Should EMS wages be call based?

[Kiwiology]

No, rural providers should be paid the same as urban counterparts. In some jurisdictions such as Victoria (AU) I believe they pay rural Officers more and/or have subsidies for rent and student loan repayments so they can get staff to work in shit hole rural towns.

[tniuqs]

Let me start by saying that I don't have recent experience in this system. I don't want to post my identity on the forum, but if anyone wants to pm me, I'll be happy to chat more candidly.

A very eloquent post for a said trunkmonkey .

[mobey]

I did not intend for my posts to reflect the idea that a rural provider is "better" in any way.

I will admit though, they soon got that way as I was typing through anger in response to the assumption that rural medics have weaker skills or less competence due to low call volume.

I think rural and urban providers have very different jobs.

For the most part an urban provider faces high call volumes, violence, long hallway waits, and degredation from patients. (feel free to correct me if I am wrong as I have never worked in a city over a million people)

A rural provider faces: Treating friends/neighbors on a regular basis, long transfers with/without critical care, lack of resources, living the "lifestyle" of on-call.

Of course we each have perks too.

The question of wages should not be based on call volume alone, when we obvioustly have such different jobs. The wages must be set for certifications/diploma/degree.

If we start setting wages based on calls, based on the idea that more calls = stronger skills, then why wouldent we be paid per skill used per call? The answer is simple... this is not a "trade", this is a profession, and you are paying me for my education.

[Bieber]

I don't think that our pay should be based on our call volume, but I do think that there should be incentive pay after a certain number of calls and even an incentive of some form (be it a bonus towards training, mandatory training days, extra pay, etc) after so many days without calls too.

The truth is, most of us aren't even making enough to make it worth it to even sit around doing anything. At least, I don't think so. All of the time you spend sitting there doing nothing is time you could be dedicating towards other, more profitable ventures, but you likely can't do that either while sitting at a station all day (depending on how good your service's internet is!). Not to mention, there's the problem of retention and skills upkeep in a rural environment that have to be addressed. I personally get antsy if I don't run at least four calls in a 12 hour period, preferably more like six plus. Going an entire shift without running a single call is torture for me.

While I know there are some folks who are more than happy to sit around making money doing nothing, I prefer to think that most of us got into EMS because we like to run calls, and in combination with low pay the low call volume of a lot of rural services can drive EMTs and paramedics away, which worsens the quality of the service overall. I know a lot of people say that their counties/cities/regions can't afford a paid department, but honestly, the money's got to be found somewhere. EMS is an essential service, and everyone deserves to have a highly motivated, highly trained and educated crew available to them when they have an emergency. Pay per call is simply not able to deliver that in a low volume, rural area oftentimes, I don't believe. As for volunteer EMS, that's a whole 'nother soapbox of mine!

[HellsBells]

This is a good discussion.

First and foremost, there should be no pay per call in EMS; not ever, it is utter bullshit. As was mentioned before in this discussion just ask how well that is working out for B.C. paramedics.

To add some context to my opinion, I will admit to working in a busy urban system in Alberta with a population of over a million (whoop-de-fucking-do), but with less than thirty murders this year. I must disagree with Stiffaliss comment that wage have stagnated and gone down for some paramedics, with the new receiving agreement, there have been modest wage increases across the board, personally, as a one year paramedic, my wage jumped about $3/per hour. The EMT's are seeing slightly lower wages than before, but those who were making more before the transfer were red circled, meaning their pay stays frozen until the wage scale catches up with them. So, although new hire EMT's may make less than before, no one actually has had wages clawed back from them.

Personally, I think it rocks that rural services now get the same wages as their urban counterparts. Since the system is not set up to pay by the call (nor should it be), the argument that urbans work harder, hence should get paid more is moot. My argument for parity is this: Urbans Paramedics work busier shifts, and have to be at the hall for their entire 10-14hr shift, but get to go home at the end of the day, turn their radio off, have a beer, drive out of town, etc. Rural paramedics on the other hand have less call volume, but typically are on call of 48-96 hrs straight, and have radios turned on, can't drink, can't leave town, etc. So both parties make a significant commitment to their job, and should be paid accordingly. Additionally, before anyone jumps on my back, saying "Oh you've just worked urban, you don't know what rural is like." I did work for about two years in a town with 3500 citizens (hopefully this is small enough to be considered TRUE rural).

As Tnuigs pointed out, this divide and conquer technique is very real within the AHS management, and we really do need to present a unified front, because I think we are going to see some low ball tactics and bad faith negotiation practices from AHS, particularly as the next round of contract negs get underway.

[Siffaliss]

questions for the people who think we should be payed less in the rural, although I am short on tiime:

I don't think rural should get paid less ... the way the province is going about things by freezing certain wages until everyone catches up is wrong. It isn't fair that some should be prevented from higher earnings by wage freezes, as cost of living still rises. There should be another way to go about all this.

