In a guest ‘rebuttal’ yesterday to a recent article by Sean Eddy on EMS wages, I apparently succeeded in generating “more heat than light” on the conversation. While I regret the author’s tone in that post, my desire to open a dialog with interested parties remains. I discussed the topic with up-coming EMS author and blogger Caitlyn Armistead who agreed to submit the following post in an attempt to re-establish a civil discussion on the topic with specific and focused talking points.
5 Reasons EMS DOES Deserve Higher Pay
Sean Eddy wrote an article entitled, ‘5 Reasons Why EMS Doesn’t Deserve Higher Pay.’ I appreciate his point of view, and I agree with many of his points. We must grow up, take responsibility for ourselves, avoid stereotypes, encourage education, and see the big picture. Who wouldn’t want those things? However, I would like to propose five reasons why EMS workers do deserve higher pay:
1) The effects of EMS work on mental health are only now being formally recognized, let alone compensated for.
The Code Green Campaign is a non-profit organization whose mission is, ‘to bring awareness to the high rates of mental health issues in first responders and reduce them.’ These mental health issues include PTSD, depression, and suicide. This organization is doing great work, and I encourage everyone to support their efforts. Suicide rates among emergency workers are increasing, and EMS agencies are often at a loss as to when and how to help their employees. Is CISD effective? Was the PTSD due to the job? Was the depression a pre-existing condition? How do we know? An organization cannot compensate for what it cannot define. Until policies are created to confront, define, and address these issues, it is impossible to ensure an employee is properly compensated. However, higher pay would allow an employee to devote funds toward whatever stress management techniques, therapies, and medications she and her doctor decide are appropriate.
2) EMS agencies tend to cut salaries before other expenditures.
A ribbon cutting for a new fire station. A ‘Your Tax Dollars at Work’ sign at a construction site for a new dispatch center. A shiny new ambulance. All of these can be great things. And all of them are great marketing tools to the public. These things are fun. People ‘oooh!’ and ‘aaah!’ It’s easy for management to want to keep up appearances, give the people what they want, and allocate funds toward exciting new ideas. But in these hard economic times (and what time is not hard economically?), budgets must stretch and sometimes strain to keep the shiny newness coming, so managers go in search of funds. Cut a building project, and the town roars. Omit a few medics’ 1% cost-of-living raises, and no one hears anything. It’s simply wrong to cut salaries or omit raises while overspending building and equipment funds. Take care of your employees first. They will take you further than any state-of-art dispatch center ever will.
3) Pay structures often do not recognize experience
No one denies that educational standards are in transition. Few advocate the current card-based system. The EMS profession is changing and maturing out of necessity, and this is a good thing. However, in the awkward meantime, it is difficult to prove that someone has the ability, skills, knowledge, and experience necessary to demand appropriate payment. A paramedic may have every alphabetic-combination card in the deck and decades of experience, but if he has needed to change departments for whatever reason, he’s now making the same as any other paramedic. Why? Because he could not prove objectively that he was worth more. Next year, he’ll have to recertify again just like the new guy. Ongoing training is critical, but in our current system, it is not cumulative for the purpose of compensation. As such, experienced medics are undercompensated for their contributions to an agency.
4) Poor wages destroy organizational culture
I’ve heard it said, “In EMS, you don’t live off the job. You live off the overtime.? This statement was not referring to mandatory overtime or even to time and a half. It means we assume an EMS job will pay so poorly that an employee must bounce from service to service in order to scrape together enough hours to pay the bills. For the individual, this leads to fatigue, error, and burnout; however, it is also detrimental to the agencies involved.
When employees bounce from service to service simply to make decent wages, any devotion is short lived and dependent upon who will assign the necessary hours. It matters little what the core values, mission statements, and the nature of care are when you are rushing to yet another job or desperately trying to find someone to stay over and cover the time discrepancy between the two shifts.
Well-paid employees are stable employees. They can devote their time and energy to not just being present but focusing on the job, contributing in a positive way, and growing the organization. Most employees want this to be the case; they want to do their jobs, not just adequately, but with excellence. But they will only do this when their own needs are cared for. It bears repeating, take care of your employees first.
5) Inflation affects everyone
There has been quite an uproar over the move to pay fast-food workers $15/hour. EMS personnel look at their own meager pay rates and cry foul. But it has nothing to do with competency. It has nothing to do with college. It has nothing to do with pickles, onions, or rapid trauma assessments. It has nothing to do with the required skills of the job.
