Why are Paramedics paid so little?

SandpitMedic said:
Enough with the cardiac calls. That's nothing to do with why we are paid minimally, and nothing to do with increasing the educational standards at the Paramedic level.

Let's be realistic, if these changes are going to occur at all, they are going to be minimal. The least common denominator is an Associate of Science degree. If we can move from a certificate based model to an AS model we'd be taking the smallest largest step forward.

Jumping straight into the Bachelor of Science arena is biting off more than EMS can chew. It also is not feasible. Starting with the AS allows the market to catch up, and allows the physicians who devise our protocols a chance to catch up...

The implementation is to be in steps not in leaps. Eventually, I hope to see the top field Paramedic level being, at baseline, equivalent to a CCT Medic with a Bachelor of Science Degree... in several years.... for now, the minimum barrier being an AS will self correct a lot of the problems we face, and better EMS providers. We will always be a hands on, first line, skill set driven employee; supplemental education in CCT skills and academia are what we need as a baseline.
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I feel the most feasible thing would be to get a real national standard, IMO. Don't let states deviate much, set a EMT, Pre-medic, medic, or whatever you want to call them. Don't let a state like NYS, North Dakota, or Pennsylvania do what they do and have 6 different types of Emergency medical responder "ranks"/titles. However advancing EMS in anyway I would like, whether thats with degree's, mandated national standards(higher), or hell even more practical hours.
agregularguy said:
So we can talk all we want about increasing our standards, our education, and what we can provide for our patients all day. But the fact is that as of right now, where is that money going to come from?
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I refer you to @EpiEMS post earlier in this thread, maybe on the previous page.
In my dumb simple answer, Less medics due to educational requirements= more money between the ones that are left.
Money comes with professionalism, which EMS doesn't have much of if im completely honest. Education is key for most problems the US is currently facing in all fields(not just EMS)
 
NysEms2117 said:
I feel the most feasible thing would be to get a real national standard, IMO. Don't let states deviate much, set a EMT, Pre-medic, medic, or whatever you want to call them. Don't let a state like NYS, North Dakota, or Pennsylvania do what they do and have 6 different types of Emergency medical responder "ranks"/titles. However advancing EMS in anyway I would like, whether thats with degree's, mandated national standards(higher), or hell even more practical hours.

I refer you to @EpiEMS post earlier in this thread, maybe on the previous page.
In my dumb simple answer, Less medics due to educational requirements= more money between the ones that are left.
Money comes with professionalism, which EMS doesn't have much of if im completely honest. Education is key for most problems the US is currently facing in all fields(not just EMS)
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You'll always have to have medics. If you can't get enough medics, then you replace them with something cheaper. Look at Delaware for example. Sure, they could spend the money and put a lot more medics on the road at one time. Instead, they choose to put medics in fly cars, and send them only to what they triage as the most critical calls. The rest of the time, they fill in with BLS trucks. (That being said, I LOVE the concept of sending ALS fly cars to only higher priority calls..) Or look at other, more rural areas. They can't always afford or attract higher educated providers in paramedics. So what do they do? Staff with intermediates. Similar care, at less education, and most importantly less money. Same with my city. Down medics for the night? Send out a few pages with incentive shift offers looking for medics, but ultimately they end up loading up on BLS units.
Cheaper for the agency. Does it provide the same level of care? No. But with a lack of medics, they have to do something.

Again, I really do believe we should raise our standards in education. Medics SHOULD have a bachelor's. We should hold ourselves to higher educational, and professional standards. Our patients deserve that. It's just a matter of where the money is going to come from for the changes.
 
agregularguy said:
Again, I really do believe we should raise our standards in education. Medics SHOULD have a bachelor's. We should hold ourselves to higher educational, and professional standards. Our patients deserve that. It's just a matter of where the money is going to come from for the changes.
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If you (profession in general) are looking for a guaranteed return on your investment before taking the plunge then you are out of luck. As with RNs moving towards Bachelors and OT/PT moving towards Masters and even Doctorates the increase in pay and privilege didn't come until years after. PTs whom are now getting doctorates are spending susbtainaly more on their education then they will recoup with current salaries. However they are using their increased education to advocate for more billable services, outpatient practice, etc in hopes that the profession advances as a whole and eventually the rewards will be worth the work. Not saying everyone in these professions are selfless but it seems like a much harder concept for many in EMS to buy into.
 
