Monday we posted an online petition to the White House in support of a Federally Mandated Minimum Wage for Emergency Medical Technicians and Paramedics. The petition, an abbreviated version of which is available on the White House’s We The People website, has garnered over 8,250 signatures. The response from all of you regarding this issue can be summed up in one word:
You added your signatures, shared the petition on social media with colleagues and loved ones across the country (who also signed it), and extended the conversation with your comments and feedback.
While many are supportive of the effort, not surprisingly, there are plenty of naysayers. After all, this is EMS—we tend toward the contrarian. To those people, we have answers to the five most common objections we’ve seen:
1. This Will Put EMS Agencies Out of Business
Yes, it very well may help to accelerate that. But agencies are going out of business on their own, without paying these minimum wages. First Med EMS is one example, EMS Plus is another. Agencies are going out of business whether this petition gathers 100,000 signatures within 30 days—the required threshold to warrant an official White House response—or not. If the status quo isn’t working, it only makes sense to take a stab at creating a new model.
2. Reimbursement Is The Problem
To be blunt, this is a myth. The truth is reimbursement rates are not the EMT or Paramedic’s problem to worry about. Agency financial health is a management concern and shouldn’t be the reason line staff feel obligated to sacrifice a quality of life for themselves and their families.
EMS is unique in that employers tend to point to the customer as the cause for keeping their labor below the poverty line. In a somewhat warped version of Stockholm syndrome, providers believe it and many offer to help their employer fight for higher reimbursement, although there is no guarantee that higher reimbursement will result in higher wages.
The National Association of Emergency Medical Technicians (NAEMT) recently published their Position Statement on Reimbursement Reform, yet has been remarkably silent since January 2010 on wages for the EMTs and Paramedics who actually comprise their membership.
Governmental rate reimbursement is not the only issue when it comes to financials. In the competitive market you will often find agencies offering their services at the cost of a Medicaid transport—a financial loss to the agency—in an attempt to procure the facility’s more profitable Medicare transports. The “Bill Hospital” or “Facility Pay” is a common practice by ambulance company executives and in many cases can be viewed as illegal. While government itself has been characterized as doing the exact same thing, since you are ineligible for Medicare funds unless you are also willing to accept the much lower Medicaid payments, none of that should be the concern of the EMT or Paramedic unless they are part of the executive team. If that is the case, we are relatively certain they are earning above the minimum wage set forth in the petition.
Reimbursement or the lack thereof, is most certainly a problem. We acknowledge that. There are plenty of stories verifying that the reimbursement rates are inadequate for EMS Agencies. Hypothetically, let’s say the government does increase reimbursement. Does that mean that EMTs and Paramedics will suddenly be paid more? No, it does not. There will always be somewhere else for the money to go. It may be a new $1.2 million dollar CAD system. It could be a $40,000 branding and website redesign. It might be the $125,000 type I ambulance to dedicate to the “special” facility/township.
Extra cash will most likely go anywhere but where it should go—to providers.
Agency financial mismanagement is also a problem. If agencies stopped doing “Bill Hospital” or “Facility Pay” for a financial loss, then they might be able to pay higher wages for the labor performed. Perhaps EMS Agencies could afford higher wages if they had a brisk vehicle replacement program instead of running vehicles into the ground, where the cost of replacement parts is inevitably greater than the purchase of a new vehicle. Maybe if EMS Agencies focused more on long-term integrated solutions as opposed to short-term Band-Aid fixes, they would be able to fund higher wages. It is possible that if an EMS Agency did not expend beyond its means for luxurious items (i.e. spending $50,000 per month on rent for executive offices housing administrative staff) then they could afford to start EMTs and Paramedics at a wage that does not have them working 80 hours a week while still having to rely on food stamps.
Reimbursement is AN issue, but not THE issue the petition looks to address.
3. The Unfunded Mandate
Lumped in with the reimbursement myth are accusations that the proposal is an unfunded mandate. Actually it is a funded mandate. The funding comes in the form of Medicare/Medicaid reimbursement agencies are already receiving. Agencies who do not wish to pay the minimum wage set forth do not have to; they just cannot be reimbursed from Medicare/Medicaid anymore.
4. Raise the Education Standards and the Pay Will Come
Another myth. There’s no guarantee that increasing education standards will result in wage increases. The truth is a person with a Master’s Degree and an EMT card will earn the same starting salary as a person with a GED and an EMT card.
Current education requirements have been cited as a reason for the recent lowering of ambulance staffing standards in both Wisconsin and South Dakota. Becoming an EMT earning $10.00 or $11.00 an hour has become more of a bother than it is worth in those communities. Raising the wage could incentivize people to once again see EMS as a profession they can afford to choose bringing us more providers and growing the industry.
5. What Are We Worth?
As a profession, it would appear our self-esteem is incredibly lacking. We believe EMTs and Paramedics have, for far too long, under-valued their worth. Part of this is because of the aforementioned Stockholm syndrome-like effect. Part of it is because we measure success on only a fraction of what we actually do. Part of it is because we have spent so long caring for others and putting their well-being before our own that we stopped caring for ourselves, which is why we really need programs like Code Green.
Opinions appear to be truly varied on whether or not the $15/$20 is too much or too little. As stated in the petition, the United States Department of Labor’s Bureau of Labor Statistics lists the 2014 Median Pay of an EMT as $15.24 per hour. For comparison, here are the listed median wages for other Health Professionals alongside how far below them, by percentage, the petitioned wage of $15.00 falls:
- Licensed Practical (LPN) and Licensed Vocational Nurses (LVN) 2014 Median Pay $20.43 per hour (-26.58%)
- Registered Nurses (RN) 2014 Median Pay $32.04 per hour (-53.8%)
- Physician Assistant (PA) 2014 Median Pay $46.07 per hour (-67.44%)
- Physicians (MD) 2014 Median Pay $90.00 per hour (-83.33%)
Even WITH the petitioned rates, we remain the lowest compensated of the Health professions. Our belief is simple. We exist to provide a service. The service is valuable. We should be compensated accordingly for the value that we provide. For that to happen we need to believe in ourselves.
We need to stop allowing ourselves from being victims of economic abuse.
If you no longer want to be abused, sign the petition. Share it with your friends and use the hashtag #RaiseTheEMSWage.