If prices rise and wages do not keep pace with inflation, then the first people to feel the discrepancy are minimum wage workers, those at the bottom with the least wiggle room. When the discrepancy becomes uncomfortable enough, they begin to push for higher wages. When they receive those higher wages, it does not mean that others, such as EMS personnel, get waged out—it means that all wages shift upwards. It takes time, and it is not an even, across the board shift, but all wages do shift upwards eventually. Wages must keep up with inflation. If the upper-level workers want higher wages, the lower-wage workers have to shift first. This is not a threat. It is not about the value of the job or the skills. It is simple economics, a symptom of inflation.
Inflation is caused by the debasement of the currency. The US Mint prints money, which lowers the value of the dollar, so it takes more dollars to equal the same value. When they stop printing, inflation stops, and there is a recession/depression. When people protest the economic correction, they start printing again and inflate some more.
Resisting wage increases does not stop prices from rising or stop inflation, and if we are going to inflate the money supply, we need to own the consequences completely. Our only option is to raise minimum wage, match inflation, and understand that in time our own wages must increase as well—just in time for prices to rise again. To not increase wages is unfair to those who have lost the most value due to inflation, and this includes for EMS workers.
– Caitlyn Armistead
High Performance EMS 
I’m not sure I understand why you should be paid more for work that comes with the possibility of mental health issues.
I feel it should be treated like any other health issue. If you develop or exacerbate PTSD or other mental illness from working in EMS I fully believe that the employer should cover the costs of counseling, medications, therapy, etc…..just like any other workers comp claim.
They will not pay for it if it cannot be proven that the EMS work caused the mental health issue. A lot of insurance does not cover these treatments. As it was stated: “Was the PTSD due to the job? Was the depression a pre-existing condition? How do we know? An organization cannot compensate for what it cannot define. Until policies are created to confront, define, and address these issues, it is impossible to ensure an employee is properly compensated.”
It’s less that a job with serious psychological stress should pay more than the structure of the job should all time to recharge. Lower pay drives the need for overtime shifts, multiple jobs, and less time-off.
Should an experienced employee be paid more? The fixed expenses and reimbursement mean that there is little difference in the bottom-line. An experienced EMS employee can’t usually show a demonstrable impact on the financials: the fixed expenses are the same, the reimbursement is the same. The only real gain is in the intangibles of patient care & satisfaction (no money there until patient satisfaction and Press-Ganey impact EMS).
In Alberta… Section 24.2(2) of the Act provides:
If a worker who is or has been an emergency medical technician, firefighter, peace officer or police officer is diagnosed with post-traumatic stress disorder by a physician or psychologist, the post-traumatic stress disorder shall be presumed, unless the contrary is proven, to be an injury that arose out of and occurred during the course of the worker’s employment in response to a traumatic event or series of traumatic events to which the worker was exposed in carrying out the worker’s duties as an emergency medical technician, firefighter, peace officer or police officer.
The Act also requires the Workers’ Compensation Board to assist emergency services workers in obtaining or providing “treatment by culturally competent clinicians who are familiar with the research concerning treatment of first responders for post-traumatic stress disorder?.
Alberta is the first province in Canada to provide presumptive workers’ compensation coverage for these types of claims.
Let’s face it, if your employer will not take care of mental issue caused by the job then it is time to look for a new employer. Mental health is a real issue and can be treated. As far as pay, EMS deserves more than what? Is this all agencies? Some EMS agencies that are a third service get paid really well. We all deal with inflation and we will all always want more money. If you feel strongly enough about needing more money, educate the people who matter. Politicians and the voters. Be vocal and organize.
The Bachelors of Science- Paramedicine does exist in several formats based on the university. Central Washington University has offered a BS-Paramedicine for years, and a quick first page Google search revealed the following: Creighton university offers BS-EMS. University of South Alabama has a BS-EMS and BS- Professional Health Sciences. Brigham Young University-Idaho has a BS-Paramedicine.
Agree that Ems works need better pay. Is there a committee that is doing anything on this. It would be nice to present the national ems and see about that
University of New Haven does as well! It’s in it’s infancy though, and as long as getting your BS doesn’t increase your wages or hire ability, as in most non-fire circumstances, it will just be a more expensive option.
I can say in the state of arizona it is soley based on number of years since you have gotten your medic cert and nothing more. As an EMT you start from scratch no matter the years. As a Medic it does not matter your degree. As far as promotion Your supervisor could have just come out of EMT class.
