Did I Really Hear Him Say That???? EMS personnel as disposable employees???

Replies to This Discussion

Permalink Reply by dr-exmedic on July 21, 2012 at 10:19am

This is disgusting. Just because "that's the way we've always done it" (and that has been the way it's been, most of the privates are seen by medics as the easy job to get while you work on getting the job you really want) doesn't mean that's the way it has to be. Apparently, this person hasn't done enough work on how much it costs to replace people--because if you think developing good people is expensive, you have no idea how much more expensive it is to have worker flux. The exception would be in a non-skilled industry, where literally any strong back will do: picking vegetables, for example. Which paramedicine isn't.

Permalink Reply by Mike Rubin on July 21, 2012 at 11:41am

Interesting. I think some of that perceived disposability of EMS workers has to do with the way we view seniority in our own industry. How do we react -- I mean inside, for real -- when we meet an EMT or a medic who has been on the streets for more than 20 years? Do we feel more sympathy than respect? Are we more surprised than proud? Do line medics feel differently about that than managers of line medics? Do business people, in general, value breadth of experience more than depth of experience?

I had a chance to explore this at a presentation I made yesterday. The topic was "40 years of EMS in Tennessee." I asked the audience of educators -- a mixture of street medics and supervisors -- if anyone had been in EMS that long. A few hands went up. As I directed those folks to stand, I was planning to call for a round of applause. I was surprised when I didn't have to -- the applause was spontaneous. I'm not convinced that would always be the reaction; and if it were, that it would be sincere.

What do you think?

Permalink Reply by Rogue Medic on July 21, 2012 at 3:25pm

Maybe we need to do something to get some tort lawyers to take an interest in the care provided in these places.

He seems to be saying that his company's patients do not deserve good care.

It is not worth it to keep the best employees.

We should expect the best to leave.

Those who stay are not capable of doing anything else, otherwise they would do something else, since they do not make a career in EMS attractive.

This is not much different from the places that use cross-trained paramedics.

The idea of working as just a paramedic seems to be offensive to many people in EMS.

Why is patient care such an unimportant job, that is not seen as a career all by itself?

Because our priority is not our patients.

.

Permalink Reply by Dale Johnson on July 21, 2012 at 5:12pm

Hmmm. I have heard something like this before. Other versions are "We have a stack of applications to take your place". I think Mike has a good perspective pertaining to how we view our 'elder medics'. My experience has been, well, not in an entirely flattering light. If someone has worked as a paramedic for more than a few years (like 23 years as a medic and a total of 37 in EMS) a lot of people look at that person as a 'failure' of sorts. We don't view the amassing of experience and knowledge as important- since that person was not 'promoted off of the truck' many view that career as a failure.

Of course, the mentality of the disposable employee is prevalent in many aspects of our profession (note- I did NOT say 'industry'). Our education programs are many times based upon minimum standards that are viewed as ceilings. Our hiring practices are aimed at the 'lowest common denominator'. Our business practices are geared around a 'fee for transport' mentality when I think that deep down, we all know that EMS cannot be provided on that basis.

Change has to come in many aspects to do away with this 'disposable employee' idea. In all honesty, I was hoping that I would see it in my career, which I am starting to doubt. Too many people have a vested interest in keeping things as they are.

Permalink Reply by Neil White on July 22, 2012 at 2:35pm

The trouble with these sorts of things is that we always bitch about the same things...no career route, poor education standards and the song goes on. There are variables that the provider does that places a burden on the employer to consider them disposable....Union negotiated deals...doing the absolute minimum and so on. 

At present EMS agencies are overwhelmed and subject to budget cuts... here in the UK massive infrastructures are set up to allow a thousand or so providers offer care to the patient. Let's be honest does anyone need an assistant director of strategy and implementation!

Now that we are in the realms of Universal Healthcare 2.0 (Universal Healthcare with the addition of commercial activities outside of patient care) those at the top begin to see that more can be delivered for less... Bus companies now tender and have won non emergency patient transfer services, providers are paid twice as much, get to use state of the art vehicles and with a brand to protect the companies are hell bent on providing a good service first.... 

