EMT/Paramedic Independence Day July 2009- Increase your pay!

[crotchitymedic1986]

I have to admit that i am as pessimistic as anyone, but you know, all journeys start with a single step. This forum has a very vast membership across several states and countries. If we decided to make a go of it, why couldnt we pull it together ? If my suggestion is not the solution that people can rally behind, lets find the one that we can rally behind.

Suggestions ......................

[VentMedic]

I do not know when RN educational requirements went up, or if they ever did. I know that for some reason RNs with degrees have become more popular in the last 20 years, that could be because of pay, by choice, or because thats what the hospital's want ? Not sure.

The nursing diploma schools started to dissolve in the 1970s. Ironically, EMS had already established many 2 year degree programs at that time and was thought to have every opportunity to get stronger before the nursing profession did. I got my EMS degree in the 1970s as did some of the other 30+ year veterans of EMS on this forum. The degree was the way the profession was headed so we were told. By the mid 1980s, several ambulance companies and FDs were milling their own in the back rooms of the stations. It should have been done differently but people were wanting to make money quickly off this new profession. There was also an endless line of applicants for these schools due to the promise of an "exciting career" quickly. EMS actually took a lot of students away from nursing and other professions creating empty seats in some classrooms.

Nursing shortage? Nurses have managed to handle their numbers well. They also have kept to their education standards in creating future professionals and have used that minimum of a 2 year degree to screen out those that truly have no place in healthcare. Some still slip through but most do not. EMS is still practicing a warm body mentality for recruitment.

There is also a play on numbers for FTEs amongst all professions. Budgets like to be set around what the ideal is and not reality. A hospital may be fully staffed but still prefer that cushion of having a few extra positions not filled on the books. These numbers may be tallied in "shortage" numbers and used for whatever advantage. Ever notice how a FD presents its budget requests to the public?

There are graduates continuously graduating from the many nursing programs at all levels. Healthcare is constantly changing. One area might be hard pressed to recruit RNs but it might be for many reasons other than a shortage of nurses. The geographical location might be undesirable. The hospital could be financially unstable on the verge of closure or a mess to work for. We have had many hospitals close and layoffs have also affected RNs. In Florida, we hire seasonal workers and provide no benefits except a slightly higher wage. In the Spring, we have no further use for them so they must move on. Lately, some of our regular staff RNs have been cut as well when the hospital census decreases. However, we also get numerous applications from RNs for our ICUs and can be very selective. As I mentioned before, Excelsior grads need not apply. There are many highly educated/trained RNs that are familiar with the basic skills of nursing that have had their work ethics and skills observed or developed during traditional clinicals.

The nurses have a national identity as a NURSE. It doesn't matter if they work county, public, private, jail, clinic, OR, dialysis or whatever. They are NURSES with a common educational foundation that they have expanded their careers on through additional education. EMS has 50+ different titles or certs recognized with each of the 50 states doing its own thing. That doesn't include all the "specialty titles" for certs given out by individual organizations, We have yet to figure out what to even call EMS providers and agree on what should be the minimum education. The education itself varies for the Paramedic with as little as 500 hours being required in some states to a 2 year degree in one state. The states that are starting to promote a degree for EMS aren't even requiring it to be in the health sciences.

Other healthcare professions have used their common education and identity to petition for reimbursement at state and Federal levels. Thus, the tech titles and OJT mentality of training have gone by the wayside so that a list of standards can be used as bargaining power. And no, that does not mean you just list "skills" but what worth you bring with those skills. Example: the skill of intubation is reimbursed differently for different professionals doing the intubations. If reimbursement drops, that skill may be turned over to another group of professionals.

Another example: Nebulized respiratory meds should be the responsibility of RRTs. However, if reimbursement makes it no longer feasible for RRTs to do them even as a "therapy" per Medicare/Insurance guidelines, they are turned over to nursing and lumped in with their collective nursing services. RRTs then moved on to develop more ICU services or take over HBO, Cardiopulmonary Rehab or the cath labs.

Healthcare is a business. You have to prove you have something to bargain with and be willing to bargain. If the traditional services aren't working, a different approach may need to be presented. CCT and Specialty are examples. But, even "regular" EMS could put a new twist into its sales pitch if it was unified with education and just a few titles for the providers.

