Why is it so difficult to earn a decent living working EMS?

[Goose 188]

As per the title, why do you think it's so difficult to earn a decent living in EMS?

This has been something that has been eating at me lately and i figured it might be an interesting/worthwhile discussion.

Take the average medic (I'm not one):

- Goes through anywhere from 1 - 2 years of school at the college level to become a paramedic which is far longer than even a 6 month PD or Fire academy (plus, it seems like most pay their way through school and work).

- Has to sit for state and local exams to become credentialed

- Has to attend a variety of continuing education programs including physician contact hours to maintain both state and local credentials

- Is faced with a constantly changing field where things are being subtracted, added, new techniques and equipment introduced.

- Thats just to do the job, factor in everything else (long hours, high volume, potential job related injuries/dangers, etc.)

I guess from where i sit this is pretty much on par with or exceeds the requirements/expectations of being a cop or firemen yet a rookie paramedic is lucky if he/she makes 20 bucks an hour, has an ambulance that runs, half-way decent equipment and has to work a second job just to survive.

So, what gives? Is it the commercials? The vollies? The politicians? Ourselves? A deadly combination of everything? And how, most importantly, do we fix it?

Edited April 7, 2009 by Goose

[Guest]

If you get outside the Northeast it seems the systems (Fire Based) pay much better, even for 'just medics.' Take Baltimore County, for example, medics start at a little more than $45k, which is far more than the starting salary for FF/EMTs ($33k). I can't speak for the commercial agencies (of which do strictly interfacility transports) pay for medics, but it seems that once you get rid of the commercial system, and make it a union protected, civil service job, everyone does better.

[Goose 188]

If you get outside the Northeast it seems the systems (Fire Based) pay much better, even for 'just medics.' Take Baltimore County, for example, medics start at a little more than $45k, which is far more than the starting salary for FF/EMTs ($33k). I can't speak for the commercial agencies (of which do strictly interfacility transports) pay for medics, but it seems that once you get rid of the commercial system, and make it a union protected, civil service job, everyone does better.

I think once you leave the NYC metro-area things tend to improve exponentially.

The reason i created this thread was to see if i was the only one that was bothered by the way things are. I mean, it just doesn't make any sense to me.

[Guest alsfirefighter]

I'm not overly bothered as I'm fire based (which as most of you know is what I think are the better systems often).

However I think there are several issues...which goose..excellent points on the education and so forth.

1. The bottom line. Privates are out to make money, so to get contracts they have to bid, to be competitive they must have market average bids, and are not going to be eager to spend money on things that will cut down on the money flow. They also won't band together to get better pay for their employees as they want the business.

2. Lack of strong unions of the lack there of any representation. How resistant are most companies to the unionizing of their businesses? Ever wonder why? See #1.

3. The employees...there are those and we all know some that will whore themselves out to anyone and everyone to make a buck themselves. Little did they know if they were union and had some sense of understanding they'd be working in one place and would making 5 bucks instead of the buck they scrap for.

4. Lack of stability. When companies rotate in and out of towns and municipalities like I change clothes...how can anything improve?

The answer is you have to be fire based or municipal based. Some may not think that's right or wrong..but its a fact.

[firemoose827 324]

I was Full Time EMS back in 1998, right before I lost my EMT-CC card. (Actually, I let it go, didnt loose it) I was an ALS provider making only $7.50/Hour...You think $20/hour is bad?? What we made was disgusting to say the least, and we did both 911 calls and inter facility transports, and ran around the clock. We were lucky to get any sleep at all.

I wasnt going to take that treatment any more so I went to PT status and got another FT job. EMS Is fine for people just out of High School or dont have families to support, but once you have a kid, mortgage, etc etc, its a different ballgame all together.

I just recently however received a raise through my PT EMS gig and went from $7.96/hour to $10/hour...a Little better, but still not even close enough to what EMT's and Medics should get.