It falls apart because the evidence is clear the majority of EMS does not require qualified staff. More and more agencies are operating with Care Assistants rather than Ambulances....ergo wage bills are lower and more resources can be deployed and thus help to meet the demand of making sure everyone who needs an ambulance gets one. 

From an executive level, I can see why there is a movement of disposable staff... whilst it didn't work this aspect was the linch pin to G4S' strategy for olympic security. Its interesting to see that TV advertisements commence around the school leaving period in the sum for big companies looking to recruit... They live very much on a cycle that employees work in a job whilst they figure out or re sit and move on, expectations are minimal and the pay supports this. 

Is EMS any different, as patient need has shifted have we created a service that lives for the disposable employee...minimal training, minimal expectations (pick up, load and drive). We don't have a proper corner on expanding into community/primary care. As a "profession" we are yet to make up our minds on the expectations of the task... until we decide what we do with the patient we can't begin to recruit or classify the employees needed to do it?

Permalink Reply by Neil White on July 23, 2012 at 2:46am

I've slept on it and thought that actually, it is important to throw generational theory into the ring. http://www.tomorrowtoday.uk.com/articles/article001_intro_gens.htm

Graham Codrington perhaps a leader in generational theory postulates on how the younger generations approach work...

They're skeptical of corporations, realising that long-term commitment is unlikely to pay the dividends it did to their parents and grandparents. They are, therefore, opposed to paying their dues the way their Silent grandparents did and they look for quick, short-term rewards, are prepared to embrace risks and work hard for themselves. This entrepreneurial, selfish and individualistic attitude is often mistaken for the rebelliousness displayed by Boomers and many of the older generation simply ignore it, believing that Xers will soon grow up and move out of this phase. However, Xers are not rebelling against authority, the way Boomers did (and still are in some cases). They're simply asserting their individuality, one of their defining characteristics.

Today, they need options and flexibility; they dislike close supervision, preferring freedom and an outputs-driven workplace. They love change so much they actually need it. Xers strive for balance in their lives - they work to have a life; they don't live to work. They want rules but from the right authorities only; their "now" matters more than their future; they don't want to know "is it true?" they want to know "does it work?" They are spiritual seekers who believe in the supernatural. Music is huge in their lives, it is the "window on their soul" and the language they use to express themselves.

So in order to retain providers it goes back to my original thought about what we ask employees to do within our profession... If all a young provider wants is a stepping stone to change, can we really negatively judge an employer who responds to that. Or in fact should we be in a position where we can mould EMS to respond to the need for change whilst retaining providers?

Permalink Reply by geoff.horning on July 23, 2012 at 10:27am

I'm quite sure you heard it correctly.  That attitude has been going around for a long time, in fact a Fire Chief once used it to recruit me.  "If you come over here, you'll have a career and opportunity, not just a job on an ambulance".  He was right, and it was a great time, great place, but my heart is with patient care,  not firefighting.  However, I realized even more how correct he was when I went back to an ambulance. 

I don't really feel this way, but I wonder how long we can fight this fight.  Maybe it would be better just to realign everything under the umbrella of nursing?  EMT, Paramedic, RN, CCRN etc.  It would definitely give some of our better and older more experienced medics a career boost ( I Know far too many EMS people who have been age or injury retired just to end up a unit secretary or at Walmart, rather than go back to school at 45).  Thoughts?  Anyone?  Anyone ever given any thought to whether or not nursing would even want us under their umbrella? 

Permalink Reply by geoff.horning on July 23, 2012 at 10:39am

I think you've hit the nail well, except for the fact that EMS folks find being "just a paramedic" offensive.  They don't only find this, they're taught it.  They're taught it by society, other hospital staff, their friends and most of all by us.  Look at the schedule for any upcoming EMS lecture/CE sessions.  How many of the presenters are listed as EMT-P/Paramedic/or NREMT-P?  Most are listed as "Flight Paramedic", "Captain Paramedic", "Firefighter Paramedic", "Critical Care Paramedic" etc...Tacking that adjective on the front of "paramedic" takes the job from boring old ambulance driving to glamorous.  Heck even I remember that much from being a new single paramedic 10 years ago.  Paramedic didn't get me very far socially...however "firefighter paramedic" did wonders! 

