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EMS 2.0 as Explained to My Brother

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My brother is an engineer. Yes, he’s a firefighter and occasionally he still drives the Fire Truck, but I’m not talking about being an engineer as it relates to the fire service. I’m talking about a pocket-protector wearing, slide-rule-sliding Engineer who draws lines on paper and calculates weight to strength ratios and the like. It’s math that’s way over my head and I’m glad that he’s the one that has to do that type of work every day and not me. When he explains his job to me my brain starts to overheat and I’m surprised that my hair hasn’t caught on fire yet. It started smoking once, but I was able to catch a glimpse of “The Hills” on the TV and it slowed my mental activity just in time.

My brother, Captain Kaiser, is a volunteer fire captain and he used to be an EMT although he let it lapse due to the fact that it limited time with his family. I guess that I got the EMS genes and he got the “go to college and get a real job that pays well” genes. I say more power to him and he’s one of my best friends. I don’t get to see him as much as I should, but we talk often on the phone. He has always been interested in hearing all of my tales of EMS glory, and I listen to tales of his two daughters. Raising daughters sounds waaaay different than raising my son.

The other day I was talking to him about “this blogging stuff I do” and I breached the subject of EMS 2.0. I haven’t written much about EMS 2.0 by name lately, although the concepts I’ve been bringing forth fit into my model of it, but trust me when I say there has been a lot of behind the scenes activity. It turned into an interesting conversation with my brother. He was an EMT but never got past the volunteering when his community needs him stage. That’s an honorable place to be, no doubt, but he didn’t delve into the level that I take it to. So explaining EMS 2.0 to him was close to explaining it to an educated lay person.

In the conversation, I brought up the scenario that I used to write the post: “Are We the Gatekeepers to the Emergency Healthcare System?” (Unofficially titled, “Did I do good?”) and explained to him how I evaluated a patient in a nursing home, performed a full assessment on her including a 12-lead EKG and a review of her recent lab work, held a telephone conference with her Primary Care Physician and the Nursing staff on scene, and triaged the patient to the Primary Heathcare System as opposed to the Emergency Healthcare System. In the process, I saved the healthcare system (in the form of Medicare) thousands of dollars and provided better care to the patient by deferring her from the emergency room. I explained to him that my ambulance service could not bill the patient for the care I provided her because we did not transport and that the current system needs to recognize the value in having EMS provide such services in terms of cost-savings. If I would have transported, our service would have made the revenue, but Medicare would have paid thousands of dollars in unnecessary care overall. Since I didn’t, I saved Medicare thousands, but the service wasn’t valued and we didn’t receive any compensation for our work.

Basically, the conversation wound up being that he agreed with me that EMS has a powerful position to improve access to primary care and “save” healthcare as it were by increasing access to primary care, properly deferring patients from the emergency healthcare system when their care could be more appropriately managed in the primary care setting, and by saving millions of dollars in the overall healthcare setting. He agreed with me that it would require deregulation of the EMS industry to allow us to attempt programs and offer new services outside of our current mold and would require increased education of street-level EMS providers to get this done. He also agreed with me that money we’re already collectively spending should be allocated from inefficient programs and given to efficient high-performance EMS systems to do this in order to realize greater savings.

Remember, he’s an engineer. He’s good at math. He may not be a healthcare provider currently schlepping patients around in a shiny red and white bus that makes “woo woo” sounds, but he’s as smart as they come…

And when I told him that he’s exactly who we should be getting our message out to, he disagreed. He thinks that we should be out there talking to politicians and Insurance Industry executives. Honestly, he chastised me for not being in my local congresshuman’s office to do just that.

So, here’s a shoutout to the politicos out there: “EMS can ‘save’ healthcare through a free-market, grass-roots, innovative solution using currently available resources. We can save millions and improve the entire healthcare system just by putting in place a few good ideas and allowing EMS professionals the ability to think outside of the box”.

So do me a favor, y’all. Go tell your local politico to e-mail me at Proems1@yahoo.com. I’d love to have a talk with them. You should too.

Posted by Ckemtp on May 26, 2010 • Filed under: Administration & Leadership, Command & Leadership, EMS, EMS Management, EMS Topics, EMS system, Economics, Emergency Medical Services, Fire Rescue Topics, Management, PR, Paramedic, US economy, ems 2.0, paramedic education, profession

Huddled Masses. Healthcare. Honor. EMS.

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A conversation that I had with another healthcare provider has me pondering a lot of things. Until now, I’d been pondering these things in a solitary way but I think that I’m going to put these ponderable thoughts up on the blog.

This post gets a little more political than my usual stuff. I don’t post politics up here unless the politics specifically relate to EMS (unless they’d get me in a lot of trouble, for example the best EMS delivery model).

But today, I’m making an exception. I think that some of the things that I’m pondering have to be put out there and I think that if I don’t throw this out to the blogosphere I’m gonna go nuts.

I work in a community that has a large Hispanic population. A good portion of them are probably undocumented immigrants from Mexico. Yes, I said “undocumented” and that can mean Illegal immigrants if you so choose to say that. It’s a fact that small towns in the Midwest have been growing by leaps and bounds with undocumented immigrants looking to find work wherever they can. Some of them have legal members of their family that they live with, some don’t.

There’s a huge debate going on in this country over illegal immigration. It’s bigger than me, it’s bigger than this blog, and it’s bigger than EMS. I’m not going to get into my personal opinion on the topic as much as I would if we were discussing this in a bar over a couple of beers, or a country cafe over coffee if you’re a morning person. I can say this: I’m all for border security. I’m all for people following the law and I believe that illegal immigration is a drain on our resources. Those points are barely arguable. Another thing I believe in are the words to a song that I used to sing when I was with a rather patriotic small-town childrens’ choir. The song went something like this: “Give me your tired, your poor, your huddled masses yearning to breathe fee. The wretched refuse of your teeming shore. Send these, the homeless, tempest-tost to me. I lift my lamp beside the golden door!” There’s a lady that stands in the harbor that has these words inscribed upon her, and they mean something.

I look upon this debate and I see both sides fervently trying to destroy any point-of-view other than their own. The lefties want them here because their hearts bleed for them. The righties think that the lefties want them because they can mold them into a new communist workers’ party. Both of them may be right. I am more of the opinion that America is an experiment. We’re a melting pot of people that have come together over the last two-hundred and some odd years to be stronger in our diversity. I believe that any cultural group entering our melting pot should come here and embrace the American ideals. “Melt” into the pot if you will. This has made us strong over the centuries and has built the country that I love, the one I will stand up for. Europe didn’t do that, they isolated their ethnicities into countries and fought amonst each other for a thousand years. We melted and homogenized into a strong nation full of rugged individuals championing their best ideals. I say that the most successful immigrant groups in the storied history of this nation celebrated their old cultures while melting in to our diverse one.

As far as today’s debate goes, I wonder if that would be the whole rub. Are the new illegal immigrants celebrating their own culture while melting into ours? Or our they placing their old culture on top of the American culture and creating discord within a proud nation? I think that we have always accepted the “Tired and poor huddled massess yearning to breathe free” because of our American Dream. People here have equal opportunity, a guarantee of the equal chance for humans to strive to reach their potential. Everyone has the chance to try and succeed to their own definition of success. “Life, Liberty, and the Pursuit of Happiness” is a guarantee of the chance to pursue. It is not, however, a guarantee of results. Our experiment is that everyone who has the chance will strive to give it their best shot, and that the people who succeed will pull others up alongside them.