In reply to Joshua Hicks,
There are even more colleges that offer Bachelor’s degrees in Emergency Services, most notably University of Maryland, Baltimore County. However, having these degrees does not guarantee higher pay. A first year paramedic with a BS Degree in Paramedicine is going to earn the same wage as a first year paramedic out of the academy. The difference comes when it’s time to promote. The paramedic with a degree pertaining to the job is more likely to get promoted than a paramedic who just has a certification. But that’s not even a guarantee, that’s just a chance to possibly earn higher wages.
I have followed the debate and wasn’t sure initially if it was even a serious conversation. I’m still not sure. But I will say my part anyway. Wages are a functional of the value a job provides to the market. That’s a cold fact that you can’t argue. It’s also a function of how hard it is to attract a “body”, how much experience counts and what the turnover rate is.
It should also reflect cost of living. It often does not. It does end up a factor when you have people willing to work but not able to find housing. Go to North Dakota near the booming oil fields and housing is part of the deal. If an employer needs you badly enough they will get you what you need.
So we have workers in EMS not being paid what they feel they are worth but they stay anyway. We have medics complaining of burnout from overtime but they don’t say no. We have new medics complain starting wages are too low but they take the job anyway.
You can’t put a number on a job that people want to do so badly they will do it anyway despite working conditions. You get great benefits and conditions for medics in fire because it’s a civil job. When the military started having trouble recruiting they upped the bonus and benefits because they couldn’t get a recruit otherwise.
So it seems that until people decide there is a minimum wage or working condition necessary to do the job and then STOP filling positions that don’t meet that nothing will change. Any other argument is purely emotional. It’s because we love what we do that we are stuck in this predicament in the first place
OK, it seems there are a lot of comments back and forth about stress, education ect. I’ m a long time Paramedic with 25 years under my belt as an ALS provider. Although I’m for keeping up on training, I do not think medics with so called EMS degrees deserve higher wages than non degree providers. I’ve worked along side both and found absolutely no difference in patient care, between either one. However experience does show up in patient care. The more experience in this industry. The calmer you are, the more focused your treatment is and usually your patients are pleased with the care they have received. I left a company after 27 years of good loyal service and started with another provider and had to endure starting at base pay because ” I was the new guy”. I took a 25,000 pay cut. It really made me consider leaving the field all together thus preventing me from ever passing on my field knowledge to the newer crowd.
On Point #4, You are right.
I know very few Paramedics who don’t want to do a good job. Most people in this work want to learn more, grow and do more. I love doing continuing education, maybe not the review of the same things we have to do each re-cirt cycle, but new things.
You don’t stay in the EMS world if you don’t care about people. You want to help, be close to the action and maybe save a life or 20.
I’ve said it many times: “I love this job, I would do it for free if I did not have to worry about feeding my kids…In fact I did do it for free for 10 years.” I even volunteer with the local FD still. Better pay would allow me more time to learn more, volunteer in the small town Fire Department, and not have to do two jobs on top of all that.
I love the work and the people I serve. I really don’t like the pay. (yes, I currently work for the Metro area and am among the higher paid medics in the region, but it still is not enough to take care of a family.)
This is a complicated issue and both sides are presenting supportable arguments. We would all like to to earn more, whether based on experience, education or stress exposure, no one is going to say no to more money. Saying that we ” deserve more” is tough to prove as stated in the initiating article. I’ve been on the bus 14 years now, the biggest problem in my service is that the county did away with standard C. O. L. or merit raises. We occasionally get an annual bonus of a few hundred dollars but it doesn’t carry over to the next year. I love what I do and where I do it. I don’t plan on changing that and that may make me part of the problem according to one comment. There is no difference between a certified and a degree medic in my service. We have locally a technical college that has an associate’s program, but that isn’t going to do you any good without your cert. I wish I didn’t need a second job to support my family but I do. I support raising the bar of EMS and believe that with that wages will also improve. Like I said I love what I do, I’m a very privileged person in that I found my calling and can do it for a living, even though I have to do a lot of it. It will never be perfect, but it can be better and it will take each one of us to prove that we’re worth it.
Well
We need to form a nation wide union for higher wages. Nurses have got their stuff together and they demanded higher wages for the longest time and they get paid really well. I don’t see why we can’t do the same! Also, shouldn’t we Americans be concerned that other countries pay their EMS staff much more money than we get? Isn’t America supposed to be the greatest country in the world?? I say we at least try to get in the same vacinity of pay as Australia and Cananda EMS workers!!
2020 bois