Compare your pay

[WANTYNU]

Why? Because EMT's, Paramedic's have nothing to do with lawyers. I don't see why your even trying to make a comparison between the two; because of some offhand remark made about saving lives? WANTYNU, I also think that is irresponsible of you to make the statement that it takes 2 years for a law degree, when you know full well lawyers need an undergrad degree, go through at least 6 years of schooling, and rack up massive student debt.

If you want to compare professions, lets see where we measure up to X-ray techs, Sonographers, Lab techs, Respiratory techs, RN's, etc. Professions in the health care field that require the amount of education similar to that of a Paramedic. The question to ask is why do they make more than us?

First please don’t misread into my statements, if you looked, I do recognize it takes a 4 year undergrad degree, but there are many in EMS who have a 4 year degree, and more, however they don’t get paid any more because they have one though..

For the second part of your post, that’s EXACTLY my point, we’re looking at the wrong things. We need to look outside our field to understand VALUE, which is a composition of Education, Risk, Demand, Difficulty, and finally PUBLIC PERCEPTION, are we ambulance drivers or technicians?

Anyone remember the “Pet Rock” it was all about marketing, but the joke was the guy who did it, made millions, selling an ordinary rock in a box with a fancy name to the public…

My point is not to compare us to lawyers or any one else for that matter, my point was to open a discussion on value.

Lawyers themselves argue $1000 per hour is ridiculous, but they get it because they have set the public’s perception that they’re worth it.

What can we do as a group to set public perception that we’re worth more?

[EMS Solutions]

Supply - We keep supplying free labor by volunteering

Demand - There is no demand to have to pay us anymore than chicken feed

Whenever, we start requiring EMS instructors to be EMS Educators with a formal degree, and requiring the minimum to have an associate degree before job entry level, then and only then we have a legitimate gripe.

Yes all EMS Eductaors should have formal degrees and get paid accordingly as well. By requiring them to have these degrees , payscales will increase as an educator.

But still, the field personnel will have no drive to get the higher eduaction until their payscale and benefits improve.

I dont think the formally educated instructor will teach for free i.e volunteer.

Why do nurses, Lab techs, x-ray techs, PA's etc all get paid more? There are no volunteer nursing or x-ray tech squads.

They demand pay and employers supply it.

[WANTYNU]

Supply - We keep supplying free labor by volunteering

Demand - There is no demand to have to pay us anymore than chicken feed

Yes all EMS Educators should have formal degrees and get paid accordingly as well. By requiring them to have these degrees , payscales will increase as an educator.

But still, the field personnel will have no drive to get the higher education until their payscale and benefits improve.

I dont think the formally educated instructor will teach for free i.e volunteer.

Why do nurses, Lab techs, x-ray techs, PA's etc all get paid more? There are no volunteer nursing or x-ray tech squads.

They demand pay and employers supply it.

EMS I agree,

And to stir the pot once more....

A GREAT article from Scott Phelps written for EMS Magazine.

It is very forward thinking and controversial, "Turn the whole thing on it's head thinking", but Scott's a very Smart guy, so his opinion is at least worth listening to and giving some consideration.

The slant may be more urban in nature, however, there are seeds of wisdom we all may prosper from...

here's the article.

>>>>>>>>>>>>>>>>>>>>>>>>>>>>

http://www.emsresponder.com/print/Emergenc...E-of-EMS/1$5494

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"The FAILURE of EMSIn order to survive, the system must first collapse

By Scot Phelps, JD, MPH, EMT-P, CEM, CBCP, MEP

The concept of an EMS system has failed. After 40 years, it is time to admit defeat. The concept of an EMS system has failed. After 40 years, it is time to admit defeat. While the idea of providing an organized system of advanced out-of-hospital care was a good one,

internal and external forces have led to the imminent failure of the EMS system in America. I, for one, am glad, because the system as it is currently structured cannot work.

