do.
 
Don't mind me, just enjoying the responses...
 
MikeC said:
Are there any other major factors to consider?
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The proximate factors we have to consider are supply (of workers) and demand (for workers). Everything else gets us to the "equilibrium", i.e. where the number of workers are available (at a given wage) and equals how many are needed (at a given wage).

Those other things (Medicaid reimbursements, lawsuits, etc.) feed into demand for workers and supply for workers.
 
I posted an answer on another website (Quora, think the 100% Directionless thread turned into an entire forum of it's own), the question I answered was:
Is there any way for me to fight the ambulance charges that I feel are way out of proportion to the services rendered?
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I'm going to copy/paste my answer from there to here because I think it's directly applicable to this conversation:

"TINSTAAFL. Remember TINSTAAFL from high school economics class? Its an acronym that stands for There Is No Such Thing As A Free Lunch. In other words even if you recieve a product or service for free, someone is paying for it somewhere else.

I work for a private ambulance company in Los Angeles that has a contract with the County to provide 911 response and transport. As a private company we recieve ZERO tax dollars to provide services.

Ambulances are expensive vehicles. A basic Ford E350 van (not even modified with a box on the back but just a regular van on the outside) can easily cost upwards of $100,00+. Then you have to pay for insurance (and you know insurance for a fleet of vehicles that routinely run red lights, oppose traffic, park in the middle of the street, etc, isn’t gonna be the cheapest insurance available…) plus all the usuall taxes and registration fees. Oh and gas, each rig gets a full tank pretty much every single day, I’ve been told our company expects to spend roughly $1000 on fuel each DAY.

And I haven’t even touched on the costs of the stuff inside that vehicle, not just a couple boxes of bandaids and kerlex rolls, but also specialized large oxygen tanks (which itself you have to buy medical grade oxygen to refill), gurney, stair chair, backboards, splints, etc. If you’re a Paramedic (Advanced Life Support) ambulance like what would typically respond to a cardiac call like yours, they also have highly specialized cardiac monitors and defibrillators, dozens of different specialized prescription medications and all the needles and other equipment to administer those, etc.

Oh and the EMTs and Paramedics that staff those units 24/7 including holidays have bills to pay and families to feed, so we like to get a paycheck as well. You know how much I get paid? Minimum wage. That’s right, the EMT’s you summoned can be making less per hour than a burger flipper at McDonalds…..why do I mention that? Because it’s EXPENSIVE to provide ambulance services, and it’s not going to lavish paychecks you can demand your ambulance provider cut (as some people seem to believe we all make $100K per year and the best way to cut ambulance bills is to cut our pay vs Pay more in taxes. Funny how that works).

Generally speaking people don’t like to pay taxes, even for services they demand to be available 24/7 but don’t use more than a few times (if that) in their lives, people don’t want to pay for those services they’re not actively using. If 6 years ago your city told you they were going to raise your property taxes by $100 a year on the off chance to avoid a one time $600 bill at some vague point in the future you may not ever need to pay in the first place! So….just like the ER, we have to bill for services rendered otherwise the next time you call 911 for an ambulace there wont be one to respond because no one wants to pay for it."

(Link to the thread: https://www.quora.com/Is-there-any-...ay-out-of-proportion-to-the-services-rendered )
 
MikeC said:
So to bring the topic back on track of the original thread concerning the factors that influence pay for EMS providers, the influencing factors are mostly supply of workers, demand for services, and reimbursement capabilities through Medicare and Medicaid. Are there any other major factors to consider?

I don't know how grants play into it or if they do.
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Grants won't raise wages.... grants are one time bumps in operational capital, often for a purchase of new equipment or budgeted for a one time purpose.

one of the biggest factors in salary is how your agency is funded. if you are privately funded, ie, private ambulance service, than the largest source of your income will be what you can generate from billing. your salary is just another expense, like ambulance operations, fuel, building, and company profits. if you are public sector, you often have tax $$$ coming in, which helps offset any losses you take. if you are hospital based, or part of a larger agency, you can sometimes have the same bonus as being tax funded.

But at the end of the day, it all boils down to supply and demand.. most agencies will only pay you the minimum that they need to.... especially if you pass on it, 5 other people will jump on the chance.

and almost everywhere is looking for paramedics, and until paramedics refuse to work for low wages, there is no incentive for employers to raise wages. EMT, however, are a dime a dozen, and few employers are willing to pay you a decent wage, because if you don't like what they are offering, there are 10 more applicants who are willing to accept the wage they are paying.
 
And not to mention some places that have received the safer grant to add staffing, ends up laying those xrewembefs off when they don't get approved for the grant again

Sent from my SM-N920P using Tapatalk
 
MikeC said:
So to bring the topic back on track of the original thread concerning the factors that influence pay for EMS providers, the influencing factors are mostly supply of workers, demand for services, and reimbursement capabilities through Medicare and Medicaid. Are there any other major factors to consider?

I don't know how grants play into it or if they do.
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I'd also add to some degree the low barrier to entry in regards to length of training/education.
 
Imagine a world where every paramedic was required to gain an associates degree by the National Registry prior to being credentialed .... (Solves most state/local issues by making it a NR requirement because most states require NR).

How many folks do you (general you) know that would not be there in your circle of colleagues/friends? Then that number grows exponentially as you move outside your personal circle.

Thus, in general you move towards a solution to some of our fields largest issues. Supply is limited, education is increased, quality of applicants increases, we gain higher standing in the medical community, etc. etc.

The answer is simple, and it has been staring us in the face for a long time...The nurses did it, the PA's are doing it, the NP's did it... Barriers to entry allow for better applicants and a better position at the bargaining table.
 