Do you know whats even worse? The person standing in the middle of the road with an orange flag, no High School diploma, no formal training, and certainly no ability to save a life, directing traffic around construction sites gets $20-30/hour??? THATS what gets me even madder than before. Paramedic; College level training+State Exams+CME credits+recertification every 3 years+professional conventions+SAVING LIVES= $7-20/hour.

Flag Man; High School Drop Out+no trade skills+standing in road waving arms= $20-30/hour...Hmmmmm, am I, as a junior in high school, going to pass any more tests? Or just sign up for the nearest construction firm??

I agree with what ALS stated as well, it wont get better as long as the private companies are in charge and lining their pockets.

[PCFD ENG58 1,085]

Time to get a flag! , or a union.

[AFS1970 504]

One other factor to this is that EMS is a relatively new service, as compared to Law Enforcement and Firefighting. While there are some agencies with long and proud traditions, the service as a hole is not that old. Remember Ambulances were run by undertakers, or it was the hospital, sending one out with no medical personnel. Watch an episode of Emergency and see just what the Ambulance drivers do vs what the Fire based Paramedics do. Of course this is not the case now, but when you look at wage and labor issues at the same point in the history of any police or fire department, I would bet you see a pretty similar picture, not that this helps those currently employed in the field.

[50-65 205]

I'm not going to say that vollies are THE problem, only that they may be part of it. When I worked commercial EMS, we would have EMT's complain about the hours, complain about the low pay, complain about getting held for OT, then try to leave early so they could go volunteer at their corps. Admin figured why pay them more if they're willing to do it for free.

Personally, I feel, that until EMS has NATIONAL standards, NATIONAL recognition, and becomes another profession (as it should) with a clear advancement ladder, we will be going no where.

Set national standards. Make ALS a licensed, degree based profession. Basic EMT

should be a starting point in a career, not a career in its self. ALS providers should be the standard of care pre-hospital, but not necessarily the top of the career ladder. If you were part of a hospital based system, maybe that career ladder could include EMS management, education, nursing, PA, MD, etc. Make EMS part of the health care system.

While on the subject of national standards, can anyone explain to me how a person's physiology changes when they cross a town, city, county, or state line? If it doesn't, then why do we treat people differently for the same problem depending on where they happen to be?

EMS should be a service just like fire and police. Fire and police have standards for employment. EMS? You have a pulse and a card, good to go. If EMS were municipal based, say, on the county level (maybe a seperate city-based system for larger urban areas), you could set standards, have a little more control over the professional level of provider.

But, until we all stop trying to cut each other's throats, stop fighting like little children, and actually work together for all our good, nothing will change.

As far as unions go, I believe that with a decent proposal, and some fair bargaining, you could probably start with some of the commercials. But the union can't expect to win their top goals in the first contract. It would have to be a process. Start with the smaller things like employee representation, recognition, disciplinary and grievance process', terms and conditions of employment. Then move into rates and pay structure, health benefits, etc.

[CFD320 35]

I'm a career FF and I don't make $20/hr either.... All emergency service personnel are undervalued and underpaid, the problem is nobody thinks they are ever going to need FD or EMS...

[Goose 188]

Solid comments by ALS, Moose and 50-65, all well appreciated.

So what do we do to change all of this? Do we write our political representation? I know i've tried the latter - wrote Nita Lowey a 3 page letter about dismal state of EMS and why we need more funding and advocacy in DC and got nothing, absolutely N O T H I N G in response.

I'm not sure what it's going to take, will all the smoke and mirrors ever fade and the truth be revealed?

[moggie6 54]

County or fire based programs with Union Representation will be a good place to start to look for your answers. However I don't think NY is ready for a county based ems or fire system.

[Goose 188]

I'm not sure there is a reason not to be ready. There are countless well-run County systems out there, why can't we pull knowledge from them? It's not like we are re-inventing the wheel here, if anything we are catching up to the 21st century.

I guess my the bottom line is that no one cares, period.