[crotchitymedic1986]

Very insightful, thanks. So lets say we make a four year degree mandatory by 2012, how does that then become a "reimbursement issue" that benefits our employers, so that they can pay us more. Most insurance providers do not pay EMS by what is done to the patient, but rather a base fee and mileage. We no longer "itemize" our bills, so doing more stuff is not going to mean more dollars. Or will it ?

[fiznat]

I know it's off topic, but I have to say Ventmedic that's twice today I've been extremely impressed with your replies on this forum. I had no idea you've been in EMS so long and had such experience that you could (and do) pass on on to the rest of the community here. People of your kind don't get it often here so I'd like to offer my sincere thank you. Bravo.

[spenac]

I know it's off topic, but I have to say Ventmedic that's twice today I've been extremely impressed with your replies on this forum. I had no idea you've been in EMS so long and had such experience that you could (and do) pass on on to the rest of the community here. People of your kind don't get it often here so I'd like to offer my sincere thank you. Bravo.

I agree. These type of posts by Vent are the ones I enjoy. But at times Vent well thats another discussion. :wink:

[VentMedic]

Very insightful, thanks. So lets say we make a four year degree mandatory by 2012, how does that then become a "reimbursement issue" that benefits our employers, so that they can pay us more. Most insurance providers do not pay EMS by what is done to the patient, but rather a base fee and mileage. We no longer "itemize" our bills, so doing more stuff is not going to mean more dollars. Or will it ?

That is because it is looked at as a tech service and not on the same level as a professional serice.

I don't know if you meant the 4 year degree to be humorous, but look at the professions that do make a four degree their minimun. Look at Physical Therapy with their Masters and Doctorate degrees. I only wish either of my professions could command the opportunites, wages and sign-on bonuses that PTs have.

It also doesn't happen overnight. The other allied health and nursing professions have encouraged their members to get higher education long before it became standard even if that meant still working for a lower pay with a college degree. It eventually paid off. When the bar was raised, it wasn't a stretch to make the change.

The other part is deciding what should be the lowest level provider and where to place them in the hierarchy. RNs do not include CNAs and LVNs into their professional organizations and unions. While there is still an important place for these healthcare workers just like the EMT, how and where do you separate to advance the higher level?

Now let's examine the orgins of EMS and other professions. Nursing has always been a "career path" for women in both private and military back when women did not have many options. The 1970s when nursing moved toward higher education and professional status, women as a whole were also making a move to advance their status.

Most of the allied health professions were a spin off from nursing as medicine was advancing and the need for specialization came about. Nurses had been doing RT, Radiology, lab, EKG etc for decades. Nurses have also been involved in transport long before EMS. I do pity those that assisted in the earlier NICU transports and the 400 pound isolettes.

EMS was put in the FDs for convenience since FFs were already there to prove that a few advanced skills could be taught and utilized outside of the hospital by those with very little or no healthcare education. It was not a separate career path but an addition to an existing one.

One could also look at the Freedom House ambulance. There again it was thought that a few skills could be taught for the betterment of the community. There was a need and that need was filled. Freedom House Ambulance should have been the role model for EMS and not the FDs since it was totally focused on medicine and not an add on to an existing job for convenience. Unfortunately it never got the recognition it deserved and the model it set was basically ignored in EMS history.

Here's a little info:

http://www.freedomhousedoc.com/

Morton Coleman, of Pitt’s Graduate School of Social Work, suggested combining an ambulance service with a program to train unemployed and underemployed black men and women as medical technicians. Searching for an owner/operator Hallen approached the recently formed Freedom House Enterprises, Inc. (FHE). FHE was an outgrowth of the United Negro Protest Committee located at 2027 Centre Avenue. In an unprecedented partnership with Dr. Peter Safar, known as the Father of CPR; a world leader in resuscitation research; and other pioneers in emergency medicine, Freedom House Paramedics began. Starting from a base in Presbyterian and Mercy Hospitals in 1968, they became the first Paramedics in the United States.

Over the years 1967 – 1975 FHE would recruit and train over 50 medical attendants; own five mobile intensive care units, crammed with some of the most sophisticated emergency medical equipment available at the time; operate a round the clock service; and provide nationally acclaimed emergency service. This service was not only provided to the Inner City Hill District residents, but to large percentage of the citizens of City of Pittsburgh.