SandpitMedic said:
Imagine a world where every paramedic was required to gain an associates degree by the National Registry prior to being credentialed .... (Solves most state/local issues by making it a NR requirement because most states require NR).

How many folks do you (general you) know that would not be there in your circle of colleagues/friends? Then that number grows exponentially as you move outside your personal circle.

Thus, in general you move towards a solution to some of our fields largest issues. Supply is limited, education is increased, quality of applicants increases, we gain higher standing in the medical community, etc. etc.

The answer is simple, and it has been staring us in the face for a long time...The nurses did it, the PA's are doing it, the NP's did it... Barriers to entry allow for better applicants and a better position at the bargaining table.
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Bingo. This is exactly what I was getting at in another thread post when I quoted @STXmedic.

Admittedly, I was too tired and lazy to articulate as you have here, but this...I wholeheartedly agree.
 
SandpitMedic said:
Imagine a world where every paramedic was required to gain an associates degree by the National Registry prior to being credentialed .... (Solves most state/local issues by making it a NR requirement because most states require NR).

How many folks do you (general you) know that would not be there in your circle of colleagues/friends? Then that number grows exponentially as you move outside your personal circle.

Thus, in general you move towards a solution to some of our fields largest issues. Supply is limited, education is increased, quality of applicants increases, we gain higher standing in the medical community, etc. etc.

The answer is simple, and it has been staring us in the face for a long time...The nurses did it, the PA's are doing it, the NP's did it... Barriers to entry allow for better applicants and a better position at the bargaining table.
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Agreed, but how do you account for the 80%+ of EMS services that rely on volunteers? The time requirements and lack of incentives for training & CE would preclude lots of people who may be able to practice as a Paramedic on ambulances that would otherwise be downgraded to BLS service.
 
The same way those communities have a police force and trash collectors. If the public demands ALS, they'll find a way to pay for it.
 
PCT EMS said:
Agreed, but how do you account for the 80%+ of EMS services that rely on volunteers? The time requirements and lack of incentives for training & CE would preclude lots of people who may be able to practice as a Paramedic on ambulances that would otherwise be downgraded to BLS service.
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Is it really that remarkably high of a number?

I don't have a whole lot of experience with volunteer services. Rural? yes; volunteer, and rural? No. The EMS management course I am currently in has actually been quite enlightening with regards to management issues within an EMS operations, both paid, and volunteer/ on-call.

I don't know many of the textbooks we read when we begin our EMT careers offer the "thrill and excitement" of EMS management, and what it actually involves.

To elaborate, my point takes SandPit's and adds this to it:

Why is it that once the novelty of the job wears off with the "adrenaline junkies", and "reaper racers", they all too often up and turn away offering up a fresh batch of their equally gullible replacements?

As others have pointed out, when people are willing to do this job for free, or close to it for the "glory of the job", it severely counterbalances the kindhearted vollies who really wants to serve their communities.
 
PCT EMS said:
Agreed, but how do you account for the 80%+ of EMS services that rely on volunteers?
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What about them? Are you telling me those 80% of volunteer EMS services are running with volunteer paramedics? Or are they running with volunteer EMTs or intermediates and a paid paramedic coming from the next town over?

I don't know many volunteers who are willing to spend 2 years getting a degree in something that they aren't going to get paid for.... Nor should they!!!
 
NomadicMedic said:
The same way those communities have a police force and trash collectors. If the public demands ALS, they'll find a way to pay for it.
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Wish that were true. Rural towns may or may not have ALS services, but they don't have a growing pool of people who are
willing to go through the equivalent of one month of full time work simply to get their Basic so they can volunteer. Sure they
exist and bless them for it, but the CE requirements grow, and it can be a 60mi. drive just to get to class.

What these areas do have for certain is a growing older population and an exploding opiate epidemic.


I can join the fire service as a volunteer and get a $1500 turnout suit, the lights for my truck and free medical exams at the
local hospital. I can try to get a police job, get a uniform, badge and gun and be above the law while getting paid, or I can
be a EMT, pay for my own stethoscope and pants, and get them puked on.
 
PCT EMS said:
Wish that were true. Rural towns may or may not have ALS services, but they don't have a growing pool of people who are
willing to go through the equivalent of one month of full time work simply to get their Basic so they can volunteer. Sure they
exist and bless them for it, but the CE requirements grow, and it can be a 60mi. drive just to get to class.
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and that the trade off that happens when you live in the rural areas.... It's unreasonable to expect city services when you live in the sticks... Don't like it? Move to an area that has a 24/7 staffed EMS system...
PCT EMS said:
I can join the fire service as a volunteer and get a $1500 turnout suit, the lights for my truck and free medical exams at the local hospital. I can try to get a police job, get a uniform, badge and gun and be above the law while getting paid, or I can
be a EMT, pay for my own stethoscope and pants, and get them puked on.
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I can list several things wrong with what you just said.... But I'll sum it up by saying stay out of EMS (and fire and LEO), because if that's what you think, public safety is much better off without you in it
 
DrParasite said:
and that the trade off that happens when you live in the rural areas.... It's unreasonable to expect city services when you live in the sticks... Don't like it? Move to an area that has a 24/7 staffed EMS system...
I can list several things wrong with what you just said.... But I'll sum it up by saying stay out of EMS (and fire and LEO), because if that's what you think, public safety is much better off without you in it
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Only takes about an hour on-line to get the haters and trolls to chime in.

Fortunately, I was an EMT and have a full med kit at home, and have no need to waste my time with ****s like you.
 
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