I can’t say what’s right here. I don’t know. I don’t want to offend, but here I am, a paramedic. My job is to help everyone and anyone who needs me. I will do so. I have always done so. I took an oath and I honor my convictions. The hypocratic oath means something to me. Healthcare providers are honor-bound to help everyone as much as they can. I always will.

The conversation that we had was short, but he got his point across. I had brought up that while we have a large hispanic population in our coverage area, we rarely have calls involving those hispanic members of our population. I think that this is a bad thing because obviously these people fall ill and get injured at a rate comparable or even moreso than the other demographic groups in our area. I don’t know why they’re not calling but I can figure that it might be alleviated for the good of our community as a whole if we reach out to this population and let them know how, and when, to access the emergency healthcare system. I don’t believe in race and to me “hispanic” is a cultural label and is not even close to whatever “racial” means, but this is a cultural group that should be calling us and doesn’t. It’s deliniated over cultural lines and therefore is handy to address that way.

The other guy thought that it was stupid, pointless, and maybe even wrong to do this. It was because of the “illegal” thing. As strongly as I feel on that issue, and I do have strong feelings, as a healthcare provider my job is to help everyone. Every human deserves the best care that we can give them, every time. I don’t judge people. He shouldn’t either.

Neither should you.

Thoughts?

Posted by Ckemtp on March 25, 2010 • Filed under: Administration & Leadership, Command & Leadership, EMS, EMS Health & Safety, EMS Topics, EMS ethics, Economics, Emergency Medical Services, Ethics, Fire Rescue Topics, In the Line of Duty, Uncategorized, edemse, everyday ems ethics, inside the mind of a paramedic, medical ethics, politics, professionalism, socialized medicine

Questions About EMS on a sleepy morning – Care to answer?

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It is a very sleepy morning for me today. Yesterday was a hard-fought day on the ambulance by our standards. For the first part of the day I couldn’t run a call without somebody getting angry at me. It really didn’t bother me all that much, but you know how it goes. I actually got about 6 hours of sleep during the night though, so I got that going for me. Perhaps it’s the morning fog mixed with the lack of coffee available in the station this morning that’s causing my AM neural firings to generate random questions… perhaps I’m just nuts. However, if y’all would like to think about some things (and perhaps answer in the comments section, please) I invite you to join in on my personal morning groggies.

Here goes:

  • If Medicare would assign a payment that you could access for treating and releasing patients, thereby diverting them from the Emergent healthcare system and redirecting them to the more cost effective healthcare system, how would that change the industry?

 

  • If your service could choose to accept a lower payment from Medicare and Medicaid for every transport without regard to the nuances of medical necessity and never have to be denied reimbursement in exchange for a lower payment for every call, would your service take it? How would that change the industry?

 

  • How would you improve your service if all of a sudden a big, national competitor moved into your service area and started taking your share of the market… you’re losing calls to them and it’s affecting your bottom line… What do you do to improve your service to keep yourself in business?

 

  • How would you change your care if your medical director was watching over your shoulder on every call? What would change if it were your mother watching you?

I think that these questions aren’t the biggest questions facing the industry today, but I’ll bet ya’ that if they were considered by peons like us and also by the powers that our landscape would change quite a bit, wouldn’t it?

See you in the comment’s section.

Posted by Ckemtp on January 26, 2010 • Filed under: Administration & Leadership, Command & Leadership, EMS, EMS Management, EMS Topics, Economics, Emergency Medical Services, Funding & Staffing, Patient Management, change, ems 2.0

EMS Pay Sucks!! (Part 4) – We Control the Market

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I read a short article in Entrepreneur Magazine (to which I subscribe) that had a story about a sign hanging in a shop somewhere that said this:

“Low Price. High Quality. Good Service.  – Pick two”

The saying goes that consumers can pick two of the above things that they feel are most important to them in their buying decisions. It also implies that businesses can focus and compete on two of the three, but they can’t do them all.

I agree with the sign. It shows in the fact that there are multiple outlets in the marketplace to purchase similar goods and services. If you’re price sensitive and don’t want the highest quality of furniture you buy from Ikea and assemble your purchase yourself. If you’re always after the best quality you go to a custom furniture builder who would be more than happy to deliver and install for the price you’re paying him. As always, if you as a consumer do not like what the merchant has for sale you “vote with your feet” and go somewhere else to spend your hard-earned money.

And that is how “the market” works. Businesses compete with one another for your patronage and this competition keeps their prices as low as the consumers are willing to pay for the level of quality they are willing to accept. People are willing to accept lesser quality products for lower cost as much as they are willing to pay more for better quality. Service and support plays a role in there too as nobody wants to get burned on a deal, product, or service. If your widget store has exactly the same quality of widgets for sale with the same service as the widget store across the street, people are going to buy the widgets at the lowest cost. Change any of the price/quality/service variables and the sales will follow where the consumer sees the best value. Of course I’ve oversimplified this a bit as the system we call “the free market” is infinitely nuanced in its simplicity, but this is indeed an EMS article. So don’t even get me started on that Adam Smith guy and his sleight of hand.

So why am I bringing forth this short little explanation of the free market? It’s because the ambulance industry is a service provider. Unfortunately (or fortunately if you prefer) we’re not entirely bent upon the whims of the marketplace due to the governmental regulations that set our price, control our service types, and dictate how we run our businesses. You probably know that Ambulance Services are “service providers” as they provide a service to our patients in exchange for fees paid for that service (ha!) and their tax revenues, but did you know that the Paramedics and EMTs are collectively a “service provider” for the ambulance industry itself?

Follow me here for a bit. If you separate out the collective “ambulance industry” from the collective EMTs and Paramedics making up the Profession of Paramedicine, you can see that there are two separate groups functioning in tandem. While we’ve always been inseparable and have been defined as one collective group, I suggest that we are really two entities. The Profession (Defined here as the Paramedics and EMTs together) and the ambulance industry (defined as the places we most usually work).The ambulance industry needs a service from the Profession in the form of us providing them with bodies to run their trucks, and we need them to employ us. If you were to take this thought further, we as members of the Profession compete with one another to provide our services to the various ambulance companies in the form of applying to and accepting positions with them under whatever conditions they set for us. They set the pay rates, benefits, shift schedules, etc and we paramedics compete with each other for the positions… usually accepting less compensation than we wished to receive as a condition of being employed.

Historically, our profession has competed on price as evidenced by the fact that our pay rates are much lower than we want to accept for our services. According to the above analogy, as we push our price lower either the quality of our education and skills or our level of service is going to suffer for it. One needs to look no further than their own paycheck to see that the pay is terrible. One also needs to look no further than their local “Medic Mill” school that exists solely to pump out EMTs and Paramedics with “a pulse and an EMT card” at the lowest possible cost with the absolute minimum level of education. We’ve become the Wal-Mart of ambulance staff, always rolling back our prices and lowering quality to encourage more and more demand.

If I have any liberty to speak to our profession I ask that today we all make the collective decision to compete on “High Quality” and “Good Service”, leaving “Low Price” behind. Frankly it hasn’t worked for our profession to provide our services for the low bid price. The subsequent drop in the quality of our education and services isn’t the best for our patients. We’ll always compete amongst each other to provide our services to the ambulance industry (I.E. apply for jobs) but if we all accept that we’re no longer competing on “Low Price”, we’ll all reap the benefits. Our patients will as well.