During the eight years of the Freedom House Service, there was a mounting pride and espirit de corps among the paramedics. Hill District residents, including patients and their families, applauded the FH service. It wasn’t that long ago that the residents of the Hill could not get anyone to come into their area to pick up the sick and ill. Not only did they get an Ambulance Service but also they received the most sophisticated emergency care of the time. Jerry Esposito, an independent ambulance operator devoted to the FHE mission, summed it all up when he said. “This was a poverty program that was meant to fail, instead not only did it work but it helped to propel Emergency Care into another arena.”

The Freedom House Paramedics had come a long way from those black unemployable individuals that were first recruited for this project. A substantial number had earned bachelor’s degrees, a few had master’s degrees, and three were in pre-med. All were functioning in the field at a level comparable to the best Paramedics in the nation. But the political winds were shifting. The city decided to launch its own mobile intensive care service. There was no room in the city plans for an independent entity called Freedom House. By early autumn 1975, it was clear that city funding would not be renewed. Negotiations began to sell FHE equipment to the city and to facilitate the hiring of FHE personnel into the city system. It was a bitter time for the Freedom House Paramedics. For eight years they had battled for survival. For eight years, they had stuck with the organization while they watched white trainees leave to assume high administrative positions with city and county emergency medical service agencies. During those years the FHE was the proving ground for national standards of emergency care.

It was a time of considerable anxiety. For eight years the city administration had been the adversary. The city police had been the symbol of frustration. Now nearly 30 Freedom House technicians would have to go to that administration for work. If hired they would have to don uniforms uncomfortably similar to those worn by the police. But the alternative was unemployment, so the majority of FHE personnel elected to apply for work with the city. For its part, the city administration, anxious to avoid a confrontation and another “ambulance controversy’ in the press, offered a Memorandum of Agreement to Freedom House. In this memorandum, signed by the Mayor, the city agreed to provide jobs to all interested FHE Paramedics, without requiring needless recertification. The city agreed to provide a training program for basic level paramedics, with an opportunity to repeat the course in the event of failure. And the city agreed to offer FHE dispatchers a course in dispatching as well as employment. Over the ensuing months all of these promises were broken. The Freedom House paramedics, who had been trained to the most exacting standards in the nation, were compelled to go through yet another course: a course that did not meet federal requirements. The FH paramedics were not given an opportunity to repeat course work if they could not pass the first time. The FHE dispatchers found themselves assigned to frisking prisoners in the city jail.

By October 1976, a year after Freedom House ceased operation, only 12 of the 26 persons who had elected to work for the city remained on the city payroll. What of the other 14? Some found work outside the health professions as secretaries, salespeople, automechanics, security guards, one as an orderly at a local hospital. The rest are back on the streets, looking for work and remembering.

Note: As of this day October 8, 2003, there is no mention of the Freedom House Paramedics in any of the training materials for Paramedics.

[VentMedic]

I know it's off topic, but I have to say Ventmedic that's twice today I've been extremely impressed with your replies on this forum. I had no idea you've been in EMS so long and had such experience that you could (and do) pass on on to the rest of the community here. People of your kind don't get it often here so I'd like to offer my sincere thank you. Bravo.

Just look at my posted age. I am almost as old as spenac!

[crotchitymedic1986]

No, that wasnt sarcasm or humor, I am just trying to follow your path all the way out. Good points, I wasnt aware of freedomhouse. But if we did accomplish your plan, whats to keep the services from just pocketing the new revenue, or spending it on ladder trucks ? How can you guarantee it would ever make it to a payraise if we are not united in our demands ?

P.S. Nothing pisses me off more than this conversation that I heard over and over again throughout my career:

Citizen: Are you an EMT

me: Actually I am a Paramedic

Citizen: Do you have to go to school for that ?

:twisted: :twisted:

[spenac]

Just look at my posted age. I am almost as old as spenac!

You wish you were as young as me.

[VentMedic]

No, that wasnt sarcasm or humor, I am just trying to follow your path all the way out. Good points, I wasnt aware of freedomhouse. But if we did accomplish your plan, whats to keep the services from just pocketing the new revenue, or spending it on ladder trucks ? How can you guarantee it would ever make it to a payraise if we are not united in our demands ?

