A recent debate on EMS pay has erupted after Mr. Sean Eddy of Medic Madness wrote “5 Reasons Why EMS Doesn’t Deserve Higher Pay” on Uniform Stories.  To say the EMS industry has reacted as he expected would be par for the course.

First, I agree with most of his five points, however I fundamentally disagree with his method of dispersing said opinions and the slants with which he gave those opinions.  In fact, his decision to essentially diatribe the industry without any substantiated footing is in direct contradiction to the points that he made in the second paragraph of his essay:

“In some cases, EMTs and paramedics are even walking the streets, holding up signs DEMANDING that we ‘receive the wages we deserve.’ This is NOT how we need to go about making change in our industry, and it certainly isn’t how we are going to improve our public image. What we have done is effectively placed ourselves in the same category as the people demanding a higher minimum wage while at the same time refusing to do anything extra to earn it. Stop, just stop.”

Mr. Eddy’s use of the internet as a virtual picket line looks just as bad on the industry as any one of the EMTs or Paramedics picketing on the very streets they serve. Essays like his make it that much harder for EMS to achieve some of the goals he set in place like increased educational requirements, incorporating EMS into the bigger picture, and even revolutionizing the industry so that we do more than simply “save lives.”  He was correct in stating that EMS is a young industry, but that doesn’t mean we have to act with the immaturity that youth brings. In order to achieve recognition from the rest of the healthcare industry we must behave as they require, and that goes well beyond picket lines, virtual or otherwise.

Mr. Adam Smolensky quickly responded with “An Open Letter to Author Sean Eddy” on High Performance EMS.  A publication that seemed to add only more fuel to the fire for he too was using a large platform to diatribe directly against Mr. Eddy.

That said, I also agree with many of the points that Mr. Smolensky made because, while they go into superfluous detail, for the most part they match my previously mentioned issues with Mr. Eddy’s publication.

Ms. Caitlyn Armistead brought the debate back to solid ground with “5 Reasons EMS DOES Deserve Higher Pay” also published on High Performance EMS. I don’t have an opinion on all of her points, but I was glad to see that the conversation had resumed a more civilized tone.

1) As someone who is deeply passionate about the “second victim” phenomenon and who lives with a paramedic that served during Hurricane Katrina I firmly support any efforts to recognize the severe toll being an EMS practitioner takes on the human mind.  The missions of The Code Green Campaign in the US, and I’ve Got Your Back 911 in Canada are admirable, but nothing will change with awareness, that is simply the first step.  In order to truly know that mental health issues in EMS are recognized and respected there must be policy changes at the municipal, state, and federal level to support any increased awareness.  Single organizations should take responsibility, but with such a pervasive issue, it may be more effective to address it at a broader level.

3) Pay structures shouldn’t just recognize experience, they should recognize performance, but that would be something that is incredibly hard to measure give our current lack of evidence-based guidelines.  Sometimes the best medics rise the ranks and stop providing patient care.  While they are now being compensated appropriately, the patient loses.  Other medics dread the “white shirt” and avoid it at all costs thus losing the opportunity to receive pay increases, but maintaining their skills to kept hearts beating and lungs breathing (because yes, I firmly believe that sometimes EMS does save lives).

4) “Bouncing” employees are unhappy employees, but more importantly from an organizational perspective, they are less engaged and therefore less productive.  And since EMS is in the business of serving patients, this means that we’re actually putting patients at risk when we allow employee engagement to decrease.

I would also like to provide my own opinion in the EMS pay structure:

The compensation that EMS (or any healthcare industry) receives reflects the public’s (read CMS’) perception of the skills we have and procedures we perform.  Ignoring the transportation based issues with EMS reimbursement, healthcare generically gets reimbursed based on difficultly level of a procedure and the time it took a practitioner to reach the level of aptitude required for performing that procedure.  This is why interventional cardiology gets paid so much more than primary care, because, at least conceptually, interventional cardiologists require substantially more years of training and the procedures that they perform are more complex and require more advanced technology than most services offered by general practitioners.

To become an EMT it takes an average of 6 months of training, to become a paramedic it takes two years.  Most of the procedures performed in the back of an ambulance are relatively basic in nature on the scale of checking someone’s vitals to performing open heart surgery.   What EMS has that other healthcare industries don’t deal with at the same level is the presence of environmental hazards.  Nurses and physicians still get attacked by the occasional patient, but their risks for other things like back issues, traumatic injuries from an ambulance rollover, and even combative patients are likely lower than those of the EMS industry.

If EMS wants a raise then the industry must learn to play by the rules of the healthcare sandbox.  The industry must prove that the training required, skills being used, and procedures being performed are more extensive than they used to be.  Although alternative payment mechanisms exist particularly related to the surge in Mobile Integrated Healthcare and Community Paramedicine, they will not be the bread and butter of the industry for quite some time.

Grandmothers will still have heart attacks, drunks will still drive, and children will continue to be allergic to peanuts.

– Catherine Counts

*While I may have a problem with Mr. Eddy’s essay I applaud his efforts to make EMS a healthier profession.  As I think this entire topic reminds us, the employes of the EMS industry are its greatest asset and the more unhealthy we become the less of a service we can be to anyone, ourselves included.