I suggest that we begin to “vote with our feet” more often in our quest for employment. If there are multiple ambulance services in your town, pick the one that offers the best pay and benefits and apply there for your employment. If and when you get hired, work like heck to make them the dominant ambulance company in the marketplace. Once the other competitors realize that the ambulance service with the best pay and benefits is gaining a competitive advantage, they’ll change… or be forced out of business. What you’ll begin to see is that the ambulance service that pays the best will begin to be able to “get what they pay for” from the profession in the fact that they will only hire the best qualified among us. Therefore we’ll begin to have to compete on quality and service to get hired for the best pay. We’ll no longer be competing on price alone. You’ll have to put more effort into the profession, but you’ll reap the rewards in terms of higher pay and benefits.

In addition, we need more Medicpreneurs. I’ve said before that the only way to make a lot of money in this game is to be the owner of a service. What’s to say that you can’t start your own ambulance company to put your boss out of business? Hire the best of your coworkers and pay them what they deserve. Do your best and work very hard every day. Soon enough, you’ll win if you can beat the market. You’ll be helping your profession and yourself as well.

When we begin to see the collective power that we wield as a profession in the marketplace we can begin to change the marketplace to fit our wishes. If we want EMS 2.0 to go ahead and get here already we’ve got to collectively become aware of our power and our duty to control the playing field. We haven’t won yet, let’s change the rules so we do. We owe it to our families, our patients, and everyone who depends on us. Wake Up EMS. We control the game here folks… We just have to realize the power we have together.

Low Price. High Quality. Good Service – Which two do you pick?

Posted by Ckemtp on January 7, 2010 • Filed under: Administration & Leadership, EMS, EMS Management, EMS Topics, EMS pay sucks, EMS rant, Economics, Emergency Medical Services, Funding & Staffing, US economy, change, ems 2.0, ems salary, paramedic salary, politics, potential, salary

Fiddling While Rome Burns – The “Ambulance Industry”

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Allow me if you will to allude to some Roman history here. I know that it’s a little heavy for an EMS blog but if you would please search the dusty recesses of your memories to think of the Roman Emperor Nero, it would help this post. You know, the one who “fiddled while Rome burned”

I am way oversimplifying this, but the way that I remember the story was that Rome was being swept by the “Great Fire of Rome” that burned for days and decimated the city. Popular legend has it that Nero, unconcerned with the plight of his citizenry, played the fiddle while the city was burning.

 (Although, the MOST TRUSTWORTHY SITE ON THE INTERNET *Other than Mine* has this on the subject: http://en.wikipedia.org/wiki/Great_Fire_of_Rome)

Recent events and some things that I’ve been reading lately have brought some EMS issues to light in my mind, and thoughts about good ol’ Nero have popped into my head.

Are we Fiddling while Rome Burns?

There’s a few competing EMS system design models out there that have various people in their camps. Mention the virtues of one over another and you will get passionate and snarky responses from the various members of these camps. Trash Fire Based EMS and you’ll get a ton of people that will take a break from lifting weights and will bombard you with reasons while Fire Based EMS is awesome while wearing their T-Shirts emblazoned with “FIRE RULES!!”. Mention that 3rd service and not-for-profit EMS may have their downfalls and the EMS Chess Club will bring forth obscure research that shows how much better they are for the patients than everyone else is. Trash Private-for-profit EMS and um, the employees thereof will trash it right along with you and their management will be too busy putting out fires to care.

Try as you might to convince me that one is better than the other and I’ll agree with you on some points and disagree with you on others. I will only endorse what I call “EMS based EMS”, which is EMS provided by truly dedicated caregivers who base their decisions and actions simply upon what is best for their patients and their communities. I have my beef with fire based services that place protecting firefighter jobs and the “fun” stuff involving spraying water on things that happen to be on fire over solid patient care. I have my beef with private-for-profit services that always default to the bottom line, and admittedly, I have a bias towards third service and not-for-profit EMS agencies. However, no one system has ever proven to be a good fit for every community, none are inherently evil, and other professions find their fit within lots of configurations.

If the system design models out there are really locked into a competition for the soul of EMS then they’ve all got a lot of work to do. In this piece, I’m going to ignore patient outcomes, efficient use of tax money, and all of the stuff that I usually talk about… and focus on one thing and one thing only.

The way EMS people are treated by the competing systems will probably decide this debate we’ve got going on here. The model that treats the paramedics the best will win and will take over the industry. Why wouldn’t it? What paramedic with half of a brain would continue to work in a service model that didn’t pay and treat them the best?

Here in Northern Illinois, there are very few options for a paramedic that doesn’t want to do Fire Based EMS for one reason or another. The few options that there are don’t pay nearly as well as the fire-based groups and this creates an endless revolving door of young paramedics entering the system, working the “privates” for a while, while trying to get a “real job” with a fire department. The private services suffer for it, and the fire based services reap the benefits while fostering a system that (gulp, here it comes) focuses less on the healthcare and more on the fun stuff.

So I challenge the private, third-service, and not-for-profit services out there with my next statement.

You’re fiddling while Rome burns.

If you aren’t out there doing your absolute damndest to treat your employees well and pay them what they deserve, you’re failing. You push your employees away. You push the best and brightest into other professions and into fire-based EMS which hands down has the best pay and benefit structure. Your lack of interest in caring for your caregivers is killing our profession. You fiddle whilst complaining about decreased reimbursements and failing to do anything about it. You fiddle whilst focusing on minutia like stupid rules and regulations that degrade the dignity of the adults who work for you. You fiddle while worrying about protecting your jurisdictional boundaries and contracts while they’re eroded away by the constant stream of departing employees.

Nero could have been an ambulance manager in some of the services I’ve been to, worked for, and observed from the outside. Could he be you?

You have got to find a way to pay your people better. I don’t know exactly how it’s going to happen either, but it has to be priority #1 for every ambulance manager out there. Trust me, if you don’t do it you will find that your capital city has burned to the ground. You will lose your empire and it will not come back. If you aren’t out there doing every possible thing you can to keep your employees as happy as you can get them, you’re fiddling, and you’re failing our profession.

This blog has a lot of content on it that explores new revenue sources for ambulance organizations already. Coming soon: Ways for each individual EMS professional to take control of our own income potential, own our profession, and improve our care to our patients. I’ve said it before and I’ll say it again folks, hang on cuz it’s going to get fun.

Posted by Ckemtp on January 6, 2010 • Filed under: 911 fail, Administration & Leadership, Command & Leadership, EMS, EMS Health & Safety, EMS Management, EMS Topics, EMS paramedics, EMS pay sucks, EMS rant, Economics, Emergency Medical Services, Funding & Staffing, Management, Paramedic, change, ckemtp rants, ems 2.0, ems salary, paramedic salary, politics, profession

EMS Pay Sucks!! (part 3) – Who or What is at fault here!?

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Welcome back to the “Life Under the Lights Bar and Grille”, your local dive bar filled with lousy food, tepid beer, bad ambiance, and great friends. Like any local Midwestern dive bar, it’s a come-as-you-are-and-sit-on-down-and-hang-with-your-buds kinda place. A conversation has broken out on the topic of “EMS Pay Sucks!! Let’s DO something about it!!” and me, your local blogger has decided to write a series of posts explaining the issues as I see them.

