Pay Disparity of EMS Workers

Currently, some of our EMS brothers and sisters, depending on what part of the country you’re from, and whether you’re private, hospital, or government-based, are at the bottom of the pay scale of most career professions.  Garbage men most of the time make more then we do.  Most of the other professions that rank above us and are paid more aren’t dealing with people’s lives and making life or death choices as we are.  Also these other, more lucrative professions, aren’t walking away from their careers with bad backs, nightmares, cynicism, and other negative repercussions from being a part of the field we are.

Once the EMT is injured, what are his options?  They can move into teaching EMS, which could potentially be a similar pay scale or a bit more.  They can move into management, if positions are available, which unfortunately aren’t very often.  There are ED technicians, HAZMAT, rescue, and similar, but these also include lifting skills so this may not be an option.  Plus for some of these, the pay scale is much lower.  So what are other options for them if they were to get hurt?

Once the paramedic is injured, what are their options?  Can they branch out laterally like a nurse into different units?  They have very similar skill sets.  Unfortunately not.  Nurses have a very broad knowledge base and can easily shift between nursing fields, whereas paramedics have a very select set of skills that are very unique to what they do.  There really is not any lateral movement from where they are to another field.  If they wanted to go back to school to learn new skill sets, then they would be able, but not everyone has that ability financially and time-wise given present life loads and financial responsibilities.  They could also, as EMT’s,  move into teaching EMS, but they would take a drastic financial decrease in pay.

What about paramedics moving into a “Community Paramedics” position?  This is where paramedics visit persons at home to follow up on hospital visits to see if patients are compliant with their medication and care regiments so as not to have readmittance back into the hospitals whereas Medicare and Medicaid won’t pay for the return visit.  In some communities, these programs have been successful, whereas others it has not.  If further training would ensure an easy transition into this field. then that might be an option.  I would assume pay rates would be comparable.

This is why EMS seems to be such a transient job, and not a career.  People know going in that it potentially will not support them and their families, that there might not be any ability to move up the career ladder, and that if they were to get hurt, would they have options?

So what is the answer?

• More education initially to become a paramedic?  Minimum mandatory Associates degree, with a bachelors degree to be obtained within “X” amount of time working in order to retain your employment?
• How about broadening our scopes?  Give us more training along the lines of nursing skills.  This would certainly make us more competent and valuable both in the field and if working in a hospital system, within the hospital as well.
• How about giving us licensure vs. or certificate certification.  Once again, this would certainly give us more creditability.  Some argue that our certification in a quasi-license, but I’m sure that there are many, including the ones who pay our paychecks, who would argue against acknowledging this on the basis of pay scales.

I believe potentially the various systems who either employ us or govern us (government entities who mandatorily have to provide EMS systems for their jurisdictions) would be fighting this change given the fact that they would have to pay us more.  But once again, we would be more valuable to the system as a whole, and we’d be able to work more places in the hospital if need be.

But then who would be against this?  Potentially nurses.  They might feel threatened that we could take some of their positions.  I can see the nursing union fighting that wholeheartedly.  And that would be a shame because I see all the time there is a nursing shortage.

So would it be an option to band together nationally to form an EMS Union specific to ourselves and no other entities?  It worked well for the nurses.  They are very powerful.  let us set up our own “Paramedic Rules” like they have “Nurses Rules”, that no one else abides by.  It worked for them.  Minimally we need to band together and address the legislature for support on a national level.  If we were to push this as a united front, we just might be able to make a difference.

Paramedics in New JerseyBreaking Out of their Boundaries

What happens when a paramedic in New Jersey has a back injury and can’t work in the field anymore?

If they’re lucky they might be able to secure a supervisor’s position “IF” one is available.  Some systems only have a handful of supervisorial positions and that doesn’t loan itself out to be a viable option since many times few supervisors quit before retirement.

They may be able to transfer over to education if (a) they are a good teacher, and (b) if positions are open.

Or they may be able to move up into the corporate side of running the EMS department once again if there are positions “open”.   Here once more, few persons who work their way up the ladder into one of these positions readily leave opening up a spot for someone else’s advancement.

So what is one to do?

It would be ideal if the state allowed for the lateral movement of paramedics given their skill set.  Doctors’ offices, clinics, and other healthcare-related professions could profit from the influx of skilled paramedics, but the state’s laws do not permit such deviation from their very specifically outlined existence.  If they don’t specifically work under the medical direction of a hospital environment, they are not allowed to perform any of the duties they’ve spent years of education learning and years of training perfecting.  They are tucked into a niche and a corner to which they cannot escape.  Pigeon-toed into being held hostage by the system unable to expand their horizons.  So in essence, they can’t go anywhere.

But if this were Florida, this would not be the case.  Florida allows for a great deal of flexibility.  Their paramedics are able to bridge that gap and work for other healthcare settings, and to date, it’s been extremely successful.

Why can’t this be done in New Jersey?  If the country has been transitioning towards being universally consistent across all states through the NREMT so as everything is standardized, why would there be such a huge disparity between the abilities of paramedics in the same system?

Now one issue that differentiates the two states is the mandate that New Jersey paramedics have to be paired in order for both medics to be able to perform their duties whereas in Florida there is a “one medic one EMT” system, and they are constrained by this ruling.  (There are numerous arguments for whether this is good or bad, and this discussion is not going to address that issue.  Please see above posts for thoughts concerning that).  But that one factor alone, whereas a medic down in Florida may perform his duties without another medic present lends itself better to a medic being able to work in another setting vs. the system in New Jersey.

But there is a bill coming through New Jersey legislature promoting the “community paramedic” which might push us in the right direction to overcome this one obstacle.   If a community paramedic can work individually, apart from another medic, then this sets the groundwork for potentially having more change in the future with further legislation being passed towards possibly allowing paramedics to also work under a doctor’s license outside of the hospital and the hospital’s medical command.