This collapse was about 20 years in coming. When I started EMS in the 1980s, there was a lot of hope for the industry. I grew up in an era when BLS ambulances were nearly 100% volunteer outside of large cities, when first aiders were transitioning into EMTs, and

when statewide paramedic coverage was an almost-realized dream in New Jersey. It was also an era of mobile intensive care nurses (holy cow! a decently paid career track with options), a strong tradition of volunteer crew chiefs with a decade of experience mentoring new cadets, and a billing system that let paramedics bill enough to cover the costs of operating the paramedic system. It was far from perfect, but it seemed to be moving ahead.

Twenty-three years later, when I talk to colleagues from my era about their experiences, I hear a common refrain: "I thought being a paramedic was going to be a real job." Instead, we have regressed into an EMS system that is only interested in cost, not quality; that equates certification with competency, with no field training and supervision; EMS providers (both career and volunteer) who work an endless series of 60-hour work weeks; no upward career mobility; and McJobs (no pension, no benefits) instead of careers. How did

things go so wrong? I have a few ideas:

1) The Public Has Never Understood What We Do.

Until we jettison the acronyms that mean nothing to the public (EMT, BLS, etc.) and focus on using the term "medic" for all ambulance providers, we will never have a consistent public image. A SWAT police officer is still called "officer." We also need to be the ones who talk to the press about accidents involving injuries and fatalities. The police are not the ones who cared for the patients--we are.

2) We Let Medicare Pay for Calls, But Not the EMS System.

When Medicare changed its payment rules seven years ago, we let them fundamentally change from paying for patients' pro rata share of system costs to paying for the actual cost of the transport, stranding a huge percentage of overhead costs if your agency has a

normal level of utilization. We did not make it clear to our elected officials that they would need to pay the rest. We also accepted mandatory coverage from Medicare, which meant that systems had no reason to compete on quality, only cost, since their payment

remained fixed.

3) We Let Other Disciplines Do Our Jobs.

Where I worked, I constantly heard the EMT crews complaining about the career fire department, yet on the scene, they always let the firefighter/EMTs carry the patient. I will say it in no uncertain terms: Do your own job. Fire takes care of fire and rescue, police take care of law enforcement. If it involves injury prevention, safety or health, it is EMS' job. Carrying patients, teaching injury-prevention programs in schools, installing child car

seats and decontamination are all patient safety-related issues and clearly the role of EMS.

4) We Never Asserted Control Over Emergency Medical Care.

It is great that your community firefighters and police are EMTs and respond quickly, but providing care is our profession and we have a right to regulate it. Generally, communities should have sufficient EMS resources to be able to respond anywhere in the community within minutes. But where EMS permits fire or police to provide emergency medical care, it should be only under our direct control for care, oversight and quality assurance.

5) We Never Stood Up and Said "No More McJobs."

In the Northeast, the volunteer EMS ethic is that "this job is so important, I'll do it for free," yet inexplicably, when they begin to transition to a career system, they do not think that EMS is important enough to pay career staff a fair living wage (with benefits and pension) to do it. To be fair, this is also prevalent in the private ambulance sector, but at least they can point to a profit motive. The reason paramedics have to work a 60-hour week is that you need 60 hours to pay your rent, and nobody in EMS thinks that's crazy. If we all quit our per-diem jobs tomorrow, salaries would correct themselves within six months.

6) We Need to Admit That Paramedics and EMTs Are Not the Same.

EMTs are technicians with less than five weeks of full-time training (significantly less than the police or fire academy) who treat symptoms. Paramedics are professionals with at least 50 weeks of full-time training who treat a diagnosis. With the new curriculum, there is no longer even a continuum of education from EMT to paramedic. This is important for one key reason: It artificially depresses paramedic wages, because there are so many more EMTs in any bargaining group. This undermines a graduated pay scale that would pay paramedics significantly more and pay for their experience. Without it, how can we ever expect to retain good paramedics when their long-term wages are depressed by EMTs? The primary reason we lose so many great EMTs, who choose not to become paramedics, is because the money just isn't there in the long-term.

7) We Abandoned the Concept of the Mobile Intensive Care Nurse.