So, if you haven’t been here to read the last two, I suggest you go back and read them before you read this. If you don’t, well then that’s your choice. It’s a pretty informal place we have here.

Part 1: “EMS Pay Sucks!! Let’s DO something about it!!”

Part 2: “EMS Pay Sucks!! (Part 2) – Identifying the Problem

————————————————

In the last two parts here at the Life Under the Lights Bar and Grille, we’ve established that the time for talking about the issues is over, and that all EMS people need to band together in an effort to affect the pay rates in our profession. We’ve also established that this is a very complex issue and it can pretty much be said that if this was going to be easy, that it would have been done already. 

If you’ve read the comments that I’ve gotten on the other posts in this series, this is a hot issue with vastly different valid arguments that have been brought forth by people I respect. While I agree with a lot of what has been said, I would like to boil the issue down a bit further than it has been brought in the comments section and in the information that I have previously been exposed to. Basically it’s like this: By examining other occupations that are well compensated for their skills, we can examine the position we find ourselves in with our profession.

I think that it works like this, Well Compensated Occupations have these things in common:

  1. There is a medium-to-high barrier to entry – Whether by education requirements, location, or the unpleasant nature of the work, there is a barrier to entering the occupation that requires work and/or an affinity for the location or work involved to get into the field. Not everyone can do it, the people that do it but cannot do it well easily fail out, and the people that can hang around to do the work are rewarded for it. Look at Dental Hygienists, teachers, and IT professionals.
  2. There has to be a perceived value in compensating the people in the field at a higher rate to achieve higher performance – Look at the salaries of professional athletes and CEOs. They create value intensively based upon their knowledge and talents and the better they are at doing what they do, the more value they create for their employers. Think of it, if you could raise profits in your company $5million per year, wouldn’t that be worth an extra $1million per year in payroll?
  3. The Industry they work in turns significant revenue overall – You could be the most talented Ice Sculptor in the world, but if you couldn’t find a market to sell your ice sculptures to before they melted, you wouldn’t make any money at it. Nor would you if you were the executive chef at a greasy spoon. Sure, you’d have the same job title, “Sculptor” or “Executive Chef”, as a sculptor that worked with Marble and Gold, or an executive chef that worked at a very fancy restaurant in downtown New York… but since the places you worked for weren’t making any money, you couldn’t possibly be paid very much; Even if you were as highly educated and more talented than your counterparts at the fancy joints.

I think that overall, point number three above sets the tone for us. Our industry doesn’t make much money, therefore, no matter how caring, compassionate, qualified, or talented we are, we won’t be making much for working in it. It’s pretty much that simple. Sure, some salaries are artificially inflated due to varying degrees support from governmentally levied taxes, subscriptions, or corporate support but if we were to stand solely on our current business model, the “fee for service” model where we only get paid if we transport and most of our customers do not pay then we’d all be much poorer than we are now. In fact, most ambulance services would be out of business.

I’ve heard the argument that one form of EMS delivery or another is “Ruining it for the rest of us” with people in one camp bemoaning “the privates” for being all about profit and not paying their employees due to the money grubbing nature of their owners, and people in another camp bemoaning “The Fire Guys” for holding the profession back and keeping educational standards low so that their fire guys don’t have to get the advanced education that would be required of other well-compensated healthcare professions. People in almost every camp bemoan the volunteers saying “If they do it for free, how can we expect people to pay for us!?”

Well, while all of those arguments sound plausible enough and may hold some truth to them, they’re crap when you really look at them. Should all restaurants be Governmentally based like the Fire Departments because then pay would be equal across the board? Right now people that work in Government cafeterias earn better money than those working in Flo and Gino’s Diner down on 5th St. Flo and Gino’s Diner is *ruining* the restaurant business, right? How about IT professionals? People that work doing advanced networking at IBM earn WAY more than the people that do networking at your local newspaper office. Does that mean that smaller operations, and not large companies are *ruining* the IT business? Waitresses that work in Casinos and at Hooters make way more than do waitresses that work at your local fancy chain restaurant… Is TGI Friday’s to blame?

Every business, governmental organization, or organization on Earth in one way or another, is a system that takes in money and other resources, does something to it, and then spits out something with perceived value to it. The military takes in vast amounts of money, manpower, and other resources and doesn’t make a dime doing it. Its value is in protecting the interests of the society that funds it and therefore it’s usually a governmental pursuit. Diamond mining takes a lot of resources and money to perform as well, but since diamonds are sold for huge profits, it’s a pursuit of the private sector. I don’t get much into politics on my blog, but I can say that personal experience has taught me that capitalism works and that government rarely does anything better, more efficiently, or faster than does the private sector. Government bodies, by definition, rarely are any good at staying within budget, let alone making a profit, and when they do try to make a profit, they fail spectacularly… e.g. Fannie Mae and Freddie Mac. By definition, the Fire Service doesn’t make a profit, and they have branched out into providing EMS in a lot of cases, solely to get a piece of the transport revenue to support their other operations. Private services, by definition, are doing the same… Neither one is inherently evil.

And neither are volunteers. I work in rural areas and I’ve always lived in them. Heck, my hometown had more cows than people and yet I still needed someone to bring the ambulance whenever the farm hand got trampled on by Bessy. Rural areas have voluntary agencies where community members step up to the plate to provide services out of the humanity they have to their neighbors and also because of the fact that if they didn’t do it, nobody would. That’s not evil, it’s just a reality of rural life. (There are benefits to the volunteer services that I will expound upon in a later article not in this series as well.) (Disclosure, I’m a volunteer paramedic and dang proud of it).

A paramedic blogger who I really respect, TOTWTYTR (Who writes the blog “Too Old to Work, Too Young to Retire”) offered the following comment on my post “Paramedics Providing Physicals? Decreasing Healthcare Costs and Improving Patient Care – EMS 2.0”

“Chris, you seem to be intent on finding more for paramedics to do. I’m not sure why, when there is a “shortage” of paramedics we need a heavier work load or “expanded scope”. We’re also likely intruding into someone else’s work space in the process.

Nor can I say that giving more for the same amount of money of benefit to the profession. In fact, I’d opine that it will have the opposite effect.”

His argument looks good too, when you don’t share the same definition of a business as I do and you don’t view EMS as a business, which it is. Remember my third point above, the one about industries that don’t make any revenue being unable to compensate their employees at a reasonable rate. My idea in the above post, to have a paramedic provide your next annual physical, is another service that we can use to sell for a profit. The belief that we can survive solely on transport revenue has not panned out when most of our transport revenue is based upon dwindling government reimbursement through Medicare and Medicaid (and the looming universalization of healthcare) and the tax revenues we rely on from local governments is starting to be eaten away. We have to find new sources to generate revenue from. We’ve got to compete in the marketplace to either do old things better and/or cheaper or do new things before anyone else does them. Our profession is not insulated from capitalism just because we layer ourselves in compassion.

So to end this long rant, I think that we can go a long way towards solving our pay problem by turning our attention to the three points above.

First, educational standards must be universally standardized, universally raised, and must be owned by our professional governing body. While we should probably never make a Master’s degree the entry point to ambulance work, it shouldn’t be a GED either. Probably some PE classes should be in there as well, or at least the ability to pass them. Go Get Educated!