But chase, all medics want everything handed to them before they are willing to work hard for it.

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I can't really follow all of what people are on about, it's a bit over my head so here's what I can say:

In about 1999/2000, the Australian services (led by Ambulance Victoria) sat down and decided they wanted to move from the old two-year Diploma to a three-year BHSc degree as the base qualification. The first to do this was Ambulance Victoria and over the next decade or so all of the ambulance services in Australia moved to a degree being required for employment. There is now an oversupply of graduates in Australia. New Zealand has done so as well but only more recently perhaps maybe over the past five years?

in Australasia, Paramedics now require a three-year degree and ICPs require a post-graduate qualification on top of the degree. This means it takes somebody between 3.5 to 4 years to become a Paramedic (degree plus the internship once employed) and about seven years for ICP (degree + approximately two years experience as a Paramedic + one year PG qualification + internship). You can literally become a doctor faster than you can become an ICP!

I can't speak to whatever situation those outside of Australasia have; but in my experience if you want to do something; just do it.

If you want, for example like Australasia, your Paramedics to have a degree and your ICPs to have a post-graduate qualification ontop (or whatever you call them) then just do it. You get nowhere with little steps and piss-arseing about. Your professional regulator or body (for example the College of Paramedics or Health Professions Council or Paramedic Board or whatever it is called) just needs to do it and say, right, in five years' time we will not register anybody who doesn't have the required qualification X, and that's it. Put a line in the sand and do not look back. Otherwise you will get nowhere.
 
Like I'd stated in another thread, it seems as though I, or anyone, can effect change on a grander scale so much more with a degree, and behind a desk than in the field.

I think @Chase makes a great point, most field providers have no desire, nor do they see themselves capable of this sort of position. To me, it's sad and keeps us where we are even to this day, chasing our tails.

Before we start going on and on about where the money will come from, we need willing and able minded people to take on such roles so that the masses are given these (debatably) deserving increases in pay. Again, this defines nobility and heroism, not to mention selflessness, but hey let's keep focusing on gadgets, "life saves", and whine about our pay rut...
 
SpecialK said:
but in my experience if you want to do something; just do it..
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Just a quick sidebar, Delaware's ALS system isn't based on cost savings, it's a VERY expensive program to run. It's designed to put medics where they're needed, when they're needed. A small number of medics running high acuity calls prevents skill dilution and "rust out". But saving money with it? Not even a little.


agregularguy said:
You'll always have to have medics. If you can't get enough medics, then you replace them with something cheaper. Look at Delaware for example. Sure, they could spend the money and put a lot more medics on the road at one time. Instead, they choose to put medics in fly cars, and send them only to what they triage as the most critical calls. The rest of the time, they fill in with BLS trucks. (That being said, I LOVE the concept of sending ALS fly cars to only higher priority calls..) Or look at other, more rural areas. They can't always afford or attract higher educated providers in paramedics. So what do they do? Staff with intermediates. Similar care, at less education, and most importantly less money. Same with my city. Down medics for the night? Send out a few pages with incentive shift offers looking for medics, but ultimately they end up loading up on BLS units.
Cheaper for the agency. Does it provide the same level of care? No. But with a lack of medics, they have to do something.