[Tapout 42]

By far, the best ED RN's I have ever worked with started out as medics and got into nursing as a 2nd but in many ways overlapping career path. So many of the skill sets and clinical expertise are the same... often the medic actually knows more than the RN, having seen, done and experienced more (so many more times) at the front line--- before all the fancy machines and monitors are available and all nicely set up and ready for attachment to the pt. But the combo of the 2 perspectives makes for an excellent ED RN - ready to get hands dirty, able to wing it and improvise when things don't work/break/explode, immune to crazy stress levels at least in the heat of it, etc. That all translates to much better outcomes for patients.

To become an RN, you need 2 years of college to get an associates degree in nursing (and a community college ADN is just as good as a BSN from Yale), pass the NCLEX RN licensure exam, and then get a hospital job making $25-28 per hour base as a new grad.

Work a few years and get into an ICU or ED and bump up your pay to $35+ per hour. Get a bachelor's degree in pretty much anything (even basketweaving) and your pay grade will go up yet again, often into the $40+ per hour range.

Look, don't go piling on this pro-RN rabbit, all EMS and 1st responders out there. I'm not trying to lure any of your people away from the front lines. I'm just suggesting another FUTURE route if you still want to help people but also have mortgages and car payments to cover,and your backs are tired and broken from humping stretchers up flights of stairs for so many years.

[Goose 188]

By far, the best ED RN's I have ever worked with started out as medics and got into nursing as a 2nd but in many ways overlapping career path. So many of the skill sets and clinical expertise are the same... often the medic actually knows more than the RN, having seen, done and experienced more (so many more times) at the front line--- before all the fancy machines and monitors are available and all nicely set up and ready for attachment to the pt. But the combo of the 2 perspectives makes for an excellent ED RN - ready to get hands dirty, able to wing it and improvise when things don't work/break/explode, immune to crazy stress levels at least in the heat of it, etc. That all translates to much better outcomes for patients.

To become an RN, you need 2 years of college to get an associates degree in nursing (and a community college ADN is just as good as a BSN from Yale), pass the NCLEX RN licensure exam, and then get a hospital job making $25-28 per hour base as a new grad.

Work a few years and get into an ICU or ED and bump up your pay to $35+ per hour. Get a bachelor's degree in pretty much anything (even basketweaving) and your pay grade will go up yet again, often into the $40+ per hour range.

Look, don't go piling on this pro-RN rabbit, all EMS and 1st responders out there. I'm not trying to lure any of your people away from the front lines. I'm just suggesting another FUTURE route if you still want to help people but also have mortgages and car payments to cover,and your backs are tired and broken from humping stretchers up flights of stairs for so many years.

All of that is all well and true but it doesn't address anything for EMS. It does prove the point, however, that even after essentially the same education there is a disturbing disparity in compensation. I've never worked with a Medic who was making 28 bucks an hour, and we are talking about men and women who have 6 - 20+ years on. Thats a major problem.

But, like many have said there is no single be all, end all solution to this. The first step, in my mind, is to educate the public and the politicians as to what the truth on the ground is. Show them the cold hard facts, that may stir things up a bit.

Edited April 7, 2009 by Goose

[Bnechis 3,961]

There are many reasons but the biggest is in the NY Metro Area its not a municipal service (FD, PD or 3rd).

Look at systems in FL., AZ., MD., etc. mostly fire based municipal. What's different about them? To start with employees stay for 20+ years. Sr. medics are often fire officers who now supervise newer medics and make a living wage. In NYS the average medic is in it for less than 7 years.

What are the economics of EMS?

EMT is a great 1st job. Your 18 years old with a HS Diploma and 4 weeks (160 hrs) of training and make $20K - $35K per year, while living at home with mom & dad. You get to buy your 1st brand new car and have some fun.

You cant raise a family or buy a home on it. but your having fun. And if mom & dad want you to go to college you can go to community college, get your medic, a raise and keep them happy. Plus the job is 24/7 so you can work & go to school.

Some additional problems: if you leave for any reason, there is another 18-21 y/o ready to jump into your slot, so the companies do not need to pay a lot for retention.

Unions: I've worked both union & nonunion EMS, they can help, they can hurt I've seen both. My best paid EMS job was non union.