Second, we have to educate the public about what it is that we do and why being good at it is important. If the public thinks that a volunteer service with a BLS response is adequate, then they’ve never laid there with a broken femur only to be bounced down a gravel road next to an EMT-Basic that can’t give them a squirt of Morphine. They’ve also never had their MI go into cardiogenic shock because the BLS volunteers couldn’t give them correct medications to mitigate the damage. They have to be shown convincing evidence of these facts before they will, and someone has to be our cheerleaders. Honestly, I’ve never seen an “EMS Cheerleader” or someone who was promoting the profession to the public, that hasn’t been skewered by their peers. Maybe NBC’s “Trauma” wasn’t the most accurate show in the world… but neither was “Top Gun” and we loved that movie and wanted to be a fighter pilot after seeing it (last week, again). Be an EMS Cheerleader in your community!

Third, your EMS service needs to go do something to make itself money. Figure out what you can do to boost revenue, and do it. Try new things. There are a lot of business ventures that have a good synergy with EMS.. Perhaps you could sell those little “I’ve fallen and I can’t get up” buttons and home-safety devices to the elderly in your community. Perhaps you could do home healthcare. Perhaps you could offer OSHA safety consulting to business and industry in your jurisdiction. All of these things are very much part of what we can, and probably will be doing in the future. Seek out New Ideas and Profitable Ventures!

I haven’t figured out the title to the next post in this series, but I’ll be writing it tomorrow. I’ve loved the debates that have been popping up in the comment’s section and I’m sorry that I haven’t jumped in there much as of yet. I’m just trying to keep my ideas to the main posts, and then I’ll come back and debate when I get out what I want to say. You all have been creating some great energy and while we’re not going to agree on this, I’ll say it again “Perfection is the Enemy of the Good Enough”. Complete agreement is not necessary for us to act upon a consensus.

Posted by Ckemtp on December 30, 2009 • Filed under: Administration & Leadership, EMS, EMS Health & Safety, EMS Management, EMS Topics, EMS pay sucks, EMS pep talk, Economics, Emergency Medical Services, Funding & Staffing, Paramedic, change, ckemtp rants, ems 2.0, ems salary, paramedic salary, politics, profession, salary

EMS Pay Sucks!! Part 2 – Identifying the problem

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Welcome back to the “Life Under the Lights Bar and Grille”, your local dive bar filled with lousy food, tepid beer, bad ambiance, and great friends. Like any local Midwestern dive bar, it’s a come-as-you-are-and-sit-on-down-and-hang-with-your-buds kinda place. A conversation has broken out on the topic of “EMS Pay Sucks!! Let’s DO something about it!!” and me, your local blogger has decided to write a series of posts explaining the issues as I see them.

 So, if you haven’t been here to read the last two, I suggest you go back and read them before you read this. If you don’t, well then that’s your choice. It’s a pretty informal place we have here.

 Part 1: “EMS Pay Sucks!! Let’s DO something about it!!”

Part 2: “EMS Pay Sucks!! (Part 2) – Identifying the Problem (you’re here)

Part 3: “EMS Pay Sucks!! (Part 3) – Who or what is at fault here?

———————

The way our country compensates its EMS personnel is an abomination. It’s almost criminal, it’s inhumane, and it’s just plain wrong. Paramedics and EMTs do not deserve to live at, near, or below the poverty line simply because they chose to make a career out of helping others. We do not deserve the shame of being struggling from paycheck to paycheck. We do not deserve the hardships of trying to raise a family and continuously have to explain to them just why it is we have to work so many hours and have such little in our paychecks to show for it.

I know that EMS compensation is frankly despicable… but you don’t have to take my word for it. There is a lot written on the subject that comes from some very credible sources. Some examples:

Favorite Quote (but the read the link to get even angrier):

“Paramedics

What they do: Paramedics respond to emergency situations and attempt to provide the necessary medical care, whether it involves transporting participants to a hospital or treating them on the scene.

Surprising salary: $27,070. Seeing as paramedics have high stress jobs that require them to be on call and ready to save lives at a moment’s notice, you might expect their mean annual salary to be higher.”

”Other workers in occupations that require quick and level-headed reactions to life-or-death situations are:

All those links work, by the way. Here’s a little pre-test question for you: Of those “occupations” listed above, which one is markedly the lowest paid??

I’ve been in full-time EMS for over ten years and currently work two-full time paramedic jobs. Not only do I feel the low wages, awful benefits, and long hours personally, but I also see what my coworkers go through with their lives and their families. What does one do when their calling is something so vital to the community, yet is so unappreciated financially that it hurts their families and their future?

In my travels throughout the nation I have had the chance to seek out and speak with EMS people in a lot of localities. I tend to visit odd places and I make it a point to seek out and get into conversations with interesting strangers. Luckily, all of the EMS people I know seem to fit the description of being “interesting”. I’ve heard them speak of the same problems that I’ve experienced. I’ve seen the pain and embarrassment in their eyes as they describe their love for the job and try to downplay the fact that they’re struggling financially. I’ve heard the same stories almost every time I’ve spoken with them. When they were young and new to the profession the long hours and low wages didn’t matter all that much to them… However, once they spend about five to ten years working the box they tend to experience the same struggles that I have. Spouses and Children don’t like it when the EMS person continues to work 100 hours a week to earn a paycheck that only comes close to covering the bills. They don’t like not having any disposable income. They don’t like the 24/7 demands of the job too much either. These facts rear their ugly heads when the EMS provider reaches a certain point in their life, and a career in EMS gets harder and harder to justify. Ever wonder why you don’t see many EMS professionals that have been continuously working full-time EMS for more than ten or so years? It’s for this reason. Sure there are a lot of exceptions, but I would think that the statistical clustering would bear this out. Eighteen-to-twenty year olds enter the profession, become family people around five-to-ten years later, and realize that the hours and the money they get for those hours are killing their family life… then they get other jobs, or stay in EMS and become very bitter about it.

So if I were to be asked to identify the problem using words that everyone could understand, I’d say this:

“The public is counting on the people in Emergency Medical Services to protect the lives of themselves and their loved ones. They then turn around and compensate them for this task at about the level they compensate fry cooks. They demand that there is a paramedic or EMT immediately available to them at all times to help them when the unthinkable happens, but they aren’t willing to pay them more than they do their bartender or waitress. People need advanced care immediately available to them in order to maintain the quality and presence of their lives after an emergency, and they need highly trained, experienced, and dedicated people to provide that care, but all that care seems to be worth to them is poverty-level income. What is wrong with our priorities?”

What is wrong with our priorities indeed.

I think that the above information is enough to identify that I think there is indeed a problem here. It’s an almost overwhelmingly complex problem as well. However, if it were an easy problem to fix, it would have been fixed by now. Fixing this has become mandatory for me, as it is mandatory for all of you. I’m writing this to contribute to the solutions that we’ll have to put into place, and by participating in this, you’ll be too. Over the next few days, I’ll be posting parts in this series, because I don’t think that one post will provide as many angles as I feel I need to.

One thing I do know, we’re going to act on what I put out here and on what you add to the discussion in the comments section and in your daily lives. We can no longer hope someone else will act. I ask every person who reads this to participate for our own well-being and the improvement of our profession. We’re not going to agree on everything, but “perfection is the enemy of the Good Enough”. Complete consensus is not necessary, action for our collective professional well-being is.