I've never understood why we created paramedics in the first place in an era that also saw the development of specialized critical-care nursing. In New Jersey, and in many states across the country, almost every paramedic program had nurse preceptors for years. Nurses specializing in out-of-hospital care were quite common until the early 1990s. I never actually saw a paramedic work in the field until I began my clinical rotations. If we shifted to a three-year community college MICN program, we could ensure both a decent wage scale and true career path for medics (and it would solve #6).

8.) Volunteers Are Fine, But the Year-to-Year Mind-Set Is Not.

EMS is a complex business, with eight-minute response times within your community, a stock that is both critical and time- and temperature-based, burdensome regulatory requirements and continuing education for your staff. Who the hell told you that you can manage all this without a business plan? Without short- and long-term multi-year goals? Without strong management support for a volunteer labor force? Volunteer EMS rganizations, even more than career organizations, need career managers with a multi-year business plan mind-set or your organization is going to fail. Even the Red Cross

has career people who manage volunteer staff.

9.) Regardless of Our Employer, When We Do 9-1-1 Response, We Have

Not Said That We Are Public Safety.

After 9/11, I had the privilege of working with George Contreras and Richard Fox to try to secure federal line-of-duty Public Safety Officer Benefits for all of the municipal, hospital,

private and volunteer paramedics and EMTs who died during that event. That experience really opened my eyes to the inequality faced by medics across the country. We are not public safety because of who our employer is; we are public safety because we respond to the public's calls to a public emergency number. That is a critically important distinction.

Summary

In summary, the problem is us. While we have become very good at blaming everybody else for our troubles, in our hearts, we must think that EMS is not all that important. If we did, we would be fighting like hell, working together and pounding our fists on the table.

As it stands now, most of the talented paramedics I started with 20 years ago are no longer paramedics. Some got hurt, some died, some burned out, and many of the rest work part time, because they love EMS, but need careers to make livings for their families.

It is painful for me to say that EMS is not a career, but it is not. It is also painful to see the EMS system, which I do value and once had great hope for, collapse, but it is. While many of the problems I have identified have fixes that could be implemented now, I understand that most will only be implemented when the system collapses.

And that can't happen too soon for me."

[Dustdevil]

We've discussed the Phelps article here before. He's more than a smart man. He is an astute and visionary man with what the vast majority of those in EMS just do not have: the ability to see the big picture.

I wholeheartedly agree with him. It would be far faster, far more effective and efficient, far less expensive, and just far better in every respect to simply trash the current system in the U.S. and start over from scratch. We don't even have a foundation worth saving to build upon.

Scorched earth. Kill em all. Let God sort em out.

I wish Phelps and Bledsoe and a couple others would go before a senate committee and tell them all of this!

[WANTYNU]

We've discussed the Phelps article here before.

Sorry,

I should have done a search before the post, I know him and George, and the article so I thought it germane to the subject…

Next time I’ll do a search and a reference link.

But still a lot of good ideas.

I’ am pretty sure I wouldn’t support a “scorched earth” policy (hey green house gasses and all that), but an aggressive rebuild is absolutely in order.

However as the article points out WE are part of the problem, as long as we continue to sabotage ourselves, we will never take one step forward. A part of the problem is we’re too mixed in with other services.

In addition, I think EMS solutions mentioned the idea that as long as we work for free and peanuts, they’ll (the communities we serve) will pay us in legumes.

[VentMedic]

I rarely if ever see pre-hospital people following their state ambulance and EMS organizations' activities in legislation to see how more recognition and reimbursement would be allowed for paramedics. True, it makes for boring discussion but important. The key is getting Medicare and the various medical reimbursement agencies to recognize you. There are so many variables to consider besides "I deserve it just because...".

There's legislation called The Medicare Paramedic Intercept Services Coverage Act of 2003. Currently under Medicare, some paramedics, called "intercepts" are not reimbursed under Medicare. Has anyone made themselves familiar with this because it may set precedent for other legislature? Especially in the areas where volunteers and ALS may respond together? This is only one example.

When bargaining for improvement benefits and reimbursement, what does the lobbyists have to "sell"? On a national level as well as state, you have a mish mash of education levels, skills and various certifications. There is no consistency in any identifible form for an educated legislative body to decipher any value or worth of the profession regardless of the life-saving issues. Even discussions on this forum raise issues that question how EMS defines a professional. What is a "paramedic"?

