Why does EMS make less?

[ExpatMedic0]

I just wanted to gather some interesting opinions on why you think EMS makes less money than other public safety fields (Police and Fire) and other comparable health care occupations (such as respiratory therapy, nursing, ect)

 

[NomadicMedic]

Don't we do this every few months?

Privatized EMS, minimal education standards, and the biggest reason? the excitement factor drives whackers to the field. EMTs are a dime a dozen and in many cases, so are paramedics. There's no reason to pay more... EMTs will work for free to drive an ambulance.

 

[ExpatMedic0]

Don't we do this every few months?

haha sorry I have had a break from the forums for several months. So based on your answers, why; why are those those things drivers for this predicament assuming those are some of the reasons? Why is EMS privatized, why are education standards minimal, why are whackers so plentiful and a dime a dozen?

 

[epipusher]

Don't we do this every few months?

Privatized EMS, minimal education standards, and the biggest reason? the excitement factor drives whackers to the field. EMTs are a dime a dozen and in many cases, so are paramedics. There's no reason to pay more... EMTs will work for free to drive an ambulance.

End thread

 

[Fleury14]

It goes a little deeper than that. The standards are so low because the majority of the privates consist of nothing more than ifts and even with the occasional hot call most people who've taken a basic CPR class can handle it. Then look at how long the fdny thread is. They pay more and have an additional Academy in order to get your skills up to higher standards. It's a tough job to get.
Fire & police can't really be privatized because even though they have their share of ******** calls, their standards are automatically higher.

 

[TransportJockey]

It goes a little deeper than that. The standards are so low because the majority of the privates consist of nothing more than ifts and even with the occasional hot call most people who've taken a basic CPR class can handle it. Then look at how long the fdny thread is. They pay more and have an additional Academy in order to get your skills up to higher standards. It's a tough job to get.
Fire & police can't really be privatized because even though they have their share of ******** calls, their standards are automatically higher.

ACtually fire can and is privatized in certain areas. R/M seems to do ok with that. And honestly, I don't see the private agencies as the ones that are keeping standards low. I see if more as the volunteer fire side and organizations like the NJ First Aid Council that are keeping it low. Every time you see someone speaking out against higher education, the majority of the time it's someone from a volunteer agency that speaks out against it because they'll have a harder time to recruit and retain members.

 

[akflightmedic]

Why do they make less?
A: Supply and Demand

Why is supply high?
A: Entry Education standards are low

Why are Entry standards low?
A:
1. "We have always done it this way"
2. "America was built on volunteers"
3. No collective union representing as strong or as well funded as the IAFF
4. Public perception-Lack of awareness education
5. Reimbursement for EMS services are low thereby requiring low wage earners in order to make a profit
6. When higher education entry standards have been proposed...who protested the most?
A: IAFF
WHY?
i. Job security
ii. Budget Protection

I started writing this in jest and slowly realized I could add quite a few more categories and sub-cats....this might need to be a longer reply, someday....if only I did not have so much apathy on the subject (oh wait, there is another!)

 

[cruiseforever]

I feel I get paid well for what I do. I also think we get the same level of respect that other medical and PD's get paid.

 

[SandpitMedic]

Why do they make less?
A: Supply and Demand

Why is supply high?
A: Entry Education standards are low

Why are Entry standards low?
A:
1. "We have always done it this way"
2. "America was built on volunteers"
3. No collective union representing as strong or as well funded as the IAFF
4. Public perception-Lack of awareness education
5. Reimbursement for EMS services are low thereby requiring low wage earners in order to make a profit
6. When higher education entry standards have been proposed...who protested the most?
A: IAFF
WHY?
i. Job security
ii. Budget Protection

I started writing this in jest and slowly realized I could add quite a few more categories and sub-cats....this might need to be a longer reply, someday....if only I did not have so much apathy on the subject (oh wait, there is another!)

You win the interwebs today.

 

[Carlos Danger]

@akflightmedic hit the nail on the head.

I would add that a large factor that gets surprisingly little mention on these threads is reimbursement: EMS agencies just don't make a lot of money.

Each EMS agency bills the patient and/or their insurance for each transport. Some of those bills get paid at the rate they were billed for, many of them get settled for less than the amount billed, and many do not get paid at all. So each gency, depending on how good of a job they do getting reimbursed, ends with an "average" payment that they receive from their calls. This is the amount of revenue that they receive divided by the number of calls they had to run in order to get that revenue, and it is be used to plan budgets......and set salaries. Anyway, that average revenue per call is a surprisingly low for many agencies. So they end up trying to make up the difference with volume or with IFT's, which tend to be much more secure streams of income.

Bottom line is that EMS is an expensive service to offer, with lots of overhead. Revenue, though, is often low. There simply isn't a ton of money to give out in salaries.

Salaries are higher, of course, where the labor market is tilts in the favor of the employees (i.e., there are fewer potential employees relative to the number of positions) - or where the agencies make more money.

But until the system of reimbursement gets overhauled, there will never be much money in EMS.

