5 Reasons EMS DOES Deserve Higher Pay

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.

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

An Open Letter To Author Sean Eddy

 

I believe Sean Eddy knew he was playing with fire when he wrote his article on “5 Reasons Why EMS Doesn’t Deserve Higher Pay” posted at the Uniform Stories website. It certainly struck a chord with Adam Smolensky shortly after I posted a link on the High Performance EMS Facebook page. He later contacted me with the following “open letter” as a rebuttal (which did not meet the brevity guideline at the original website). I decided to publish the letter in its entirety, not to insult Sean, but to continue the debate he started. The tone almost made me reconsider publication, but then I considered the recent “What if we’re wrong-a-thon” challenge by blogger Brandon Oto at EMS Basics. So, in the spirit of debate and not wanting to squelch opinion (or even temper in this case), here is “An Open Letter To Author Sean Eddy. By Adam Smolensky, NR-Paramedic”

Why “5 Reasons Why EMS Doesn’t Deserve Higher Pay�? Demonstrates Basic Economic and EMS Ignorance

A few days ago Sean Eddy (SE) blogged “5 Reasons Why EMS Doesn’t Deserve Higher Pay.�? This poorly thought out and unsubstantiated personal rant deserves a response breaking down why it’s so wrong. It is not my intent to insult Mr. Eddy, although I will repeatedly do that. I write to him with the same flippant and condescending tone he chose to address his readers with. That being said, in his writing he made the decision to present himself and his experience as the primary and only source of all the information contained in his ramblings. I see it not as an ad hominem attack, but responding to what Mr. Eddy has fairly placed in the space of public comment. Namely: his ignorance.

This ignorance runs so deep that I am going to break down some of his misunderstandings sentence by sentence. All quotes are from Mr. Eddy’s “5 Reasons Why EMS Doesn’t Deserve Higher Pay�? posted on Uniform Stories unless otherwise indicated and sourced. From here on out I’ll address Mr. Eddy directly, as I’m considering this an open letter to him (it was an “Op-Ed�? after all).

Let’s dive right into the introduction of your writing, Sean.

“A lot of people aren’t going to like what I have to say, but just because we don’t like something, doesn’t mean it shouldn’t be said.�? – SE

This is arguably the only part of your blog that could be construed by a rational person as true. Unfortunately for you, it’s not true about what you have to say.

“Lately, my EMS newsfeeds have been flooded with stories about the “outrage�? over our wages.�? – SE

No one cares about what “…[your] newsfeeds have been flooded with…�?. What your “newsfeeds“ reflect are not much more than your personal internet habits (please, we don’t want to know, incognito tabs are your friend). So, before you go deciding to fix all of EMS’s problems with your infinite wisdom of: “…quit buying things [you] couldn’t afford…“, “…do the industry a favor and just quit…“, and my personal favorite relational narrative advice of yours “But you know what? I freaking grew up…“, you might want to do a little more research than glancing at a picture on your tumblr account. I hate to be the one to break it to you but, judging by this tantrum you decided to so publicly post, you haven’t quite achieved that life goal of growing up.

(Mr. Eddy is referring to the ongoing dispute in San Diego between the employees of Rural Metro, the current holder of the 911 contract for ambulance response in the city, and corporate Rural Metro over field employee pay rates.)[1] [2]

You go on to say:

“In some cases, EMTs and paramedics are even walking the streets, holding up signs DEMANDING that we ‘receive the wages we deserve.’ “ – SE

Here we really get at the heart of one of your misunderstandings. A lot of the ignorance in these “5 Reasons…“ stems from the fact that you don’t understand the definition of the word demand.

“You keep using that word [demand], I do not think it means what you think it means. “ – Inigo Montoya, The Princess Bride

You seem to think that “to demand�? is synonymous with “to beg�?. You imply that here:

“… stand in the streets with my hands out waiting for someone to throw me a bone.” – SE

This couldn’t be further from the truth and is where your thought process could be helped with a deeper understanding of democracy. Our society is a Republic (lands and infrastructure are shared “public�? goods) and then a democracy (majority rule), specifically America is a representative democracy (majority is represented by elected officials who make decisions / vote). Our entire system is built around the idea that you do exactly what the workforce in San Diego is doing to catalyze change. Those EMT’s and Paramedics who are in your words “… walking the streets, holding up signs… …with [their] hands out waiting for someone to throw [them] a bone.�? Are continuing in the strongest and most honorable traditions of American democracy that exist. Your blatant mischaracterization of that, for what I would glean from your article is the purpose of narcissistic bragging, is disgusting. You embarrassed yourself, and that’s not a melodramatic overstatement. You insult every person that struggled throughout the American Labor Movement and expose your historic incompetence. It is childish to implicate that if we don’t like it we can quit and move on when you say:

�?We weren’t forced into this job. We applied, interviewed, tested and ACCEPTED a job offer that included an hourly rate. We gave our word that we would do our job to the best of our abilities for an agreed-upon salary.�? – SE

Not only is this implication untrue, undemocratic, and totalitarian in nature, it has a very real misunderstanding of a basic economic principle bundled within it: agency. Let’s address why your statement, misguided as it is, has no place in the discussion at all anyway though, just for fun.