Other professions can say they have a minimum degree (not certification), standardized credential testing for minimal proficiency and similar licensing requirements throughout all states. Now medicare has a minimum professional standard to consider in that industry.

Other professional forums and newsletters are full of pending legislation and its effect on each healthcare industry. Their national organizations are going full steam and have had excellent successes. Many hospitals expect their employees to belong to a professional organizaton (not union) that respresents them. And, most professionals proudly list these organizations on their resumes. All I hear from some pre-hospital providers is "waste of time and money" to belong to state and nation organizations. And these same individuals wiil continue to complain that life is so unfair to them. They are also the ones who will probably not advance past their PDQ Medic Mart certification either. The educated will have to take the lead. But what to do with the rest? Other professions did get strong enough to put a little pressure on the lesser credentialed individuals and raise the bar. That has made a big difference now in their present and future bargaining power for their dollar value in the healthcare industry. Other professions also teach in their college curriculum the "business model" and how it pertains to their worth. So, they are more politically aware of the factors going on around them and how each one will affect them. This gives them the opportunity to strengthen and plan accordingly.

[Dustdevil]

Vent, it is interesting and significant that you should speak on this topic. I don't know how long you have been in RT, but certainly know the history of RTs struggle for professional status. It started about fifteen years before EMS, but they transformed the field into a full-fledged profession, with significant educational standards and commensurate rewards in under 25 years, from birth to maturity. EMS has been at this for thirty five years now and they still don't even know what their goal is. Other than "more money," most seem to believe that EMS doesn't even need any more growth, and is fine just as it is. We're stuck nowhere, and going nowhere.

There is always talk of who we should emulate. We hear people constantly telling us we should be like the firemonkeys and other so-called "public safety" workers. Then there are those who insist we should be like the nurses. I believe that, if there is any profession we could take serious lessons in professional development from, it is the Respiratory Therapists. Having been in the RT profession in the early days of the struggle, I am amazed at how far they have come in the last 25 years. I think one of the most telling signs of the seriousness with which they take their mission to professionalise the field is the fact that they shut down the one distance-learning institution that provided certifications, ensuring that all candidates received a more intense and formal education. Can you imagine the cacophony of bitching that would elicit in EMS? It would never happen.

One major problem -- among the many -- that EMS suffers in our current struggle for professionalism is that nobody sees any role models for us that are really analogous. It seems that most of those trying to guide our future think they have all the answers and don't need to learn anything from anybody else. Unless somebody with both vision and the intelligence to know the importance of alliances comes along to take the lead, our struggle will continue to be nothing more than bald tires spinning in the mud. It would behove the people at NAEMT to quit spending their time and money sucking up to the firemonkeys and sit down with the leaders -- past and present -- at the NBRC and take notes.

[VentMedic]

Almost 30 years ago I started in EMS and got the A.S. in EMS because "that was the future" as told to me when I was 18 y/o. This was impressive since the roots of the paramedic started by some doctors wagering that they could teach a few advanced life-saving skills to any education level in the 1960s.

Yes, RT has come a long way. I am watching a handful of co-workers sweat as the December 2007 deadline approaches. If they don't upgrade to RRT, they may lose their unit (ICU) status as well as the ability to do their advanced skills (ECMO, transport, intubations, IABP, A-line and central line cannulations etc) in many hospitals. The A.S. is the minimum now with another increase to B.S. in the next 5 - 10 years. With it, we now have more billing power and are lobbying for independence outside of the hospital. This piece of legislature I personally am following for the prospect of a cush job with a small medical group when I tired of hospital work and vested at the university.

And yet, RT is modeling after OT and PT. PT is especially impressive in the way they have been able to obtain professional status and reimbursement recognition. Their command of the political and business machines have generated them an impressive salary and recruitment as well as retention bonuses.