VAC's: As stated before why pay when they will do it for free has a little to do with it, but how many VAC's have perdiem medics & EMT's working multiple agencies to make it? Make it civil service, merge them into a big enough pool and stop accepting nickles and dimes.

licensed: Doctors, Nurses and Barbers are licensed, the difference is they have a lot more training, not the license. Did the pay change in CT when they went licensed?

National Standards: There are basic national standards, but the same can be said for FD, PD, RN's and many others, this has no real bearing in the economics of the problem, low bid services.

How many communities even know what type of service they have? How many are "demanding" the best?

Municipal Officials: We proposed a municipal service in NR. With one of the cornerstones being the ability to attract & hire the "cream of the crop" by limiting the total number of medics and offering better pay & benefits. The City administration was not interested in improving quality and asked will our service have the same NYS Certified sticker as the commercial service. When we said yes, the answer was "thats good enough".

Until there is regionalization of EMS, I think it is highly unlikely to ever make major improvements.

[NWFDMedic 58]

The real answer here has nothing to do with union v. non-union or municipal v. 3rd service, the answer lies in the cashflow into EMS.

I'm sure most of you couldn't name another field where the government is allowed to set the price of your product or service. Could you imagine if Obama went to Ford and told them that an F-150 that they are selling for $30,000 is now going to be sold for $10,000? The good news is that the government will pay you that $10,000 but the bad news is that you cannot bill the buyer of the vehicle. Oh, by the way Ford, you don't have a choice... you have to give the F-150 to anyone who requests it; you cannot turn them down, even if they don't qualify for the $10,000 government payment.

EMS is a tough business in which to remain profitable. One can make arguments for or against unions but I've seen good and bad results. One can also make an argument for municipal service but you really need a good tax base to make that worthwhile. A town in this area went for a "quasi" municipal service over a third service... the result was a 270% tax increase and less coverage than the town had to begin with with the third service.

I think the best thing we can do to better the standard of living in EMS is to go out there and work. We should be constantly pushing to increase our scope of practice and increase the amount of education that is required for the job. Education is not the enemy here; it's the opportunity. The more we can do, the more valuable we become and eventually... the more we will get paid. Nurses weren't just given money without working for it; the scope of their profession has changed a lot in the last 30 years.

[NB514 0]

I too do not feel that this is a union issue. In one aspect, Paramedics choose to put themselves through the schooling necessary to perform the job and take a spot in a commercial ambulance agency for average pay. In another aspect, the oppertunity to be a civil service medic in this area is slim to non-existant.

We (north of NYC) have the luxury of having enough commercial ambulance agencies that it isn't necessary to hire municiple paramedics. This keeps the cost down, which keeps their pay minimal.

Consider a volunteer FD. If you can get people to volunteer their time, why spend money to pay people for it? In my opinion the same is true for EMS. If you can contract a commercial agency for a marginal cost as opposed to paying your own (mainly unionized) people much more for the same job, then why not?

I think it is an abomination that medics make as little as they do. Maybe the question isn't why is it so difficult to make a living as a medic, but how can we make medics more appreciated in order to earn a better living?

[50-65 205]

How do other, nearby, states/areas compare to the lower Hudson Valley region as far as pay goes?

If you search the job boards, there seems to be a decent amount of jobs available in NJ, a few less in CT, and very little in PA.

[Raz 14]

I too do not feel that this is a union issue. In one aspect, Paramedics choose to put themselves through the schooling necessary to perform the job and take a spot in a commercial ambulance agency for average pay. In another aspect, the oppertunity to be a civil service medic in this area is slim to non-existant.

We (north of NYC) have the luxury of having enough commercial ambulance agencies that it isn't necessary to hire municiple paramedics. This keeps the cost down, which keeps their pay minimal.

Consider a volunteer FD. If you can get people to volunteer their time, why spend money to pay people for it? In my opinion the same is true for EMS. If you can contract a commercial agency for a marginal cost as opposed to paying your own (mainly unionized) people much more for the same job, then why not?

I think it is an abomination that medics make as little as they do. Maybe the question isn't why is it so difficult to make a living as a medic, but how can we make medics more appreciated in order to earn a better living?

