What should I look for when applying to an EMS agency?

[Floridastudent]

I know this is a little premature, because I've only finished my first month of my one semester EMT program, but...what are some things I would look for when considering what EMS agencies to apply to? Salary enters into it to an extent, but beyond that - what are desirable characteristics of an EMS agency?

Yes, I am going on to paramedic at some point. Not sure yet if it's going to be immediately after this semester is over or if I'm going to try to get an EMT job first and then go to paramedic school while working for an EMS agency. (Money is an issue. As in, I'd like to start earning some sooner rather than later.)

[sacemt]

Dear FloridaStudent, a few things I've learned when considering ems agency as I am currently very active in talking to the staff of all the different ones in my surrounding area,california, to concentrate on is finding which agency gets the most calls or even which ones get to do 911 calls because, atleast in my area are all by contract and only one agency,amr to be exact has the 911 contract and almost all the rest which there are multiple do transport and well transport isn't exactly what I want to do all the time, I think you should just talk to employees of your surrounding areas of different agencys and see which suites your personal wants in work envirment and type.

[Floridastudent]

Dear FloridaStudent, a few things I've learned when considering ems agency as I am currently very active in talking to the staff of all the different ones in my surrounding area,california, to concentrate on is finding which agency gets the most calls or even which ones get to do 911 calls because, atleast in my area are all by contract and only one agency,amr to be exact has the 911 contract and almost all the rest which there are multiple do transport and well transport isn't exactly what I want to do all the time, I think you should just talk to employees of your surrounding areas of different agencys and see which suites your personal wants in work envirment and type.

That's true - I should have mentioned that I am definitely interested in working for agencies that do 911, not transport. Since I live in Orlando area, I am almost definitely going to have to move in order to get a job, because most of the 911 here seems to be fire department based. I'm fine with moving, even out of state if I have to. In an economy like this you have to be flexible.

Edited February 15, 2010 by Floridastudent

[Kiwiology]

Look for an orginisation with a good culture; one that is open and informal where the employees work together to achieve thier goal.

Strong clinical support is a must; a good medical director who is involved and does more than review forms to disclipine people, the supervisors must be more than means to dole out write ups, a structured continuing education program.

Does the company get involved in research or offer journal access, do they take part in trials or send people to conferences etc

How does the company support continued professional development, who can you talk to if you feel you are having a problem about something of a clinical nature? If you want to go to Paramedic school do they encourage a Degree or just a quicky stop down at the local medic mill?

Take a look around thier operation; do thier trucks work, are thier supplies up to date, is thier station falling apart; things like that.

It is as much as them being a good fit for you as it is about you being a good fit for them

That's true - I should have mentioned that I am definitely interested in working for agencies that do 911, not transport. Since I live in Orlando area, I am almost definitely going to have to move in order to get a job, because most of the 911 here seems to be fire department based. I'm fine with moving, even out of state if I have to. In an economy like this you have to be flexible.

Do not overlook the value of patient transfer.

If you are serious about being a MEDICAL professional then you will see the benefit in doing low risk, sub-acute transfer work that gets you reading paperwork and building knowledge as well as the finite primary skills like communication and assessment.

You should be taking college anatomy/physiology, pharamcology and pathophysiology; these combined with a transport job will give you a much better insight into WHAT is wrong with your patient, HOW the medication they take affects the body and WHY you treat how you treat.

This will get you 1000% more VALUABLE AND RELEVANT experience when it comes to dealing with critical or complex patients than any Paramedic program.

Edited February 15, 2010 by kiwimedic

[46Young]

+1 on Everything kiwimedic said, especially taking A&P and pharm, maybe patho.

From an economic and career standpoint, this is my short version of what to look for in applying to an EMS agency:

Look into what the benefits are, what is the pension, what is my starting salary and what is the pay progression to top pay? What are the opportunies for promotion in the job?

Starting salary - ask them how they determine compensation; experience based, step based, case by case basis? How do they progress to top pay? step based, merit based, favoritism? If not step based is it percentage based? This is a good thing due to the compound interest effect. Any COLA's?

Benefits - what medical plans do they have, PPO, HMO, OAP, monthly premiums, any deductibles, percentage of coverage out of pocket limit, prescription coverage, etc. How many sick days, admin days, and holidays? What is the process for requesting leave? Are you actually able to use your days, or do they make it prohibitively difficult to take any days off? What are their policies regarding injury leave and opportunities for light duty?

