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August 2004 Letters

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Mail: EMS, 7626 Densmore Ave.
Van Nuys, CA 91406-2042
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A Fair Day’s Wage

Bryan Bledsoe’s cover report in the March issue, We Don’t Pay Them Like Heroes, left me conflicted. I am torn between honest analysis of shortcomings in EMTs’ earnings and the manner in which the findings are represented. First of all, I applaud Bledsoe and others who document our fiscal deficiency; but, I write this with all due respect for my fellow professionals, because we all sacrifice so much to do what we love. My goal is not to offend those profiled in the story.

I have grown annoyed by reading, watching and listening to clichéd “victim of the economy” stories. Although these tug-at-the-heartstrings tales make for abundant ratings or curry political favor, they do little for real change. The majority of Americans are not only in a similar situation, they also find a way to make do.

First and foremost, each and every one of us needs to live within our means. It is effortless to condemn managers and pretend that a larger paycheck will magically make our jobs easier. Unfortunately, unlike any for-profit business, we are bound by a limited scope of practice. Yet there is one thing that stifles income, and that leads me to my second point: insurance reimbursement. Each story reinforces the chasm that pits employee against employer, as if ambulance companies are operating some draconian sweatshop. The culprit here is government price controls in the form of Medicare. More HMOs are riding on the coattails of Medicare, by reimbursing at substandard rates for an ambulance service. As we add high-tech tools to our arsenal, and more advanced skills become expected standards of basic care (along with the cost of extra education), government regulations and requirements increase the cost of doing business. As less responsibility falls on the insured, the system becomes overtaxed, causing insurance companies to ration payments.

In short, I would like to acknowledge that wages have been less than adequate. Yet a living wage is determined on a personal basis. I didn’t take a vow of poverty when I earned my National Registry, but I enjoy what I do and take pride in the care I provide, fully cognizant of the low wages. Let us focus our political power toward reforming the insurance business—away from single-payer healthcare.

Aaron Florin, NREMT-P
Minneapolis, MN

I have just finished reading the editor’s message, A Fair Day’s Wage, in the March issue, and I agree wholeheartedly. I’ve been an LPN for 12 years and an EMT-P for five. After getting fed up with nursing, I tried working full-time as a medic, but all I could get was two part-time jobs with two different services. And no benefits, of course. After three months of working 48–60 hours a week to make ends meet, I was terminated at one company for refusing to buy new uniforms ($50 each, plus $150 for the jacket), and from the other for living too far away to be on-call. I have since returned to nursing, but even there the wages are too low to get above poverty level without overtime. I still volunteer as an EMT and maintain continuing-education credits for my medic certification. I would really love to return to EMS but with all the insurance and reimbursement cuts, I doubt that wages will ever get high enough to make that possible. You would think that with the shortage of medics and nurses, wages and benefits would improve, but I don’t think they will anytime soon. At least not without the federal government’s help and cooperation, and that’s definitely an oxymoron.

Craig Hebets, LPN, EMT-P
Tionesta, PA

I have been in EMS since 1963 and the single element that has not changed is the pay and conditions for the EMS provider. I can tell you unequivocally that you cannot make a living wage in EMS unless you work a horrendous number of hours per week. When do you have time to rest and have any sort of life?

There are some EMS services that take better care of their people, but in all my years, EMS has always been an employer’s market. They know that personnel will make up time lost at another service.

Many people say that education is the key. I agree, except the ones who need to learn are the ones who manage or oversee EMS. They need to learn that to keep good people you must pay a decent wage, or you will forever have turnover. I think that some are actually exploiting the situation: By always hiring new people, the wages stay down.

Retirement is offered by some services, but it falls short in many cases. Benefits may be few and continuing education and other costs can eat into what salary you have. I would not have been able to survive and feed my family if I had stayed in EMS full time. The fire service was the safety net for me.

I do not mean to say that all EMS providers are underpaid or ill-treated, but I believe that too many fall into this category. EMS has never been internally driven as well as other services have been, and this is perhaps one reason for our plight. We must align and put aside differences in order to present a more unified and professional appearance if we are ever to receive what we need.

Law enforcement has had federal dollars for nearly 40 years, and finally, after 9/11, the fire service as well, but still a much smaller piece of the pie than it should. EMS, as best I can recall, lost virtually all funding back in the 1970s. That is a travesty that should be corrected. No one cares but us, it seems, so if we get help, it must be by our own labors.

Little Rock, AR

Excellent! Excellent! Excellent! That was my first response after reading the March issue of EMS Magazine regarding the topic of the pathetic wages EMS workers must endure. I only wish my amateur writing ability would enable me to express exactly how much despair and frustration I feel in my own little EMS world. The danger, the stress, the poor sleep and diet habits, endless hours and forever continuing ed—it hardly makes it worth it.

This is how it is for me and most of my peers here in the northeast region of Pennsylvania: Paramedicine is my only employment: a full-time job at $12/hr., two part-time jobs at $12/hr. and I consistently work 100–120 hrs./week. I also contribute approximately $300 monthly to a barely adequate healthcare policy. To help put things in perspective, my 14-year-old nephew earns $10/hr. cutting grass while I earn $12/hr. to resuscitate babies! How obviously absurd! EMS is also partly to blame for the failure of my marriage; the strain on an EMS spouse is equally as great.

