Happy Medic said it in response to Ambulance Driver,
One nail, hit on head. I’ve said this before and I no doubt will say it again. There is no shortage of paramedics. What there is, is a shortage of paramedics who are willing to work for the low pay, high call volume, crappy or non existent benefits, sitting in an ambulance for 8-10-12 or more hours, not able to even go to the bathroom without asking for permission, lowest common denominator medicine, that is EMS in much of the country. It’s arguably worse in the private sector, but you have to look no further than NYC to know that the public sector treats much of it’s EMS work force like crap.
Until that changes, until EMT and paramedic educational training programs are little more than diploma mills, until EMS defines itself as at least a trade if not a profession, then nothing will improve.
I’m not sure why AD thinks that 75% of the people in EMS are overpaid, I certainly don’t see them. My service pays better than the average, by far, and yet I don’t know that we are overpaid. I’d guess, knowing him as I do, that he’s seen too many lazy medics who do just enough to get by. No doubt they exist, because they exist in every field of endeavor. Happy Medic no doubt knows fire fighters who do just enough to skate by, I know that there are police officers who do exactly that. I’ve seen doctors who do that too. Many lawyers are cringing as they read this because they know that it’s not how they operate. Still, in every field, those are the fortunately rare exceptions.
Most of the EMTs and paramedics I know work their asses off. What’s odd is that I know a lot of people who left higher paying jobs to become EMTs or paramedics because there was something in their previous careers that just didn’t make them happy.
Either way, for whatever reason, most EMS jobs pay far less than they should. It’s been that way since I started in EMS and I expect it to be that way long after I’ve gone.
If you’re in EMS and want to know why, look in the mirror.
As I said on AD’s blog, a big problem is fire medics who only ride on engines; i.e. medics for fire departments that don’t have ambulances. If you’re going to be a paramedic in the field, you should be transporting patients that need to go to the hospital. ALS fire departments that don’t run ambulances attract people who don’t like patient care, but want to be “paramedics” for the boost to their resume and the pay increase that most fire departments give to medics.
If you believe, as I do, that the first five minutes of just about every EMS call is BLS, then putting paramedics on fire engines is a waste of time. It’s perfectly acceptable to put firefighters trained as EMTs or First Responders on apparatus as long as they can do CPR correctly, apply an AED, and stop
breathingbleeding. There is no evidence that the 2-5 minutes that they might be there before an ambulance arrives will make one bit of difference to patient outcomes in anything but cardiac arrest. Since more and more we’re finding out that Oxygen has no real benefit in most cases, having them put O2 on every patient not only doesn’t help, but may well harm them.Thank you for phrasing it better than I did.
Only I have to fix my inexplicable typo about fire fighters stopping breathing, when I meant stop bleeding. The comedic value may be there, but I’m actually being serious for a change. Thanks though.
mpatk, I disagree with you in general. While I would agree that yes, there are FF/Medics out there who fit this role, I don’t think that you can say that they’re the rule. For example, my FD is a First Responder organization. We don’t transport. Our minimum level of certification is EMT-B, though we have many paramedics and EMT-I’s. Most of us with advanced training have worked for transporting agencies, and still do as a second job. The money and the security (as well as the better management and treatment of employees) are the main reason many of us work for the FD, not simply because we don’t like patient care.
My view may be skewed, as that’s just how my FD is. Maybe it’s a more prevalent problem in other places. But I hate to see FF/Medics generalized that negatively as a rule.
I think you’ve proven my point. You and your co workers are fire fighters because you like the pay and benefits. Fair enough. What you didn’t say is that you think that being fire fighter paramedics (or EMTs) gives you more opportunities to do patient care or that it allows you to be better paramedics ( or EMTs). In the fire service in general EMS is an afterthought, or as some refer to it “A red headed step child”. I hear report after report of EMS being up to 80% of a department’s work load, yet EMS personnel get paid less, have fewer promotional opportunities (that don’t take them out of EMS), or are restricted to being “Rescue Captains” as opposed to real Captains. A few years ago I related the story of a friend of mine who was bypassed for promotion to LT because he “wasn’t a real fire fighter”, even though he went through the same academy, rotated from ambulance, to engine, to ladder, worked the same shifts, and did every other job function every non paramedic fire fighter did. That’s not an isolated case, either.
Sorry. I worded that wrong. When I talk about money, I mean the security of it. A fire medic on my department makes less than a medic working for EMS. About $14,000 less, barring promotions. There is no incentive pay for medics or EMT-Is. The difference is the turnover rate. Sure, EMS pays better, but they drop medics like flies and promise raises they end up canceling. Fire medics here are medics entirely by choice and without monetary gain (outside of possible second jobs).
As far as patient contact and care though, it’s the same.
I guess I just get my drawers in a bundle when people generalize firefighters as bad medics because they’re firefighters. I know it happens. But in my case I just take it personally.
“Hire the over-qualified & starve them to death” seems to be the mantra with many EMS providers. I’ve never understood why the paramedics would put up with it.
Perhaps I’m looking at this from too high an altitude, but the described problem …low pay, lack of respect, poor working conditions, is hardly restricted to EMT’s, paramedics, etc..
It has nothing to do with how hard one works, how lousy the hours are, etc.. There are plenty of difficult jobs that pay poorly.
It’s supply and demand. And lots of people, at relatively little notice and minimal preparation, can become qualified to do that job. (I took an EMT class when I was 17 and still in high school nearly 35 years ago.) Over half of America depends on purely volunteer EMS personnel. Same with firefighters. Is there a quality difference between professionals and volunteers? Sure, but that only matters to the guy lying on the ground. Not to the taxpayer writing his annual tax check. Face it, a lot of the EMS job is waiting for a victim to show up…which hardly contributes to a professional aura. At least no one thinks doctors aren’t busy practicing medicine all the time they are at work.
The service professions all have similar circumstances. The ones that have overcome them the best are those that have implemented strong state oversight and licensing; e.g., lawyers, doctors, architects, electricians, plumbers. Legal barriers to prevent cheap competition.
You’re right. It’s creating a guild to set the bar high for entry that does that. The same for nursing, they have done a masterful job of increasing the education requirements to be a nurse over the past 30 or so years. Would that work for EMS? Maybe. In the case of the fire service, unionization has had the same effect. In most areas EMTs who are also fire fighters make more than EMTs who are not. It’s not a matter of learning two skill sets, it’s a matter of having a union that aggressively negotiates contracts.
It actually should matter to the guy lying on the ground who responds because someone with poor skills, despite what the card in his wallet says, is going to run a greater risk of doing something stupid. For example, would you want someone who just passed the bar to defend you at trial or someone who has tried and won several big cases? I know who I’d want.