Retirement - defined contribution, as in the 401k or 403b was originally designed for the affluent in the corporate world as an additional tax shelter, nothing more. The thing is, these corporations realized that they could save a bundle by discontinuing their defined benefit programs, pensions and instead offer 401k's. Unless you're young and earning six figures with low overhead, you have absolutely no chance in saving enough to sustain yourself in retirement with a defined contribution plan. Especially someone such as yourself with college age children. You'll be living on an EMT salary for a few years and then a medic salary afterward. Enough to pay the bills, but you'll retire poor.

You absolutely, without question, need a pension. When looking for a pension, there are several things to consider; what's the multiplier, required years of service, and also number of years to be fully vested.

For example, when I worked at Charleston County EMS they were on the state retirement system. You can retire at 28 years of service or 65 years of age, whichever comes first, provided you're vested with five years of service. The multiplier is 1.8 x years of service x average three highest earning years (or one year, I forget). This works out to about 50% of your salary as a yearly pension benefit, plus 1-2% COLAs. They also have the TERI program, which is similar (maybe the same) as our DROP, more on that later.

http://www.retirement.sc.gov/scrs/active/basicinfo/default.htm

At my employer, we have a 25 and out with a 2.8 multiplier, or 55 years of age. This works out to be 70%. We can also continue to work afterward, to increase the multiplier up to the point that we get 100% as a yearly benefit. Since I was hired at 32 y/o, I can retire fully vested at 53 years of age, with the multiplier adjusted as if I worked 25 years. We also have the DROP, like the TERI in SC. How this works is that you "retire", but then continue to work for up to three additional years. You continue to earn your salary and benefits, and also receive the full amount of your pension checks in a deferred comp account! It's a great way to save up a few hundred grand at the end of your service years, in addition to your deferred comp. You'll also have a 457, which is the same as a 401k except that the employer won't typically contribute anything, since they're helping fund your pension. Also, what percentage of your salary are you required to contribute to your prnsion? We pay 7%. Anything over 9% is a ripoff. If you were to invest that 9% in a deferred comp instead of the pension fund, and received a generous 10% compounded return, you'd still break even after 7 or 8 years, and then the pension would continue to pay until you expire.

So, what looks better, a 401k where you need to contribute money that you probably can't spare, and maybe have some clue as how to invest, or a pension that's guaranteed for life, possibly with a DROP or TERI? Think "ENRON" as an extreme example.

Promotional opportunities - Are promotions awarded off of a list, where the scores are based on a written exam and maybe an oral interview; or are promotions subjective, with favoritism as the main selection criteria? And what is the actual opportunities for advancement? Are there admin positions available? Or maybe only dispatch? Hospital based and fire based services generally offer the best opportunities for career advancement.

[46Young]

Edit: the last post should read that I could retire at 55, or 58 w/DROP.

Anyway there are a few more things:

Starting salary - if it's unusually high for the area, check if that is a tactic to distract from the inadequacies of the dept.

Schedules - are they 24's, 16's 12's, 8's? A 24/48 or other variants will be a 56 hour workweek. Be careful with a 24/48, as they can mandate you to stay for up to an additonal 24 so you're working a 36/36 or 48/24 if vacancies abound. For a busy system, 12's and 16's are more desireable. At Charleston, where I worked a 24/48 (no kellys) if I took a day off, or called in sick, that reduced my OT hours. In a 56 hour week, 16 hours are OT. When I took a day off, those OT hours would convert to straight time. This is unacceptable. What's also unacceptable is being paid on call for the overnights. You're paid for the first 16 of a 24 hour shift, and for the last eight you're only paid for the time you run calls. The employer gets over on you for this. The rig is staffed, but they only pay if a call comes in. Don't work for a place that nickle and dimes you like this. If they're cheap with work hours, they'll fall short in other areas as well, I can assure you. Another major factor is if they change schedules periodically. When I worked for NSLIJ hosp in NYC, they would wipe the slate clean every two years and bid out tours on a seniority basis. CCEMS did it every six months. My employer only does it if you're promoted to a new position. Changing schedules can add travel time, or thwart one's plans for child care, school, side jobs, etc.

Uniforms and equipment - do they give you uniforms, boots equipment, etc? If they only give you a couple of shirts and maybe a windbreaker, then they're cheap. They'll also be cheap in other areas as well.