My plan? I am pro education and that should also start with establishing a much higher minimun standard for those teaching in EMS. The minimumly educated should not be teaching as role models if higher education is to become the norm.

Demands? This is not a union picket line but the birth of a profession that is long past due at the age of 40. And no, nothing will be accomplished to reset the reimbursement schedule unless EMS becomes a profession with established titles and education minimums across the board. Change can come slow and some professions were able to establish their mark in under 20 years. But, they took lessons from others in healthcare and were careful to lay a foundation. EMS has isolated itself into believing it is very different and thus some do not identify with being a part of healthcare. The "nobody understands us" statement is more of an excuse for the lack of progression and a reason to stay the course as it is because anything else might look scary. Some just don't want things to change or going back to school for some is a scary thought that brings out insecurities. Each heathcare profession from nursing to all of the allied health professions have gone through this. They did however have the advantage of working with others who had achieved respect and recognition by Federal/State insurers through education and professional organization.

EMS has got to give their lobbyists something to work with other than 50+ different certs and education all over the map for "hours". Presenting this mess to educated legislators, who know what their titles are and how much education they had to get to be where they are now, is a difficult task for even the best supporters of EMS. One member from the House was even quoted as saying "Come back when you know who you are". Unfortunately, that message still did not spark a movement forward but rather just the same old "they just don't understand us" complaining came out of it.

Pocketing the revenue?

Other places that employ healthcare professionals can turn a profit. It the FDs can also gain then so be it. It is going to be difficult to get FireMedics to leave their career job but if the educational standard is raised, there might be an attitude change toward the profession as a whole. With increased education, there might also be a "demand" for more accountibility.

P.S. Nothing pisses me off more than this conversation that I heard over and over again throughout my career:

Citizen: Are you an EMT

me: Actually I am a Paramedic

Citizen: Do you have to go to school for that ?

:twisted: :twisted:

While it may sound insulting it does have a ring of truth to it. Some in EMS did not attend a "school" but rather were OJTed in the backrooms of ambulance and fire stations. Many of those from the 1980s were trained this way. AMR at least established a "traditional Medic mill" (NCTI) and took their training program out into the open. Some FDs are putting the training back into the station and taking it out of the colleges as seen with recent headlines and a rather heated discussion on this forum.

Surgical and Ortho techs in some hospitals are still trained by OJT programs and they must reply in all honesty, NO, when asked the same question. Their programs may also be up to a year in length with more classroom hours than the Paramedic. However, there are those that are also trained at a votech school or college (like some in EMS) who may have a different point of view about their education and their own thoughts about the OJTs.

My ending message: Stop making excuses. Enough with the "we're so different" isolation statements. Join the world of medicine. Learn from the trials and triumphs of other healthcare professions. The comparisons should be constructive and not the juvenile "we can intubate" or "we start IVs too so we should be paid just as much". Educaton should go with the skills. If that truly was the case now we would be hearing less remarks like those just mentioned.

Attend those boring meetings in your county, state and at the national level...not just the fun stuff. If you don't speak out, listen to where others are coming from in their views of EMS.

Even if the steps you take may seem small, they are steps nonetheless. Florida has recently passed a bill to obtain specimens without consent for exposure incidents which should be of interest to EMS providers. This was in anticipation of the Ryan White Act not getting extended. States should not have to depend on such a lengthy and costly bill to establish one very important aspect of care. Yet few have actually read the Ryan White Act. This was something I lobbied for since I am becoming tired of fighting Medic Mills in a state where many of the Paramedics are obtaining or holding the cert for the wrong reasons and don't want to see the "hours of training extended. The agrument I hear most is that 700 hours is way too much and 550 or 600 would be more reasonable. Afterall, many FDs only give FFs a year to get their Paramedic. How can one take these arguments to legislators when lobbying for increased reimbursement? However, if the education was raised across the board to 2 years, those in the profession now would be grandfathered and those that want to be FireMedics by the time they are 21 y/o had better hit the books in a college program. That shouldn't be too much to ask for. It might even change the way some view FFs as also having brains to go with the body.