You're talking in circles. Especially that last sentence.

First off, the volunteer FD analogy is full of holes, because EMS has clearly definied guidelines as to what's acceptable and what's unacceptable when it comes to certification. While a volunteer FD can get by with the old smoke and mirrors of "we have X amount of members", a VAC has to have documentation of every single EMT under their umbrella (including recert dates, etc.). The strain of maintaining qualified people makes any comparison to the Fire Service unreasonable.

Also, unlike the Fire Service (discounting the grey area of code enforcement), EMS has a bonafide available revenue stream. After all, commercial services wouldn't exist if there wasn't money to be made, right? I'm not saying that municipalities will see a profit, but a rather sizeable portion of the cost of running a service can be recovered and offset if you do your own billing. Further reduction in costs could come from integrating EMS into your existing FD, after all, you're already paying the guys to train and wait around for emergencies, right?

I'm not saying that every podunk town should go out and get a municiple EMS system, but there are places with paid PD's and FD's that have no municiple EMS, and that just doesn't make sense to me.

Of course, when you have someone who's willing to go to school and do the work for pay that puts them below the poverty line, while saying they don't need a union and praising the low cost of commerical EMS, I don't expect anything to change.

[Guest alsfirefighter]

I too do not feel that this is a union issue. In one aspect, Paramedics choose to put themselves through the schooling necessary to perform the job and take a spot in a commercial ambulance agency for average pay. In another aspect, the oppertunity to be a civil service medic in this area is slim to non-existant.

We (north of NYC) have the luxury of having enough commercial ambulance agencies that it isn't necessary to hire municiple paramedics. This keeps the cost down, which keeps their pay minimal.

Consider a volunteer FD. If you can get people to volunteer their time, why spend money to pay people for it? In my opinion the same is true for EMS. If you can contract a commercial agency for a marginal cost as opposed to paying your own (mainly unionized) people much more for the same job, then why not?

I think it is an abomination that medics make as little as they do. Maybe the question isn't why is it so difficult to make a living as a medic, but how can we make medics more appreciated in order to earn a better living?

Did you actually read your own post before you hit the button?

1. Keep thinking its not a union issue. Most privates in the burbs do not have any representation of their collective bargaining rights. Then wonder why you get those silly little "merit" raises which most know are BS and not even fair. One agency I worked for on their "merit" raise evaluation form still had a spot for a rating for the black boxes in their vehicles. They weren't even using them at that point but still assigning employee's a "0" for that section causing a lower raise percentage. Oh yeah that was fair and without any union what was the recourse or action taken to stop it?

2. As Raz so poignantly stated...how can you make an argument against your own argument in a single post? You have the "luxury" to have enough commercial ambulance services in the area that it isn't necessary to hire municipal ems providers? And this keeps the cost down? Then you want to say how can you make them more appreciated and that its an abomination that medics make what they do. Well which one is it? The luxury that commercials drive the prices lower to cause the abomination you so speak about? Or the appreciation part? Cause most commercials appreciate them very much that they bounce from agency to agency to make the peanuts they do and with no collective bargaining to force them to give decent raises and working conditions.

3. Why not hire your own? Maybe its the fact that you like to make $6 an hour or you have nothing better to do. However, how about the simple fact that you control the hiring criteria and standards. Not whoever was available that day to fill the spot as in most commercials services. Or the person who happened to stroll through the door with or without a card filled out an application but meanwhile can't so much as lift the first in bag, less a patient on a stair chair. Standards go a long way. Why not have volunteer garbagemen? Oh I'm sorry sanitation engineers. They're unionized as well aren't they. Or what do you then do when no one answers because they aren't getting paid to do it? Weak argument.

Let's not forget something...sometimes you get what you pay for! And sometimes people are worth what they are paid.

[ny10570 745]

unions would absolutely go a long way towards fixing the money problems in EMS. Without it, why would employers pay more for someone with more experience when they can just keep on hiring the latest tech out of school for many dollars an hour less.