Again, I really do believe we should raise our standards in education. Medics SHOULD have a bachelor's. We should hold ourselves to higher educational, and professional standards. Our patients deserve that. It's just a matter of where the money is going to come from for the changes.
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agregularguy said:
Where is the money for our pay raise coming from?
If you're in a smart, publicly funded third service/municipal/fire based EMS, you're paid through taxes supporting your agency as well as reimbursements for care.
But if you're with an agency like AMR, or other private services which cover a vast, if not majority of America at this point, where is that increase in money going to come from? How about volunteer agencies, who remain volunteer out of either stubborness or complete inability to actually pay for providers?
AMR for example, literally pays the cities near me to be the 911 (and hospital) coverage provider. They make the most money off of IFT's near me, as I'm in a poverty stricken area and Medicare is what's paying most of our 911 bills. Medicare doesn't cover the full amount for services though. They can only reimburse up to X number of dollars. Exceed that amount in providing good patient care, and you're taking a loss for that extra amount of $. I don't have the exact figures off hand, but if you're bringing in a complicated ALS patient with multiple medications, cardiac monitoring, intubation, there's no way that they reimburse the full amount.

So we can talk all we want about increasing our standards, our education, and what we can provide for our patients all day. But the fact is that as of right now, where is that money going to come from?
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I think you just answered your own question: transition EMS from all those private services to a taxpayer funded system. 911/EMS is a money losing system, especially in the inner cities. I'm sure EMS in the rural areas are also money losing, because you don't have the call volume to make it profitable.

Volunteer EMS can work, but they need to bill for services. Volunteers in the 60s, 70s, 80s, and 90s, did EMS a huge disservice, by doing the job for free, and relying on donations. Now that EMS is advancing, and the donations are drying up, people everywhere are saying "wait, now I have to pay for this? lets see how we can get this service now and still avoid paying for it."

I agree, EMS needs a stable funding source, and like most of the public sector, if you want service you will need to pay for it. ditto healthcare, if you want medical care, you are expected to pay for it.
 
My service does a decent job paying for itself. We are a county EMS system that does rural and suburban 911 and we have a NET division that does non emergent transfers separately from 911. Plus those trucks can double up and backup the 911 system if things get busy. We also will occasionally send a 911 truck on an als or CCT run. This has made it so we have a budget surplus of several million and we have just put up two new trucks without any additional funding from the communities we serve. There are ways to do it. But it's not easy and what may work for one place will not work for all.

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TransportJockey said:
My service does a decent job paying for itself. We are a county EMS system that does rural and suburban 911 and we have a NET division that does non emergent transfers separately from 911. Plus those trucks can double up and backup the 911 system if things get busy. We also will occasionally send a 911 truck on an als or CCT run. This has made it so we have a budget surplus of several million and we have just put up two new trucks without any additional funding from the communities we serve. There are ways to do it. But it's not easy and what may work for one place will not work for all.

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Can I borrow a cool million?
 
DrParasite said:
I think you just answered your own question: transition EMS from all those private services to a taxpayer funded system. 911/EMS is a money losing system, especially in the inner cities. I'm sure EMS in the rural areas are also money losing, because you don't have the call volume to make it profitable.

Volunteer EMS can work, but they need to bill for services. Volunteers in the 60s, 70s, 80s, and 90s, did EMS a huge disservice, by doing the job for free, and relying on donations. Now that EMS is advancing, and the donations are drying up, people everywhere are saying "wait, now I have to pay for this? lets see how we can get this service now and still avoid paying for it."

I agree, EMS needs a stable funding source, and like most of the public sector, if you want service you will need to pay for it. ditto healthcare, if you want medical care, you are expected to pay for it.
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I would love that. I think our healthcare system needs an overhaul.
I think it'll just be interesting to see how they (and by they I mean people smarter than I)do it. What works in the south, may not work for the midwest, and vice versa.
 
TransportJockey said:
My service does a decent job paying for itself. We are a county EMS system that does rural and suburban 911 and we have a NET division that does non emergent transfers separately from 911. Plus those trucks can double up and backup the 911 system if things get busy. We also will occasionally send a 911 truck on an als or CCT run. This has made it so we have a budget surplus of several million and we have just put up two new trucks without any additional funding from the communities we serve. There are ways to do it. But it's not easy and what may work for one place will not work for all.

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We just recently did a cost analysis and found that we only cost ~$12 per person in the county. There are ways of making EMS cost effective.