Rogue Medic said:

Maybe we need to do something to get some tort lawyers to take an interest in the care provided in these places.

He seems to be saying that his company's patients do not deserve good care.

It is not worth it to keep the best employees.

We should expect the best to leave.

Those who stay are not capable of doing anything else, otherwise they would do something else, since they do not make a career in EMS attractive.

This is not much different from the places that use cross-trained paramedics.

The idea of working as just a paramedic seems to be offensive to many people in EMS.

Why is patient care such an unimportant job, that is not seen as a career all by itself?

Because our priority is not our patients.

.

Permalink Reply by Bob Sullivan on July 23, 2012 at 10:39pm

Sadly, I am not surprised at all.  A politician even said so to me when he did a ride along. 

A few years ago when the economy was better, the service I worked for was trying to reduce the number of years of service needed for our pension.  At time we had a 30 year plan, cops and firefighters had 20.  We wanted 25.  One of the arguments was that we were losing people to become PA's, nurses, doctors, firefighters, and cops.  The medical professions paid better and had more diverse career opportunities.  Cops and firefighters were paid about the same, but had more career options and a better pension. 

His response to this was that paramedics seemed to be an entry level position for other medical and public safety careers, and that the focus should be more on recruitment than retention.  He also compared us to the municipality's lawyers, who were expected to work for a short time and move onto something better. 

So no, I am not surprised.  The person who made that comment is probably surprised that some people disagree. 

And no, we should not tolerate it.   

Permalink Reply by Rogue Medic on July 24, 2012 at 12:52am

geoff.horning,

I agree.

We do not seem to think that our patients deserve care by someone who is just a paramedic.

We need to be able to sing, and/or dance, and/or play an instrument, and/or a bunch of other things, but being just a paramedic is seen as being not worth our time.

We don't need to know what we are doing - we only need to memorize our protocols.

Just don't threaten to take intubation away from a protocol monkey, because that is an excuse for claiming to be better than someone who is just a nurse.

We are our own worst enemies.

.

Permalink Reply by Bob Diehn on July 26, 2012 at 11:36am

Why do people view EMS as a stepping stone job?  Simple:  low pay and crappy hours.  Who wants to work in that kind of field the rest of their lives when their are better opportunities to make a living elsewhere?  Ideally, everyone who works in EMS should be doing it more for the patient than themselves, but bill collectors could care less if we have a great bed-side manner.  We all know that nobody gets rich in this business, but we all also know that jobs like firefighter, cop, and nurse pay much better so that we don't have to work 2 or 3 jobs.  If EMS paid like these other fields, retention might not be as much of an issue.  When you pay barely better than minimum wage with few or no benefits, don't expect too many people to stick around.  You may say I'm being cynical, a pessimist, or that the reasons I listed above are not the priorities EMT's and Paramedics should have in our field, but that's reality.  You can't fault someone for wanting to make a good living.  Service, quality, or price:  pick 2 because you can't have all 3.  If you want lots of high-quality services, you have to pay for them.  Reality.  You get what you pay for.

Permalink Reply by Skip Kirkwood on July 26, 2012 at 11:50am

There's a "chicken and egg" issue.  Pay doesn't go up because too many people are willing to be EMTs for little or even zero money.  Basic business - because no business pays any employees any more than it has to to get the quality and qualifications that it wants.

We in EMS have contributed to this problem, because WE work really hard to keep standards LOW.  That means cheap employees.  Employees who have to go to college for 4 or 7 or 10 years to get their state license command salaries that are much higher than people who go to school for 100 hours.  Minimum qualifications - minimum pay, lots of takers.  It's as simple as that.  If paramedics had to have a college degree, it would cut the supply of paramedics and salaries would rise.  ECON 101 at its best.

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