Sometimes I Drive the Ambulance (but I’m not an ambulance driver)

Paramedics and EMTs were drawn to EMS for various reasons.  Obviously there is the excitement, the variety, and the opportunities to help people.  EMS workers are usually lumped in with the other helping professions: Physicians, Nurses, Firefighters, and even Police Officers.  In fact, when you talk to any of these folks, you’ll find the overwhelming majority are motivated to help people.

Something has changed in the last 30 years, and I’ve been trying to put my finger on it.  My first experiences in emergency services were with organizations that truly sought to help people in need.  Whether working for a government agency, or a for-profit ambulance company, there seemed to be a push to help people.

Things are different now.

Some of my co-workers will say outright that EMS should not be provided by for-profit agencies.  I’m not in full agreement with that.  Most healthcare in the US is provided by for-profit agencies.  Physicians, Chiropractors, Dentists, Hospitals – all of these seek to make a profit by caring for people’s medical and health needs.  Even some non-profit hospitals have really good cash flow.

Many of my coworkers see their private ambulance employment as merely a stepping stone towards a full-time career with a public agency.  As a veteran, who has worked for public, private, and non-profit, hospital-based EMS agencies, I encourage many of my younger coworkers to find a more solid career path.  Private ambulance paramedics earn fraction of their public agency colleagues.  The benefits, health insurance, and retirement packages are nowhere near what fire service paramedics make.  And yet they work just as hard, and have the same amount of training and license requirements.

Several of my coworkers are pursuing a nursing career.  Though paramedics have a broader scope of practice and the same level of education, we are paid about half of what an RN makes.  And, like the illustration above, the benefits, healthcare insurance, and retirement package pales to that of nurses.  Should a paramedic have to become a nurse, in order to have less responsibility, yet a better quality of life?

Research has shown that paramedics are one of the most respected of all career fields.  People usually look at me in amazement when discovering they’ve met a real paramedic.  Their praise flows freely.  A lady the other day said something to the effect that I must be “really smart” to do this job.  I laughed and brushed it off with some self-depreciating humor.  I’m certain she would be fascinated to learn that I can barely keep my family afloat on the wages I make.

“It’s natural, EMS is still in its infancy”

I’m certain people have no idea how similar the nursing and paramedic jobs are – yet how much disparity exists in our wage and benefits packages.  I know that people have a very high regard for fire agency paramedics, and rightfully so – they are all well-trained, highly motivated individuals, working for great organizations.  But I bet they don’t know that we actually are grossly underpaid, compared to what those firemedics earn.

It’s natural, EMS is still in its infancy.  Less than 50 years old, we don’t have longevity and history of the other helping professions.  Nurses came into their own during the Civil War; Police agencies have been operating for centuries; and modern firefighting was an invention of Benjamin Franklin.  Relatively speaking, the EMS professions are a mere blip on the timeline of history.  It’s no wonder that a whole generation of people still think of us as mere ambulance drivers.  When they were kids, there was no such thing as a paramedic – there were only ambulance drivers.

Many of us had high hopes in the early days of EMS.  We believed we would rise up and be recognized as medical professionals – treated with the same respect as our counterparts.  Unfortunately, it looks like we’ve fallen to the technician level.  Very interesting.

“In other words, it’s complex and will take time to evolve…”

My coworkers, and our local union, are currently embroiled in collective bargaining negotiations.  There has been a strike authorization vote, and things could get interesting in the next few weeks.  In this economy, and this stage in the development of EMS as a profession, I’m not sure we are ready to see the breakthroughs we need to have a decent standard of living.  I believe there are three four five things standing in our way:

• Public Perception.  I’m certain the general public has no idea what we do, how much education we have, and how dedicated we are to making a difference in the lives of our patients.

This is, in my opinion, the single greatest impediment to change within EMS.  The fire service has done an amazing job of helping the public understand their role and place in society.  Our employers, Unions, and professional organizations are making some progress in this arena, but much more remains to be accomplished.

• Lack of Professionalism.  While some of my colleagues are striving to be more than just employees, the bigger picture eludes others.  Until we go above and beyond what is asked of us – collectively, we will never achieve the respect we deserve from other medical providers.

Advanced education is one of the single biggest ways we can  improve our professional image.  In Oregon paramedics are now required to have at least an AS degree, and a few have Bachelor degrees – however, even without the requirement, more of us need to strive for post-graduate degrees and pushing forward – even when there is no pay or benefits associated with this advanced education.

In addition, we need to develop a learning culture – where we are reading books, gathering in discussion groups, and looking for creative ways to advance ourselves personally, professionally, and as a group.

• Supply & Demand.  Currently there are more paramedics and EMTs looking for work than there are jobs available.

There is nothing inherently wrong with having too many aspiring paramedics.  However, we may need a better screening process to help channel the right people into the career path, and help those who would not be a good fit to avoid going down the wrong road.

In addition, as the professional standards improve, the costs (monetary, personal, and academic), will be self-selecting and recruitment factors will drive wages and benefits upwards.

• The Economy.  With zero job growth last month, a looming federal deficit, and rampant unemployment – our employers are just not able to make drastic fiscal changes in their business model.

Where do I start?  I think I’ll leave this issue alone.

• Passion for Caring. In many ways, EMS has lost it’s vision.  Due to the pressures of the economy, the desire to actually make a profit, and the consolidation of the industry into two primary, for-profit competitors, we have lost our passion to actually make a difference in the lives of the people we care for.

If our employers are not going to supply the passion, the employees need to take the high road, by going above and beyond what is required of us – even if our wages and benefits are not up to par.

In other words, it’s complex and will take time to evolve…