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It's called separating it from the hose monkeys

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Handsome Robb said:
We just recently did a cost analysis and found that we only cost ~$12 per person in the county. There are ways of making EMS cost effective.


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Do you guys bill for transport? (Is that net of transport revenue?)
 
EpiEMS said:
Do you guys bill for transport? (Is that net of transport revenue?)
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Yes we do, but county residents pay far less for our bills than out of county residents do. Out of approximately a 15 million dollar budget (IIRC) we are able to recoup ~10 million through billing and only have to cover the other 5 million with county tax money.

Those are very rough numbers, I'm going off of memory. It's all publicly accessible on our county website.


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Because even though this topic is always being brought up...

Because even though the piece is two years old, and it will never lose its relevance...

And, because every new "reaper-racing-Nightwatch-loving-adrenaline-junkie" should read this, I'll copy and paste this as the blog (I'm sure many of you are already aware of) was referred to me by a good online buddy:

http://www.lifeunderthelights.com/2...more-money-a-guest-post/#sthash.TcyfSpqv.dpbs
 
I guess my definition of little is different from everyone else, but I may be one of the select few. I started out at a terrible AMR shop and spent many nights getting ran into the dirt, off the streets 3 hours late and down 12 reports. I worked my butt off building a reputation as a competent provider and reliable employee. The last two years at my current job i made 50k and 52k. Thats 8k-10k more a year. This year im on pace to make 60k and havent worked overtime beyond my regular schedule (kelly schedule).



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VentMonkey said:
Because even though this topic is always being brought up...

Because even though the piece is two years old, and it will never lose its relevance...

And, because every new "reaper-racing-Nightwatch-loving-adrenaline-junkie" should read this, I'll copy and paste this as the blog (I'm sure many of you are already aware of) was referred to me by a good online buddy:

http://www.lifeunderthelights.com/2...more-money-a-guest-post/#sthash.TcyfSpqv.dpbs
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not for nothing, but there are numerous things wrong about the piece you posted...

To start with, EMTs IS a skilled profession. there ARE requirements for entry. It might be a low skilled profession, but its not like you can hop on an ambulance with 0 education and 0 experience and do anything when faced with a sick patient (we will assume the volunteers who do this are doing so under a more experienced and educated provider). there are entry level requirements, but they are just entry level requirements, not the end all goal.

I'm not going to say it's a difficult class, but most decent classes do have students fail out or get dropped due to poor performance. the fast food industry has 0 requirements to get hired.... you might need a HS diploma. the EMT class I run is around 240 hours, with tests that you need to pass or else you get booted from the program. The two week boot camps and super condensed programs are an embarrassment, but that's what happens when you add for profit entities and the fire service (do whatever you can to get them certified the quickest, regardless of if they know what they are doing afterwards) to the list of EMS training entities.... lets do the bare minimum and get it done as quickly as legally possible to maximize revenue and minimize work time.

I will agree that the supply outweighs the demand; but that's what happens when you have training programs pumping out more EMTs and paramedics than their are jobs. the other question is how many of graduates are working full time in EMS following graduation; I would imagine the number isn't as high as you would believe.

In some areas the police and members of the public can administer medications that you are not allowed to. And even if you were truly the heroes you believe yourselves to be, so what?
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oddly enough, I agree with the statement; if the general public can give meds, or a non-medical person working in another field, why can't the "medical professional?" But it's irrelevant to the topic at hand.

The bottom line is, EMS is a profession to some..... and if you are working in a profession, you should get paid a living wage. If you don't like what you are being paid, and you think you are worth more, than either explore other opportunities with other companies, go to school to make yourself more valuable to your employer, or leave the field altogether, and enter a different field where you will be paid more. When enough people leave, and agencies can't get people to accept piss poor wages, than wages will increase (remember the whole supply and demand principle?)

BTW, there are plenty of "certifications" in the real world that are shorter than EMT class..... just go to any community college and see what "test prep" classes they offer. Many are not in healthcare, and many will result in getting paid more than you will make in EMS.
 
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