[Goose 188]

There is a lot of talk about Unions and representation. I've thought that some day this may be part of the solution, but i have never heard good things about EMS unions - and that is coming from men and women who work union EMS. It's not like we have an equivalent to the IAFF or PBA that has any sort of political leverage in DC/locally and authority at the bargaining table.

[gamewell45 258]

Do you know whats even worse? The person standing in the middle of the road with an orange flag, no High School diploma, no formal training, and certainly no ability to save a life, directing traffic around construction sites gets $20-30/hour??? THATS what gets me even madder than before. Paramedic; College level training+State Exams+CME credits+recertification every 3 years+professional conventions+SAVING LIVES= $7-20/hour.

Flag Man; High School Drop Out+no trade skills+standing in road waving arms= $20-30/hour...Hmmmmm, am I, as a junior in high school, going to pass any more tests? Or just sign up for the nearest construction firm??

I agree with what ALS stated as well, it wont get better as long as the private companies are in charge and lining their pockets.

You know why? Because the flagman is most likely a member of a union. I have a friend who flagged both union and non-union; when he worked union he made $35 an hour; when he flagged non-union, his pay went down to $11 an hour and he has a high school diploma.

What honestly needs to happen is for all private sector EMS workers to organize under one union; one that has a good track record of representing their members at the bargaining table. If the "Free Choice Act" goes through as expected, it will make it a lot easier to organize. Only then under the strength of collective bargaining will terms and conditions of employment improve for everyone. One other thing, the union is only as strong as the members of the bargaining unit; if members are strong and united, then the contract will reflect that. Another reason why Fire and Police contracts are so superior to their non-union colleagues; they all stick together. Food for thought.

[Raz 14]

There is a lot of talk about Unions and representation. I've thought that some day this may be part of the solution, but i have never heard good things about EMS unions - and that is coming from men and women who work union EMS. It's not like we have an equivalent to the IAFF or PBA that has any sort of political leverage in DC/locally and authority at the bargaining table.

Things will no doubt take time. Since the recession hit, some people have noticed that cops and firefighters make a decent wage. People also complain/brag that a majority of East Coast emergency workers are Irish or Italian. Some of those people don't put two and two together to realize that 150 years ago, being a cop or firefighter was such a low paying, crappy job that only the immigrants wanted to do it.

Now, I don't think we'll have to wait 150 years for EMS to start paying out a wage that can support a family, primarily because the groundwork has already been laid out. As more and more municipalities branch out into fire based EMS, the IAFF will naturally absorb those numbers and gain their leverage in DC. Some municipalities (Greenburgh) have proven that policed based EMS is a viable route, and the PBA will take additional members under their wing. As for the rest, they'd probably be best off joining a catch-all union. It's not the best option for them, just the most viable. In this day and age, I can't see a major labor organization rising from nothing. At least the unionized medics would be able to collectively bargain, which is number 1 on the list of things that need to happen if they're going to see a decent wage.

I don't believe the Taylor law applies to private EMS employees, which could work to their advantage, if everyone is willing to stick together. Something has to change, paramedics are the most trained/least paid out of all emergency workers.

Edited April 8, 2009 by Raz

[NYMedic37 22]

I think once you leave the NYC metro-area things tend to improve exponentially.

The reason i created this thread was to see if i was the only one that was bothered by the way things are. I mean, it just doesn't make any sense to me.

I must agree with you. It is difficult making a decent living on an EMT / Paramedic salary. I'm a retired Police Sergeant and EMS has always been my second job. It could never have been the other way around. Per diem Paramedics at Lenox Hill Hospital in Manhattan are making $28.50 / hour. Full timers are making $30+ / hour depending on the amount of years in the service.

[gamewell45 258]

There are several main-stream unions out there that do an excellent job of representing those in both the private and public sector and have excellent political influence in Washington, D.C. and locally in Albany, Trenton and Hartford. Some are; CWA (Nurses, Dispatchers, Law Enforcement, Paramedics, public service workers), Teamsters (Nurses, Dispatchers, Paramedics, public service workers), ASCFME, (Nurses, Dispatchers, Law Enforcement, Paramedics, public service workers), SEIU (Nurses, public service workers) and others.