Nurses must now closely re-evaluate their minimums because it is more difficult for them to maintain their same status, even with history, alongside allied health professions with a minimum of Bachelors, Masters preferred professionals. These professions do not make not claim to anything in the nursing field even though they have similar (and often more advanced) sciences and skills. They do not want to be nurses. Their focus is integrating into the healthcare profession with their own unique knowledge and skills for the benefit of the patient. Thus, they use this uniqueness to reap the benefits of the politically charged reimbursement challenges.

These allied health professions all channel their lobbying power for the patients' benefit and stress that which gives them as edge in not looking like they are purely in it for greed and personal gain. For example, Medicare is always readjusting it coverages for home O2 and pulmonary rehab. Strong AARC RT lobbyists are present fighting for the people who need these services. Great PR and reimbursement possibilities for RT.

Again it is about knowing how your profession is viewed by the people that make the legislation. Then, each profession must think of itself as a business. The profession must surround itself with enough business savvy to acquire the right lobbyists to get a part of the money that's being handed out or budgeted for each year in government. They have to keep their state legislation active enough to have a voice.

Paramedics waste more time comparing themselves to other professionals like nurses instead of defining who they really are and attempting to profect that. They have actually provided the nurses with more valid arguments to justify the nurses' strong hold than they realize with their vocal comparisons. Do the paramedics realize they were a profession specially designed for pre-hospital with an unique set of skills and knowledge? Just like their predecessor the Mobile ICU Nurse, who is still very much around in the U.S. and many other countries, they have a special place in the world of healthcare.

[WANTYNU]

Very interesting input, theory, and history.

I have a lot of homework to do now (I was not aware of the RT history, and never even considered looking at PT).

I do know that in NY Doctors and Nurses are LICENSED by the Department of Education, where as Paramedic’s and EMT’s are CERTIFIED by the Department of Health. (talk about control)

I’m sure there is a difference how they are viewed under the law, but I will need to do some research to better understand what it is.

How are RT’s and PT’s empowered to practice (Licensed or Certified)?

I agree we waste time and effort comparing ourselves to nurses, but the response is a logical one, as we tend to work closest with them in the hospital setting, and it has long been considered the (unofficial) next step for medics.

I have over 6 partners currently in nursing programs.

Great thread.

WANTYNU

[VentMedic]

How are RT’s and PT’s empowered to practice (Licensed or Certified)?

They have been licensed in most states for more than 20 years. PT now has a Masters minimum with a Ph.D preferred in their professional standards.

Most allied health professionals are licensed in the U.S. Massage Therapists are licensed in most states while certified in others awaiting licensure. They, too, are in the process of establishing college degrees for entry level. The college programs are up and running while the legislative process is churning. Massage Therapists are now recognized in healthcare and are very employable in the hospital setting due to their reimbursement potential. They have very strong state and national organizations to keep their presence known in the political arena. Phlebotomists and Patient Care Technicians have increased their requirements for certification. The Medical Assistant is still certified but are struggling to establish some minimums and get recognition by their states. They too have been affected by the numerous PDQ Marts in their profession and are going to have a long struggle to gain professional status.

The establishment of licensing has little to do with control of one profession over another. EMS actually had more going for it in the 1970s than nursing. EMS was establishing degree programs in colleges. RNs were still diploma based. RNs then spurred themselves on to being degreed and recognized the LVN as a much less skilled professional inside the hospital. EMS lost it by not establishing the degree for licensure. Too many ambulance services, FDs and private tech schools started turning out EMTs and Paramedics at a rapid fire rate. The "I can do anything you can do" attitude without the extra education helped bring whatever push for minimum education standards in EMS to crawl by 1990 if not before.

The sheer number of nurses that had to unify to achieve a higher professional standard should be recognized as a great accomplishment. The diversity in their profession is incredible with the thousands of different nursing specialties and places of employment. Yet, nurses were able to come together and agree on education for minimum licensure requirements. They are now struggling for the Bachelors as a minimum. I'm sure there will be an agreement soon. They know the need and the colleges are graduating more BSNs every semester to bring fresh progressive attitudes.

Why is it that pre-hospital people who work primarily in the pre-hospital setting doing pre-hospital job descriptions, whether private, public or FD, can not come together for one common goal?