Coming tomorrow: EMS Pay Sucks!! Part 3 – Who or what is at fault here?

Posted by Ckemtp on December 29, 2009 • Filed under: 911 fail, Administration & Leadership, EMS, EMS Health & Safety, EMS Management, EMS Topics, EMS pay sucks, EMS rant, Economics, Emergency Medical Services, Funding & Staffing, Paramedic, change, ckemtp rants, ems 2.0, ems salary, paramedic salary, politics, salary

EMS Pay Sucks! Let’s do something about it

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We’re gonna have ourselves a little Audience Participation Exercise.

This whole blogging thing is a pretty intimate relationship, isn’t it? I mean, you all have your favorite bloggers that you regularly read and I’d be quite honored if you’d count me among them. I write straight from the front of my ambulance and I’ve been repaid by all of you for it by your sheer act of coming to read what I have to say. I rarely hold anything back from your eyes, and this is no exception to that rule.

So please, dear reader, humor me for a bit here while I pull you in to a pretend scenario. I’m a rural Midwestern guy and like any of my peers I like my dive bars. Of course, I’m a family man and I try to be a good one so I don’t frequent them very often anymore, but the one thing that I’ve always liked about them is the conversation that develops centered around the non-formal atmosphere that they hold. It’s pretty intense most times, usually brutally honest, and always entertaining as all get out. Everybody’s equal with a can o’ PBR in their hand. (or, diet pepsi for the young folk as we’re a family establishment) (no swearing either) (well, not much).

So let me invite you to the “Life Under the Lights Bar and Grille”. Coming soon to this little blog of mine is the beginning of my crusade to kick the current EMS pay rates and system thereof squarely in the behind. I’m frankly, mad as heck and I’m not going to take it anymore… well, at least as blogging is concerned as I still have to make a living, you know. Don’t get dressed up, come as you are, and let’s have a spirited conversation about why EMS people make such crappy money for doing what we do. I’ve got enough ideas on this topic to carry me through a few evenings of my wooden “free drink” nickels and I’d love to share some brutally honest conversation with the EMS folks in my audience that I think can make a difference in the quality of life for those who save lives. We need to, we have to, and we deserve to.

On duty personnel will be limited to a three-drink-maximum, as long as it’s coffee or a soft drink of their choice. We are consummate professionals, you know.

Starting tomorrow I’m going to be writing a few good rants on this topic. I’m holding back tonight because well, coffee lends itself to more coherent writing than does late night camaraderie enhancement beverages. However, if you all would do me the honor of getting started by reading the following posts of mine:

Read this too if you want to get mad:

http://www.bls.gov/oes/current/oes292041.htm – The US Bureau of Labor Statistics Paramedic Salary page

————————

I’m turning this into a 5 or 6 part series, so here they are:

EMS Pay Sucks!! (part 2): Identifying the Problem

EMS Pay Sucks!! (part 3): Who or What is at Fault here?

Posted by Ckemtp on December 28, 2009 • Filed under: EMS, EMS Health & Safety, EMS Topics, EMS pay sucks, Economics, Emergency Medical Services, Funding & Staffing, Paramedic, US economy, ckemtp rants, ems 2.0, ems salary, politics, potential

Paramedics Providing Physicals? Decreasing Healthcare Costs and Improving Care – EMS 2.0

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Sitting down at your station one night finishing paperwork, you’re startled from your daydreaming by a knock at the door. You get up, and answer it to find one of the off-duty firemen from the town standing there at the door. He looks like heck warmed-over. He’s pale, sweaty, and his respiratory rate is elevated. He says He’s “Glad it’s you on tonight” and that he feels worse than he looks. He asks if you can “Check him out” since you’re “all medical and stuff”.

Treating this like a walk-in medical call, you help the guy walk into the back of the ambulance and have him sit on the bench seat. Your fire and EMS departments aren’t connected so you’re not really on a first name basis with the guy, but you know him from sight and know him from seeing him around the town on calls and social things and such. He just looks sick, he says that he’s having a bit of trouble breathing and that he feels like he’s freezing one minute and hot the next. He also says that he’s been coughing up “all kinds of stuff” for the last few days.

Putting on your best caring EMS provider face, you begin your assessment. He’s a 26yo Male patient in generally good health and with good appearance other than for right now. His skin is very warm and moist to the touch and he seems to have a fever. His pulse is rapid and bounding at around 120bpm, but that decreases after a few minutes of rest as does his respirations. He states that for the last few days he’s been sick. It started with a sore throat and some sinus gook and now has “gotten into his chest”. You listen to his lungs and hear some diminished sounds in the bases bilaterally with diffuse rhonchi throughout.  His abdomen is soft and non-tender but says that he’s had some mild bouts of diarrhea. He complains of exertional dyspnea and his BP is way high at 184/98. His temperature is 101.4 degrees F taken at the tympanic membrane.

So based upon the assessment, you’re thinking that he’s got a respiratory infection, probably bronchitis. Just because you can, you run a 12-lead EKG which is otherwise normal other than for the sinus tachycardia. His pulse ox is 94% on room air. He says that he doesn’t have insurance and that he can’t afford the emergency room, but that he’s willing to pay for a visit to the urgent care doctor if you think he should go in.

Now, faced with the above, as I have been a few times in my career, you have a few options here. You could do what we’re supposed to do by the book and recommend transport to the ER even though you know the guy’s condition probably isn’t life threatening right now. You could also tell him that you think that he may have a respiratory infection and that while he should see the doctor as soon as he can, that he probably doesn’t need the emergency room.

(Remember, we’re talking about today’s protocols, not the ones I want that I posted in “The Current US Economy and EMS – An In-depth look at how this mess will affect 911 in your community”)

Usually, I choose to tell my buddies that they should consult their regular doctors or go to an urgent care clinic instead of going to the ER. Sure, in cases where I thought they had a life threat or needed immediate care above the level of the local Urgent Care, I’ve transported my friends a few times. However, most of the time I give them my assessment findings written down on a piece of paper, hand them a copy of their EKG if I took one, and send them on their way to the non-ER doctor.

The last time I did this, it hit me: I’m conducting a physical when I do this. Sure, in the above case and in the cases where I’ve done this before it is a complaint-based assessment, but a patient examination is a physical exam. When I write my assessment findings on a sheet to give to the doctor, I’m writing them on a physical examination form. While my assessment isn’t as in depth as that of a physician, it certainly is better than not being examined, and a paramedic has specific training in detecting disease processes that may go undetected by a patient and their families.

(Note: In all of the cases where I did not transport the patient to the hospital, I did obtain a proper refusal form after educating the patient about their condition as best I could. They made the decision, not me.)

If you type “Annual Physical Exam” into Google, you’ll see quite a few articles about the topic, including a study published in the Archives of Internal Medicine and this article published in US News and World Report basically, they say that Preventative Health Exams account for approximately 8.0% of all ambulatory care visits costing approximately $7.8 billion in health care costs. They also say that the cost of providing these services may outweigh the benefits of receiving them. In 2005, a survey of 800 Primary Care Physicians reported that 65% of them recommended an annual physical, that 74% felt that it improved early detection of illness, and that 94% felt that it improved patient-physician relationships, there is currently “No major North-American clinical medical association” that “currently recommends that health adults get a physical each year.”