Equipment - are their rigs fully stocked? Is their medical equipment state of the art, or do they just supply with the bare minimum to pass a state inspection? Are their rigs kept in good repair with regular maintenance? Or are they falling apart. If an agency doesn't keep their apparatus and equipment well maintained, then where else are they cutting corners?

Protocols - progressive evidence based, or stuck in 1984? Is there a full time medical director? Is the director accessible for questions?

Continuing Ed and training - How do they provide (do they provide?) continuing ed, new equipment/protocol inservices and alphabet card recerts? On duty, off duty or are you on your own? With NSLIJ, we had inservices and ABC card recerts, but no CME's. CCEMS held monthly all inclusive inservices, for 6 hours each, mandatory, but only for straight time, not OT. My employer sends us to EMSCEP, the EMS Continuing Education Program for eight hours quaterly, at a facility run by PA's, RN's and an RT, with a living room and ambulance mock up with SimMan/SimBaby, for lectures, skills instruction/testing and ABC recerts. We also do monthly in station EMS training with both lectures/powerpoints and skill drills, and also quaterly EMS multi unit drills at the fire rescue academy. Is you ConEd free, or out of pocket? Quality employers care about their employees and getting them to re3cert without any financial insult.

Discipline - is it progressive discipline, or does it differ on a case by case basis? It ought to be progressive discipline - a verbal warning, a written warning, another written warning with someone in upper management, and then a meeting with the head of dept which typically results with a termination. Of course, the seriousness of the infraction can land you at step 2,3, or ever 4.

Union or non union? You need someone to watch your back, to level the playing field with management. $30-50 bucks a month in dues for an extra 10 to 10 grand in salary plus benefits and protection. I'm sold.

Stay away, far far away, from agencies with system status management. It's a way for employers to do the most with the least amount of resources. Translation: you'll be worked to the bone, but not see any additional financial benefit from being more "efficient".

For pensions, as mentioned in my previous post, the Carolinas have many single role EMS third service agencies. There's also FDNY EMS, but the working conditions suck. It'll be really fun for the first few years, then you'll burn out.

Another word on career advancement - you may want to focus in on hospital based EMS if you want to advance out of EMS. Hospital systems afford that opportunity, as well as fixed schedules, that can be tailored to school. It's good to have that option in case you burn out with EMS.

I've outlined what I think are the main considerations, from a career development and economic standpoint, regarding EMS agencies. It's up to you what you'll tolerate in choosing an EMS agency, as it's highly unlikely that you'll find all of these qualities in a single agency. That's a huge reason why I went fire based, to enjoy all the positive qualities in an employer as described above.

Edited February 15, 2010 by 46Young

[46Young]

I've thought of yet another consideration. You mentioned some time ago that you may relocate to NYC. I don't know if you still plan to go there, stay in FL, or are open to other regions.

When discussing compensation, salary vs cost of living is important. Taking a lower salary with the rationalization that it's an area of lower cost may be a mistake. Let me explain:

Let's say that you earn 50k/yr, and your monthly cost of living is 2k. Assuming no disposable income is squandered, that leaves an additional 500/month for investment or even more if you invest in in deferred comp pre tax. This is based on 24 pay periods, the other two would be for clothes, recreation, dining, etc. Your pension benefit at 50% would be 25k/yr for the rest of your life.

Now, let's say that you earn 100k/yr, and your monthly cost of living is 4k. You now have an additional 1000 post tax for investing. Your monthly pension benefit will be 50k/yr rather than 25k. You've now doubled your annual pension, and an increased your deferred comp (DC) due to compound interest. How much so? Let's assume a 500/month contribution to your DC, starting with 6k at the end of the first year, and an additional 6k added yearly for the next 29 years, at a realistic yet underwhelming 7%. After the 30 years total, you'd have $603,450. Now do 1000/month, or 12k/yr, for 30 years total as above at the same 7%. You'll have $1,206,900, or double the previous calculation. So, when choosing two regions based on cost of living vs salary, be aware that you'll retire much wealthier, providing the pricier area has a more or less proportional cost of living to salary ratio to the less expensive area.

This is where those earning meager salaries in inexpensive areas lose out in the long run. You can always leave the expensive area after retirement and move somewhere both desireable and cheap.