1. If we are justifying lower wages in the rural setting by saying skills are weaker because of low call volumes, aren't we showing a level of acceptance for the crappier patient care? For those in slower settings, should there not be periodical review? The MCP's we had to complete weren't set up to appropriately edumicate everyone, including those in busier settings.
   

BTW Siff: Rather than tell off a STARS medic, I have a few on Fb.

Great, who DOESN'T have a few on FB? You did say "Oh, BTW: On the topic of skills..... are we certain that a "inner city" medic has the skills to run critical care transports for hrs on end?

How often do City Medics run transport vents for more that 15min? Nitro drips? Initiate blood transfusions? Use PEEP/CPAP for extended periods long enough they can actually do damage if used incorrectly? Several of these "inner city" medics are flight medics as well.

Check out this model.

Every Medic starts at $25/hr and tops out at $35/hr.

There are incriments or "steps" that a practitioner moves up usually annually based on job performance and continuing education attendance. If one does not qualify for his anuall "step" increment, they are given 90 days to correct the deficiency then reviewed and or disaplined as necessary. Yes, this depends on quality management... that is another thread.

In this model, those shitty employees get left behind, while others excel. Also, it is fair for all based on education/attitude/competence.

Sure, for most of this. I don't however agree with a medic getting paid $25 an hour. Hardly makes the 2 years worth it. And there should be a bigger spread between EMT and medic wages. On top of more opportunities here and abroad, it should be somewhat financially appealing to obtain a 50#, shouldn't it?

I don't think that our pay should be based on our call volume, but I do think that there should be incentive pay after a certain number of calls and even an incentive of some form (be it a bonus towards training, mandatory training days, extra pay, etc) after so many days without calls too.

Perhaps ... it's an interesting idea.

This is a good discussion.

First and foremost, there should be no pay per call in EMS; not ever, it is utter bullshit. As was mentioned before in this discussion just ask how well that is working out for B.C. paramedics.

Per call absolutely not. Bieber had an interesting idea however.

To add some context to my opinion, I will admit to working in a busy urban system in Alberta with a population of over a million (whoop-de-fucking-do), but with less than thirty murders this year. I must disagree with Stiffaliss comment that wage have stagnated and gone down for some paramedics, with the new receiving agreement, there have been modest wage increases across the board, personally, as a one year paramedic, my wage jumped about $3/per hour. The EMT's are seeing slightly lower wages than before, but those who were making more before the transfer were red circled, meaning their pay stays frozen until the wage scale catches up with them. So, although new hire EMT's may make less than before, no one actually has had wages clawed back from them.

New hires do make less now than they did even 3 years ago. Unfortunately this new model does not benefit everyone, only a few are seeing gain. There were part timers here who had wages reduced almost $3/hour, not sure if the same happened south of me.

Personally, I think it rocks that rural services now get the same wages as their urban counterparts.

The rural spot I've had since 2007 still pays much less than what I currently make, approximately $9/hour less. It's still less that what I started at in the city almost 4 years ago. I could see a lot of city folk going back to their "roots" if that's where they came from, if they made their city wage out there. Different pace, different calls. Several are finding it more and more appealing, but don't leave because most wages aren't parodied just yet.

As Tnuigs pointed out, this divide and conquer technique is very real within the AHS management, and we really do need to present a unified front, because I think we are going to see some low ball tactics and bad faith negotiation practices from AHS, particularly as the next round of contract negs get underway.

It will be interesting to see how the negotiations turn out. Our only saving grace here (not sure if it's the same elsewhere) is that we have some members from the past union at the table for us. Will that be enough? Who knows. They're doing the best they can.

[systemet]

To add some context to my opinion, I will admit to working in a busy urban system in Alberta with a population of over a million (whoop-de-fucking-do), but with less than thirty murders this year.

Nice! I wonder where that is?

[mobey]

For those in slower settings, should there not be periodical review? The MCP's we had to complete weren't set up to appropriately edumicate everyone, including those in busier settings.

Absofreekiglutly!

This is a HUGE problem that many rural providers and employers are really quick to sweep under the carpet. The old volunteer mentality still exists in some areas and it discusts me.

Periodical review as well as strict con-ed format is an absolute must in my opinion...

This should have it's own thread

[flamingemt2011]

In a sense yes, more calls mean more revenue, if u are in Podunk running 2 calls per shift and u r paying los angeles wages, u will either go bankrupt or be privatized soon

[Asysin2leads]

In a sense yes, more calls mean more revenue, if u are in Podunk running 2 calls per shift and u r paying los angeles wages, u will either go bankrupt or be privatized soon

And yet again, profit-driven healthcare is at odds with quality healthcare administration. Rural settings have the problem of retaining employees. If you pay them less, they will leave for higher wages.