Only and only until an overwhelming majority of private/public sector workers are organized will conditions improve for workers in our lines of work.

[Guest TCA-ALS25]

I'm not overly bothered as I'm fire based (which as most of you know is what I think are the better systems often).

However I think there are several issues...which goose..excellent points on the education and so forth.

1. The bottom line. Privates are out to make money, so to get contracts they have to bid, to be competitive they must have market average bids, and are not going to be eager to spend money on things that will cut down on the money flow. They also won't band together to get better pay for their employees as they want the business.

As someone who's been in EMS full-time since 1988 (started as a vollie in '81), I've worked for-profits, non-profits, hospital-based and municipal-operated in both 911 and transports.

I've been on both sides of the aisle, too (ops vs management - currently management, BTW).

The bottom line isn't "the bottom line" most times as much as its cash flow. We you have to pay your vendors in 90 days or less (or else), but insurance companies won't reimburse you for anywhere between 100-125 days, you start to run into major issues. Paying us all a decent living wage would be great, but you can pay anyone on promised money, so you have to keep every expense including, unfortunately wages, down as much as possible.

And when ambulance services band together as you suggest, Medicare screams things like "price fixing" and "collusion."

Its even worse when you're a chase car and Medicare only pays those who actually transport. Then you have to work out some beg-and-plead with the ambulance squads you assist.

My $0.02

[helicopper 1,050]

There have been great responses to this question and some interesting perspectives but I don't think the problem is as simple as any one thing or even any few of the things that have been cited here. Here are some random thoughts on the subject...

It's not as simple as saying a union will fix things or Medicare/Medicaid is to blame for the pathetic pay in EMS.

One major problem is the recognition of EMS as an essential emergency service and the proper designation of EMS providers as professional healthcare providers. To accomplish these things, the notion that EMS can be a hobby needs to be seriously and intelligently discussed. Questions about the training curriculum and certification process have to be asked and answered. Course sponsors need to be reimbursed for properly training EMS professionals not just pushing people through the program who only know 70% of the job!

Municipalities need to have realistic expectations not based upon emotion or tradition but based upon standards and credible studies. EMS agencies need to be held to these standards and there must be some type of accountability if you don't.

Existing providers need to be committed to performing at the highest standard not just meeting the bare minimum to stay certified or MAC approved.

Medical Directors need to do just that - direct medicine - not rubber stamp things or passively participate in the programs they authorize. For this, they need to be compensated as well. The idea that a licensed physician puts his/her license on the line in the hopes that the system they authorize will perform adequately without their guidance and direction is absurd.

If agencies can't maintain the staff necessary to do the job or their members fail to do the job consistently, resulting in abuses of the mutual aid system, there needs to be some sort of recourse. Obviously the existing oversight structures aren't working so its time to look at other alternatives.

When EMS was born, the idea was that the pre-hospital component was only one element of the system. We need to get back to that idea and put the system back together. It is too fragmented and poorly organized/coodinated to be considered a system. Some agencies do it well, some don't yet all are treated equally and that's no system.

When contracting for a service, jurisdictions need to stop trying to save a few pennies by taking the low bidder who can't possibly meet the terms of the contract and develop RFP's for comprehensive EMS. The vendors awarded these contracts need to perform to the highest standards and not simply be the low bidder.

As for a salary comparison, JEMS does a good job of reporting national averages and related info. Not specific to our immediate area but it does paint a good picture of what things are like elsewhere.

2008_JEMS_Salary_Survey.pdf

2007 JEMS Salary Survey (too big to upload here)

2006_JEMS_Salary_Survey.pdf

[NWFDMedic 58]

Great post Chris.

[crcocr1 8]

This article from MSNBC offers some guidance on the issue:

http://www.msnbc.msn.com/id/28368691//

Scroll mid-way down, it addresses how EMS being excluded as an essential service from state constitutions has addressed salary pay.

(I would be more thoughtful in responding to this post, but am at work...tons to do.)