So there’s a debate being held in healthcare circles. On one hand, patients probably perceive a benefit to the annual physical exam, and certainly the people who have disease processes detected and stopped with early intervention see a very tangible benefit. There are also a majority of physicians that when questioned individually state that they see a benefit to the exam. However, there is also the fact that the costs probably outweigh the benefit of the exam, even though “preventative care” is batted about in the current healthcare debate quite a bit and most organizations and physicians recommend health screenings for specific disease processes that benefit most from early detection.

My opinion is that when the cost outweighs a benefit, there is the choice to either forgo the benefit or find a way to decrease the cost. I am suggesting that we can decrease the cost to the overall healthcare system as well as increase the availability of preventive care by introducing paramedics into the debate. I believe that paramedics could provide a more than adequate annual physical examination in most cases for a large subset of the population. In fact, most of us probably already do without thinking about it. The articles state that 80% of preventive health care is provided within the context of complaint-based ambulatory care visits. I would say that paramedics in ambulances provide this care to the rest of the population. I’d also say that we provide a lot more patient education on chronic health issues to a larger segment of the underserved population than any other healthcare provider. Think about it, how many times have you personally attended to a patient who called you for a complaint such as a “fall” and upon assessment found evidence of an undiagnosed chronic condition? I have, and I like to think that with a thorough assessment on every patient, I can improve their overall health more so than just helping them with their current complaint.

To implement this plan, I would think that functionally, paramedic training already gives us a strong background to provide a detailed physical exam. We would, however, have to undergo more intensive training in examination skills and pathophysiology to be able to detect subtle underlying signs and symptoms of disease processes, mental health and substance abuse issues, and sexual health problems. I would envision that there would be a detailed and formalized set of procedures, tests, and paperwork that would be completed in full that should be pre-agreed upon with the Primary Care Physicians in an ambulance service’s wider sphere of influence. Tests such as a random fingerstick glucose, a monitor strip, and a baseline 12-lead EKG could be obtained as well as a review of the patient’s social and other risk-factors. These findings would then be forwarded to the patient’s personal physician, or could be given to the patient to bring to a physician of their choosing.

This is an easily implemented service that we could be providing our communities with tomorrow with the right planning. The chance to improve the overall health of our patients exists coupled with a chance to decrease overall healthcare costs. It’s also another potential revenue source for ambulance services, which is sorely needed in order to implement EMS 2.0 and improve the EMS profession for tomorrow. Imagine the revenue boost to your service’s and your bottom line if every crew started performing ten physicals a day for $50 a pop. It’s a bargain for the patient, but would be a boon for us.

Paramedics are underutilized for our skill sets and education, this is a way that we can further contribute to the health of our communities while improving our profession overall.

References:

US News and World Report “Do You Actually Need a Physical Exam” – http://health.usnews.com/articles/health/2007/09/24/do-you-actually-need-a-physical-exam.html

Archives of Internal Medicine “Preventive Health Examinations and Preventive Gynecological Examinations in the United States” – http://archinte.ama-assn.org/cgi/content/abstract/167/17/1876

Posted by Ckemtp on December 8, 2009 • Filed under: Administration & Leadership, EMS, EMS Blog, EMS Topics, EMS paramedics, Economics, Emergency Medical Services, Paramedic, Patient Management, Training & Development, US economy, change, ems 2.0, patient care, physician

Request for ideas on a problem – Can we be paid enough already?

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Howdy! This post is random, disjointed neural firings. It comes from me trying to reconcile the fact that I really, truly do love working EMS but also hate the fact that I get paid worse than a fry-cook. It’s not the easiest read, and I’m sorry about that, but I can’t think of any good ideas.

So really, I’m just complaining about being paid so poorly. Sorry.

Can you help? At the end I’ve put some ideas. Care to expand upon them in the comments section?

A comment I received on my last post got me thinking on this beautiful Sunday. Here it is:

“Loved the quiz.  It would not only appear that I have another decade left to supplement the two already under my belt, but will most likely be found pulseless and apneic while seated in the rig one day….  I can’t think of anything I would rather do for a living!”

(Thanks to JimHaden for the comment)

On that post “Will Your Career Survive a Decade or More in Full-Time EMS? Take this 3 question quiz!” I got a lot of cool comments from long-time EMSers stating how they “beat the odds” and have survived upwards of a decade or two in this business. Then, the above comment kinda tied it together for me.

And on a warm, Indian Summer day here on duty, I gotta admit that I’m getting the warm fuzzies from my career choice. I’ve always said that I have an abusive, co-dependent relationship with paramedicine and EMS. I may need it more than it needs me, but…

Dang I wish I got paid more.

I love this job. I like the quirky personalities of the people I’ve met that do this. I like the camaraderie I’ve got with them. I like the pressure to perform in challenging conditions. I like having to think on my feet. I like meeting new people. I like making people feel better. Heck, I even like driving fast and breaking things.

I could go on.

Sure, there’s a ton of things about this job that I could do without. I’d like to be able to schedule calls to handle them when I’m ready. I’d like to be able to have the 911 dispatchers instruct certain patients to “Take a shower and then call 911 back when you’re done.” I’d also like magnetically levitating stretchers that can pick patients up with cranes.

I can go on there, too.

How are we going to make this into a profession that pays, heck… If not a “good” wage, at least a “fair” wage?

It’s not fair what we make. It just isn’t. Sure, I’m a rural paramedic but I feel strongly about rural paramedicine and the fact that the lives of people who don’t live in urban areas are just as important as the lives of those who do. The fact is though, that rural paramedics make much less than their urban counterparts. Yes, I know that it’s because of call volumes, but also because the competition with the overall amount of jobs available in urban areas as opposed to rural ones. It’s also due to tax base and service delivery model issues as well as overall economic conditions and demographics of the areas we cover.

I could go on, but you get that it’s a complex issue.

Today I had someone complain to me about their recent ambulance bill that they received for a long-distance transport. They felt that it was unfair to be billed so much for something they felt they could do with a taxi cab. I was very professional like I always am, but honestly I’ve got mixed emotions on this one. I don’t know how many people share this opinion, but I’m one to think that ambulance bills are a tad on the too expensive side. I don’t think that cost should be a deterrent to people calling for emergency assistance. On the other hand, this person is a resident of one of the jurisdictions I work for and I don’t think that our bills are out of line. I wish I could have told this person that they had the ability to help their own problem with the bill by simply paying more of their share of the ambulance service though their taxes. The money’s gotta come from somewhere, folks. People need 24 hour ambulance coverage and more lives are saved (debatably to some, but not to me) by 24hr paramedic coverage. While I would do this job for free, and do so by volunteering my time in some places, I also have to eat

So I don’t have the answer, even though I would like to say that I did. I think that it’s too complex of an issue in order for there to be a magic fix to the entire situation. If there were, I think that despite the political forces at work, someone would have put it into place by now. I will say that the “Fee For Service” model of ambulance revenue is failing. You know, the one where we only intake revenue if we transport and the volume of transports is supposed to be able to pay for everything. Well, what if you’re in a small town that cannot support a high volume of transports like I am? Or what if you’re in a big city like The Happy Medic (follow @CoEMS on Twitter!) and a high percentage of your patients can not or will not pay you for your services?