We as paramedics have a great skill set that can be extremely beneficial to many other healthcare organizations, we just need to come together and work towards broadening our ability to branch out.  If we could do this, it would be a huge asset to not only those present in the field but also those who need to retire from the truck because of health reasons but aren’t financially stable enough to physically retire and just need to move to a more amicable setting.

Let’s come together and make things happen!

Pay Disparity – EMS vs. Police & Firefighters

Currently, we do more training (2 years) than both fire and police but are paid considerably less.  This does not include ongoing training each year to uphold our certifications.  On the basis of work performed while in the field, we do exponentially more than both entities as well based on the interaction between all professions regarding people encounters.   As far as being in the line of danger, though we don’t face as deadly a degree of danger as police, we are predominately in more potentially dangerous situations that police, and at times, when they aren’t available, can be in the same degree of danger.  As far as firemen, the same rings true other then we don’t go into burning buildings.

And though we aren’t paid or given the same recognition as police and firefighters, our line of duty death rate, suicide, divorce, and substance abuse rates are the same.  I’m not even going to start talking about flight medics, because those numbers become exponentially higher.

Also, though we aren’t given the same consideration as  “essential personnel”, wait till the next tragedy that strikes, whether big or small, who are they going to call?  It ain’t going to be “Ghostbusters”, it’s going to be us.  Without hesitation.  Just because Medicare and Medicaid have set certain prices, doesn’t mean that our lives are dictated by this standard.  When someone is trying to burglarize your house or kill you, does anyone warrant how the police operate and respond based on how much you’re paying in your taxes?  No, they respond for both the homeless person on the street who’s attacked or the wealthy mansion owner.  If a house in the slums is burning down or a mansion in the hills, is the firemen going to respond based on tax revenue?  Absolutely not.  Their existence is not dictated by who’s paying their paychecks.  It’s backed by taxes which are paid by all.  So, since we’re called collectively as they are each and every time there’s an emergency, why are we not compensated similarly, by the same pay system?  Why are police and fire necessary entities and we aren’t?  If we’re not that important, stop calling us…..  Put them in the police cars and firetrucks and drive them to the hospital!  Let’s get out of the M&M system and get in on the government system like everyone else.  Then let the government fight the M&M system for better reimbursement.  I’m sure they will do a grand job because you know one thing about government, they hate competition!  They hate anyone who’s stealing worse then they are!

We need to classify ourselves as Public Service entities in order to even be considered for a third entity and higher rates of pay.  Currently, we are classified as “Healthcare, Other”.  This has to be done nationally in order to have any creditability.

This pertains to any unionization as well.  If it’s not done on a national level, then all the individual rinky-dink unions don’t have any real power.  If it’s done on a national level, this becomes a very powerful entity, similarly like the police’s, nurse’s, and fire’s (IAFF) unions.  In this situation, if there were to be any type of a walk-out, it would be national.  Individually with the amount of money EMS workers make, even if they wanted to walk out, they couldn’t afford to either for financial reasons or for the possibility of losing their jobs.

Also if we’re looking for more creditability nationally, we need to incorporate more education and training into our field.

One Paramedic One EMT System

The state is trying to correct the shortage of paramedics with going to a one paramedic one EMT system.  Yes, the majority of calls we handle, one paramedic is all that’s needed, but for those really sick patients, two paramedics are absolutely needed, and who is going to roll the dice to know exactly which patient is the one who needs the “two paramedics”?  Plus the fact that in a single paramedic system, paramedics don’t have each other to buffer and learn against meaning that skills can decline.  Sure we can compare notes and chat after the calls, but that isn’t the same as having that “in the moment” “do or die” experience to really train when the “chips are down”.  There’s really no textbook that can give you the life experience and training that occurs when you have that seriously ill patient and you are learning from the paramedic that has 20 years experience.  Some of those moments are invaluable.

It has been argued that two paramedics “one stone sharpens the other” helping each other grow can be supplemented by in house simulator training, but it’s also debated that not everyone learns effectively by being in a simulator style training scenario.   Some say that it’s not realistic enough to learn effectively.  I’ve seen 25-year paramedics and nurses who wouldn’t skip a beat in the field, trying to associate on a manikin, and just having a difficult time just because it’s not a real situation.

Another repercussion to consider, if we go down to a one medic one EMT system, is the potential to lose some advanced skills and techniques that are only authorized to a two-paramedic system – i.e. – RSI and some other advanced techniques.

What we do know is that a lot of this discussion is just that – discussion – as there’s not a lot of data so far to back up this debate either way.

What do you think?

Overtime Battle vs. Properly Staffing Teams?

The company’s complaining that they’re not making budget  (Are they actually not making budget, or are they just not making enough profit?  We’ll never know for sure).  But they’re holding off on staffing “ALL” the trucks on the tour even though there are people willing to work.  They cite that the reason is the “budget”.  So what happens now?

The personnel on the team are running their axxes off trying to make up for the loss of trucks and everyone is pissed off.  People are getting burnt out physically and psychologically and morale is down.  So what happens next?

When employees are in a service-oriented profession where person to person interaction is paramount, any negativity has the potential to affect patient care for even the strongest and most positive of providers.

When employees are continually working in understaffed environments and becoming burnt out typically they consider going elsewhere which now compounds the existent situation.

When there aren’t enough trucks on the road, patients are waiting longer for ambulances.  When there aren’t enough paramedic units on the road, sick patients aren’t getting necessary advanced life-saving care.

When patient care suffers, patient reviews become negative, when reviews are negative, Medicare and Medicaid reimbursement suffers.

So in the end, are companies really saving with keeping their tours minimally staffed?

I there some balance?