 

[SandpitMedic]

I think the whole... Privates don't get reimbursed enough is kind of a hogwash. Admittedly, they probably don't get what they should. That said, I've never met any poor or middle class ambulance company owners....
I think they do alright, or there wouldn't be the large market.

Envision - for example - made like 6 billion in profits last year (and I am aware they dabble in other markets too, no need to make it a big ol deal). And every small ambulance business owner I've met is a ****ing millionaire...

So.... That's my take on that aspect. Wages cut into profits, and with a sea of folks willing to do it do free or for pennies.... Well... Supply and demand.

You guys know - I've been fired up on this topic before. Then I learned here on this very forum, the economics of it trump the "I deserve more for being a hero" mantra.

They could start reimbursing 100% tomorrow. No one will get a raise. Lol.

 

[SeeNoMore]

I also don't see things chaning any time soon as most Paramedics I know who become disatisfied with the pay / education either become Nurses or branch out from working primarly on the street into a variety of other related positions (teaching, consulting, etc) to make the kind of money they want. The rest may be dissatisfied with the hourly rate but are often glad for the abundance of overtime that is so common at many services.

 

[akflightmedic]

Which is another issue unto itself. No one should rely on OT to live, not in our profession.

And I detest when a new hire or prospective new hire bases their employment decision on how much OT they can get.

 

[Carlos Danger]

I think the whole... Privates don't get reimbursed enough is kind of a hogwash.

Think that if you want.

But what is the profit margin for a small private ambulance service versus, say, a taxi company?

What percentage of that profit is spent on payroll?

 

[akflightmedic]

Not sure that is fair analogy.

Most taxi companies do a daily lease or 12 hour lease to the driver. The driver then has to share some of the fare with the taxi company. The driver also has to fuel the taxi.

The company carries the insurance and maintenance hence the ****ty insides of most taxis and rough rides. (Praise Uber).

In a sense, the taxi company has NO heavy payroll costs at least when discussing drivers as they are all typically contractors.

 

[looker]

Lets forgot about reimbursement rate and also supply and demand and talk about education. What could emt can possible do more on bls ambulance with more education when it's just ift. That is the main issue which is why higher education is not being required because it will not actually do anything in terms of offering higher level of service. Now let go back to supply and demand. Yes with higher education you will have less supply of emt but all of them will be over qualified as their higher education will not be put to use

 

[46Young]

Supply and demand as was said above, and it's also in the employer's best interests to keep the barrier for entry education (KSA's) low, to keep the supply high, which keeps wages low. Remember, employers didn't push for nurses to get degrees. The nurses organized, got their degrees, then sold the idea that their increased education is more of a benefit to their patients, and then commanded better working conditions and salary.

Edit: In Charleston SC, Paramedics are paid better than police and fire.

 

[ExpatMedic0]

In terms of the profits and reimbursement argument, it is a possibility, and medicare medicaid aren't exactly cash cows. However, does anyone here have any actual accounting experience for an EMS agency, or even EMS management experience where they have at least seen a "balance sheet"? From what little education in EMS finance and management I have (and keep in mind, I have zero experience), it seems to me that stakeholders and upper management take a much larger chunk of the revenue than mere field employee's get when you analyze the assets and how they are redistributed. Even in "not for profit" organizations, you would be surprised how this money can be redistributed and allotted.
From my experience, an ALS ground transport normally bills at least about 1000 USD at a "non profit" private agency. So how much does a respiratory therapist working for a "non profit" hospital bill for a 30-60 minute patient interaction? How much does a fire department bill for responding to a an issue taking about this much time? Their salary seems to be 25-50% higher than mine on the west coast, is the employer getting reimbursed more for their calls?

 

[triemal04]

Even in "not for profit" organizations, you would be surprised how this money can be redistributed and allotted.

I love the term "non-profit," it's such a non-sequitur for a lot of places. Kind of like "charity"...

From my experience, an ALS ground transport normally bills at least about 1000 USD at a "non profit" private agency. So how much does a respiratory therapist working for a "non profit" hospital bill for a 30-60 minute patient interaction?

A lot. A whole hell of a lot and more than they are paid by the hour when it's all said and done. If you ever have to go to an ER or an Urgent Care, take a look at your bill sometime and how it's broken down and itemized. Good times.

How much does a fire department bill for responding to a an issue taking about this much time? Their salary seems to be 25-50% higher than mine on the west coast, is the employer getting reimbursed more for their calls?

Well that's a sticky subject, and it really depends. While there are exceptions, outside of EMS calls, most fire departments don't bill for services; if your house catches on fire you won't get a nice bill a few weeks down the road. Of course, fire departments get public funding. EMS agencies often don't. If a private has to create all of it's income and revenue stream (and in some cases pay for the right to be the 911 provider in a given area) that creates a very different dynamic than another agency that gets a gaurenteed amount of money from public sources.

EMS, or at least the provision of an ambulance for "medical" transport can be a cash cow for various groups, though the reasons why will vary widely.

 

[akflightmedic]

Do not confuse Not for Profit and Non-Profit...two totally different things and no rule says they cannot make a profit...rules only govern what they do with that profit when it is made.