Edited February 15, 2010 by 46Young

[Floridastudent]

Thank you SO much! I'm going to cut and paste all of this! You've given me a lot to go on - this was like a thesis on what to look for in an employer! And since I'm not on the inside, I wouldn't have thought of any of those.

I don't know yet where I will end up once I get my EMT and/or paramedic - I'm looking around FL, I'm still considering NYC - I have to consider quality of living as well as salary in the cities that I apply to.

I've thought of yet another consideration. You mentioned some time ago that you may relocate to NYC. I don't know if you still plan to go there, stay in FL, or are open to other regions.

When discussing compensation, salary vs cost of living is important. Taking a lower salary with the rationalization that it's an area of lower cost may be a mistake. Let me explain:

Let's say that you earn 50k/yr, and your monthly cost of living is 2k. Assuming no disposable income is squandered, that leaves an additional 500/month for investment or even more if you invest in in deferred comp pre tax. This is based on 24 pay periods, the other two would be for clothes, recreation, dining, etc. Your pension benefit at 50% would be 25k/yr for the rest of your life.

Now, let's say that you earn 100k/yr, and your monthly cost of living is 4k. You now have an additional 1000 post tax for investing. Your monthly pension benefit will be 50k/yr rather than 25k. You've now doubled your annual pension, and an increased your deferred comp (DC) due to compound interest. How much so? Let's assume a 500/month contribution to your DC, starting with 6k at the end of the first year, and an additional 6k added yearly for the next 29 years, at a realistic yet underwhelming 7%. After the 30 years total, you'd have $603,450. Now do 1000/month, or 12k/yr, for 30 years total as above at the same 7%. You'll have $1,206,900, or double the previous calculation. So, when choosing two regions based on cost of living vs salary, be aware that you'll retire much wealthier, providing the pricier area has a more or less proportional cost of living to salary ratio to the less expensive area.

This is where those earning meager salaries in inexpensive areas lose out in the long run. You can always leave the expensive area after retirement and move somewhere both desireable and cheap.

Edited February 15, 2010 by Floridastudent

[Floridastudent]

I definitely plan to continue my education. Last semester I took medical terminology, and I'll be taking biology, A&P I and II, etc., some time in the near future.

I'm not against transport in the short run. It would actually be a great way to learn in a lower-pressure environment. However, my ultimate goal is responding to 911.

Look for an orginisation with a good culture; one that is open and informal where the employees work together to achieve thier goal.

Strong clinical support is a must; a good medical director who is involved and does more than review forms to disclipine people, the supervisors must be more than means to dole out write ups, a structured continuing education program.

Does the company get involved in research or offer journal access, do they take part in trials or send people to conferences etc

How does the company support continued professional development, who can you talk to if you feel you are having a problem about something of a clinical nature? If you want to go to Paramedic school do they encourage a Degree or just a quicky stop down at the local medic mill?

Take a look around thier operation; do thier trucks work, are thier supplies up to date, is thier station falling apart; things like that.

It is as much as them being a good fit for you as it is about you being a good fit for them

Do not overlook the value of patient transfer.

If you are serious about being a MEDICAL professional then you will see the benefit in doing low risk, sub-acute transfer work that gets you reading paperwork and building knowledge as well as the finite primary skills like communication and assessment.

You should be taking college anatomy/physiology, pharamcology and pathophysiology; these combined with a transport job will give you a much better insight into WHAT is wrong with your patient, HOW the medication they take affects the body and WHY you treat how you treat.

This will get you 1000% more VALUABLE AND RELEVANT experience when it comes to dealing with critical or complex patients than any Paramedic program.

[46Young]

Thank you SO much! I'm going to cut and paste all of this! You've given me a lot to go on - this was like a thesis on what to look for in an employer! And since I'm not on the inside, I wouldn't have thought of any of those.

I don't know yet where I will end up once I get my EMT and/or paramedic - I'm looking around FL, I'm still considering NYC - I have to consider quality of living as well as salary in the cities that I apply to.

You're welcome. From what I understand, most of FL EMS is fire based. Try Lee County, or any other quality municipal agencies that you know of. You could get your RN, then challenge out the medic, just a thought. In any event, regarding the long term (just get your foot in the door somewhere for now), stay away from private EMS. Acadian in LA/TX/MI is decent, though. Observe the example of Rural Metro in Atlanta. The operation could pack up and leave at any time, leaving you without a job.