The fix, in my opinion, to find new revenue sources for EMS. If you look at professions with the highest salaries, they’re the ones where the people earning those salaries earn large amounts of revenue for the company. Say someone in sales whose salary is commission-based and is dependent on making large sales, or large amounts of small sales, or an athlete who not only fills the stands but also earns tons of money from licensed products. EMS people don’t do that, for the most part our patients cannot afford what we charge them and aren’t using their disposable income to pay our salaries. We’ve got two sources, Secondary payers (Medicare/Medicaid/insurance) whose revenue depend on NOT paying as much as possible, and tax revenue. Yes, there are some that rely solely on one or the other, but most services that I’ve seen rely on both.

So what do we do? As I’ve said, I don’t have the answer and I’m pretty much winging this post from this point on. I don’t know. I’ve thought about adding home care services, having EMTs and Paramedics staff a community health-care clinic, and even working a 2nd job while on-duty (really, I’ve picked up an application from the local McDonalds to see if I could park the ambulance out back and flip burgers for a while in between calls – I’m only half-way joking about that) to increase the revenue potential for me personally.

Hey, maybe that’s the answer. Could we get the local ERs to let us staff them as techs whilst on duty? The local clinics? Dialysis facilities?

No, probably not…

Help. I can’t finish this because I don’t have a good idea. Maybe I will later, because I’m thinking of this issue pretty hard lately. I need EMS to pay better. You probably do too. Let’s work this out.

Posted by Ckemtp on November 10, 2009 • Filed under: Administration & Leadership, EMS, EMS Health & Safety, EMS Topics, EMS rant, Economics, Emergency Medical Services, Funding & Staffing, Paramedic, Uncategorized, ckemtp rants, paramedic salary, salary

The current US economy and EMS – An unexplored potential

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I’m not one to be consumed by doom-and-gloom type news stories on the state of the economy. I firmly believe that in most cases macroeconomic forces do not generally affect the pocketbooks of individuals. A wise man once said that if you choose not to participate in an economic downturn and instead innovate, strive, and meet all challenges head-on you can and will thrive in any economy.

But this particular time in our history seems to have gotten me down lately, as you can see from some of my past posts which are included in this one. Read this one for the message though, it’s important.

See also “Why Does Being a Paramedic Seem So Worthless” and then please come back to this one.

There is starting to be quite a bit written in the trade journals and big online sites regarding how the economic collapse will affect EMS and the ambulance industry overall. It has been said by others, and I believe it too, that as people lose their jobs and therefore their employer-provided health insurance they are going to be less likely to seek out expensive primary care and will default more to the 911 system and the ER when their condition worsens to the point where they cannot manage. This will affect the EMS system twofold: First, with increased call volumes as people depend more on the healthcare safety net that is the EMS system; and second as more of these patients who have lost their health insurance will not be able to afford to pay for their ambulance care. More of these people will be self pay. Combine that with the already minuscule reimbursement rates from programs like Medicare and Medicaid coupled with the increased demands placed on them by uninsured and unemployed people who now qualify for these programs and we have a real problem on our hands.

With personal finance issues, as coached by excellent books such as “Rich Dad, Poor Dad” by Robert Kyosaki (which you should go to your local bookstore and buy right now if you haven’t) I believe that financial health is increased by creating multiple streams of revenue to swell your pocketbook. Most EMS people, at least in my neck of the woods, do this already by working a full-time and a part-time job. I have three jobs and also support my revenue streams by taking on database projects, MS Excel problem-solving (E-mail me! J
proems1@yahoo.com) and by those nifty Google AdSense ads you see on this blog in a few places. Some people build revenue generating assets, like rental property or by holding instruments that gain value over time. I’m not a financial professional (“never take financial advice from a poor paramedic” is the first thing they teach you in Stockbroker school) so don’t take my advice as such.

I keep hinting that I will write a post about EMS obtaining more revenue streams, stay tuned. I believe that the “fee for service” model for EMS has failed and will write about it soon.

However, there is another phenomenon within this economic downturn that I haven’t seen anyone address as of yet. It involves the fact that when EMS people reach a certain age and age in the profession they tend to gather houses, families, and responsibilities. They realize at that point (and I’m there, don’t you doubt) that their love of the profession is outweighed by their need to increase their income. A lot of them leave the profession for jobs with shorter hours and bigger paychecks. A lot of them further their education beyond the EMS certification level to the degree level that will launch them into a new career. In addition, in smaller communities with volunteer services or with services that allow people to work part-time there are EMS people who work full-time in other industries. It is a tragedy for an experienced EMS professional to leave the field, but it has become an unfortunate rite of passage for many.

See Also: “The Profession that is EMS” – And then please come back, I’m getting to a point soon, I promise.

These people in other industries that hold EMS credentials and have maintained them since leaving a full-time EMS job, downsizing to a part-time or volunteer only role, or have never worked full-time but are credentialed volunteers are losing their jobs. I know five licensed EMTs that worked good-paying jobs in other industries that lost their jobs to layoffs or outright closings.

Newsflash to some: These people view their EMS certifications as marketable credentials on their resumes. They are applying for EMS jobs in droves. For the first ten years of my career there had always been a paramedic shortage. The rules have changed, and people are flocking to open EMS positions in droves. The paramedic shortage has ended. This is a game-changer. Where in the past, dismal compensation for EMS people had at least been buoyed by the law of supply and demand pushing wages higher in the face of a limited workforce, the future does not look like it will have the same rules.

Does this kill our wages? Does the coming overabundance of EMS people drastically lower our wages, making our jobs truly “a-dime-a-dozen”? Look at all of the minimum wage positions you know. They all share one thing in common: low barriers to entry. McDonalds’ Restaurants employ people whose only qualifications are a nice smile and/or the ability to get to work on time. They make minimum wage. Our industry’s barrier to entry? An 8 week EMT-B class. Paramedic school is much harder and longer, but is certainly achievable by someone who could manage a restaurant or do some other like job with the requisite cognitive abilities. People see our industry as stable and almost recession-proof because people will always become ill and get injured. They’re right… but it’s no fun if we’re making as much as the guy who flips our hamburgers.

Don’t panic. As the eternal optimist I actually see a benefit to the above. While our wages could drastically deflate overnight (not that they could go much lower), there is a big potential for benefit here. The people who have stayed in the profession have generally been able to do so for a few reasons: They were promoted into a management role that pays better than the Street Medics make. They bought and/or founded a service and make income off of company profits. Or, they just aren’t cut out to do anything else in life for um, whatever reason. These people are who are running the industry in most areas of the country folks, and some of them are intelligent, dedicated, and consummate professionals who truly care and strive for excellence. Some of them are the other kind. Who do you know more of?

When people who have deep experience in other industries, have solid educational credentials, and have experience and knowledge regarding how business really works reenter the profession and find the current state of EMS I’m willing to bet they get mad. Then, I’ll bet that they begin to work to change it. These returning EMS people have the potential to breathe new life into a stagnating profession. Their ideas gained from experience in other areas will bring vibrancy and rejuvenation to an industry ran by people whose only qualifications and ideas come from EMS classes.

Folks, this is our “Bailout” and it brings me a combined sense of terror and optimism (“Terroptimism” Hey! I coined a phrase!). No matter what happens, I never see the collapse of EMS in our future. We’re vital and are ingrained into the fabric of our society. There may be dark times ahead, but it is always darkest before the dawn.

I see a coming renaissance. How about you?

Posted by Ckemtp on July 12, 2009 • Filed under: Ambulance, EMS, EMS paramedics, EMT, Economics, Paramedic, US economy, potential, renaisance