So, now I’m leaving EMS, full-time anyway, to take a position stocking shelves at a local hardware giant for $10.50/hr. and full benefits. Wouldn’t you? I love what I do; I don’t mind saying I’m good at it; but I can’t take it anymore. I do feel a change is on the horizon, but I can’t wait—I need a life now. Keep up the crusade; first-line lifesavers truly deserve it.

Norman Heinz, EMT-P
Luzerne County, PA

I admire your taking on the EMS salary issue. Bryan Bledsoe’s article was enlightening. I lecture nationally to all medical personnel and EMS audiences are my favorite.

A personal experience brought new meaning to the matter for me last week. My wife, who is a nurse, took me to a local hospital ED with what turned out to be a posterior infarct. The nurse on duty seemed uncaring, if not rude. I thought maybe my situation led me to that conclusion. At any rate, there was no cath lab there, so I was transferred with “bells and whistles” to another hospital by a private ambulance company.

There was a nurse and a paramedic from the company on the rig with me. Their treatment and attitude were exemplary. I mentioned the nurse and they reported that they were routinely treated with disrespect and condescension. They also said the staff at the receiving hospital were no better.

When I stated what I did and how I felt about EMS, they beamed.

Both hospitals are in affluent communities. I suspect the salary issue, at least in part, leads the hospital staff to their attitude toward EMS. But, frankly I don’t think the nurses could do those jobs.

What to do? Get a strong national union. What if the politicians, administrators and “health professionals” had an MI and nobody came?

Go get ’em, EMS.

Joseph Dillmann, RPh, ACCP, FASCP, MAC
Libertyville, IL

Bravo to EMS Magazine for putting EMS pay issues on the cover. I went into EMS 10 years ago. My hope was to become a movie career medic and work on film sets and locations in Los Angeles. Unfortu­nately, I could not break into the union, and because many films are now made in Canada and overseas, there are just too many people on the roster. Some producers choose not to use set medics, and I cannot afford to sit by the phone waiting to be called for work.

Instead, I joined an independent ambulance company that specialized in event work. My salary started out at $5.15/hr. and worked its way up to $9.25. I only worked that job part-time and used it as a supplement to doing office work. Sadly, I still only work part-time as an EMT because my day job pays me close to three times the amount to simply answer phones!

I love being an EMT and am on my fifth re-cert, but I just cannot afford to work for any ambulance companies on a full-time basis, especially in Los Angeles, where living expenses are out of control. The only way you can make a decent salary as an EMT in L.A. is either by working as a set medic ($22/hr.) or with the fire department.

Something needs to be done. To be paid such low wages disrespects what we do! We need to let the general public know EMTs and paramedics are not well-compensated.

Linda L. Simeone
Toluca Lake, CA

It was with some wry amusement that I read your March issue concerning EMS paychecks and double jobs. Your listing of states did not include Pennsylvania. No wonder. Western Pennsylvania is not known for paying their EMS personnel well at all, with very few exceptions.

I work as a dispatcher with one of the largest hospitals in the Pittsburgh area and have a sort of unique perspective on the issue. I have occasion to talk with many EMTs and paramedics from many different services that feed through my ED. Needless to say, we talk about money and jobs. Through this, you find out that having two jobs are the norm. When taking ambulance reports, it is not unusual to hear the same people giving reports for at least two and sometimes three of the local services over the course of a week. I know and care for my “regulars.” To keep my paperwork straight, I have to clarify who they are running with that day. They even get confused!

What is sobering to me is the fatigue that I see in the personnel who bring in the patients. I work many different shifts and have the opportunity to see what prolonged shifts and the stringing together of different jobs can do to people. As a dispatcher, I can tell when someone is tired just by the quality of their reports. One has to hope that quality of care is not suffering also. To a large extent, understaffing is a contributing factor also in these extended shifts. Open shifts can be a problem. I’m sure you have been there. You are working and you get some back-to-back calls. Of course you hate to give away calls, but you just cannot staff another truck, no matter how many times the tones sound. And no wonder, the people you are trying to call in just responded for the mutual aid working for another service! And now, another shift has to be covered. Hmmmm!

Gary Wotherspoon, EMT-B/Dispatcher
McKeesport, PA

Heated Response

I enjoyed the article Fun-Run Turns Mass Casualty in the June issue. As a Physician Assistant (PA), I routinely volunteer on the medical team of local and national races. Distance running was my passion and seeing the “other side” allowed me not only to return my skills to the sport, but also work alongside some awesome docs, nurses, podiatrists and EMTs.

One important item I did not see mentioned was core body temperature (CBT). Especially in heat-related incidents, it is imperative that a rectal (not oral nor axillary!) temperature be done as soon as possible to correctly identify those who need immediate assistance. CBT greater than 103ºF portents heat stroke and the need for vigorous intervention.

Thank you for the wonderful article. I would even mention that EMTs consider volunteering for these events, but in my experience that is unnecessary as they already do!

Charlene M. Morris, MPAS, PA-C
President, Association of Family Practice PAs
San Antonio, TX

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