That statement is an Ignoratio Elenchi[3], or “irrelevant conclusion�?. You state that we weren’t forced into this job and that we accepted an offer at an hourly rate, both true. Then the funny part: �?We gave our word that we would do our job to the best of our abilities for an agreed upon salary..�?. Do you imagine that agreement lasts forever? Your implication is that it’s therefore shameful in some way to do what? You already made it clear you think “demanding�? a raise is akin to begging for a hand out. As well as, that to actively seek higher pay by doing anything other than quitting is disgraceful, and that you’re above such things. Do you see the logical disconnect here? No one agreed to indentured servitude for a fee and no one agreed to lifelong employment at a certain rate and no one agreed to not organize and advocate for the workforce. Your argument is an irrelevant conclusion because you are trying to imply that people are breaking some sort of honor based promise to do what? Never fight for a raise? This is a for-profit company we’re talking about and this is exactly how democratic capitalism works.

You are witnessing the market putting pressure on an employer through the individual actions of independent players that have economic and political agency. What you whine about, that employees should stand up for themselves, is literally what’s happening. Then you, in your narcissism, criticize them for doing it in a more difficult way than you did, by fighting instead of running to another system (as we see you mention below).

“By going out and now complaining or making demands, we have effectively gone back on our word.�? – SE

This is, and I’m not exaggerating, THE stupidest economic statement that may ever have been published about EMS. You might damn well deserve an award for that, honestly. You imagine that at will employment results in a loss of one’s economic agency to the point that it is �?…effectively [going] back on [your] word.�? to fight for higher compensation. When someone accepts a job offer, it’s not about their �?word�?. It’s a business agreement for services as a qualified Paramedic. In that role a Paramedic treats the public. Separate from the clinical aspect, the role of Paramedic in their personal life is primarily an economic one. You talked about growing up before, grownups don’t provide professional services for poverty level compensation because Sean Eddy thinks that once you sign on to work in EMS you are honor bound to poverty or running away or working two jobs.

“We Need Higher Education Standards

Can I say that again? WE NEED HIGHER EDUCATIONAL STANDARDS. You want to picket about something? Picket about that! And no, higher pay doesn’t come first. You don’t go to your local mediocre burger joint and voluntarily pay them double what they normally charge with the hopes that it will somehow motivate them to make a better burger. So why should our employers do it? After all, if all we’ve been able to accomplish is to compare ourselves to fast food workers, then we have accomplished nothing. You want better pay? Produce a better product.“ – SE

This is an interesting point, it’s wrong, but in an interesting way. You actually caught a lot of people in the social media response with this point who said that your delivery was flawed, but at least this idea was correct. I’m a huge advocate of increased education in EMS for all kinds of clinical reasons, unfortunately for your list, education has little to do causatively with pay.

You have a really drastic misunderstanding of the issue of wage stagnation and further-more, of the economic factors that determine pay in a workforce. According to the Economic Policy Institutes position on “Causes of Wage Stagnation�?, specifically about the current status:

�?Low-wage Americans are not the only workers affected by stagnant wages and rising inequality. The middle class has also experienced stagnating hourly wages over the last generation, and even those with college degrees have seen no pay growth over the last 10 years. Since the late 1970s, wages for the bottom 70 percent of earners have been essentially stagnant, and between 2009 and 2013, real wages fell for the entire bottom 90 percent of the wage distribution. Even wages for the bottom 70 percent of four-year college graduates have been flat since 2000, and wages in most STEM (science, technology, engineering, and math) occupations have grown anemically over the past decade. �? [4]

There are a host of factors that affect the wages of a workforce, but increased education standards aren’t one of the ones EMS has to worry about in relation to pay. Increased education generally equals a higher pay rate inside of a high wage, high demand workforce. Overall, if you have a PhD in Comparative Latin Poetry about Flowers, you are going to have a hard time finding a market that employs you at a high wage. Inside the industry where that PhD would hypothetically work they might be paid above less educated workers but when compared across the board their PhD isn’t going to get them anything intrinsically. The situation EMS finds itself in is the overall compensation bracket for the profession being too low, rather than the mobility from lower to higher paid practitioner. You have confused the two. Paramedics for instance, already make the top pay grade in the EMS industry for field personnel. A paramedic with a bachelors doesn’t bring any value to the market above one without right now. Until they do (whether they should or not is another discussion) education isn’t the solution you’re making it out to be. There is no such thing as a BSP (Bachelors of Science in Paramedicine) the way there is a BSN (Bachelors of Science in Nursing) which directly makes a difference in clinical responsibility or position… or pay.

We see another example with doctors. Pay in the medical doctor profession is actively managed not by simply relying on the education of a doctor, but by regulating the number of doctors available and thereby manipulating the market to always have a high demand. That results in higher pay. According to a Duke Law article:

“In other words, the AMA represents both the buyers and the sellers of physician services in determining the output of physicians. Given this anomalous position, it is difficult to believe that the AMA will ever permit the number of physicians to be produced that the public is willing to support with its patronage.�? [5]

If higher educated professions are stagnating as well then exactly why do we need increased education standards to increase pay? Again, I support increased education standards for other reasons, but your logic is absolutely wrong when it comes to the issue of pay.

“We Are Responsible for Our Own Actions�? – SE

“We�? really needed to hear that so “we�? can pull ourselves up by the bootstraps and achieve the American dream just like you did, Sean. Thanks. We’ve already discussed how demand doesn’t mean “to beg�?. That pretty much explains where you came up with this half-cocked idea that picketing is anything but literally taking responsibility for their own situation. Your writing is so poor that you are now listing one of the most important things EMS workers could do to increase pay as a “reason�? why they don’t deserve it.

“You want better pay? Produce a better product.�? – SE

I realize that from the attitudes in this article you likely just found yourself introduced to Ayn Rand and are awash in wonderful libertarian economic ideas. You do realize that EMS isn’t a commodity “product�?, right? No? Oh, well EMS is a public service. That’s why private EMS companies contract with municipalities to provide emergency response. Additionally even in the inter-facility transport world, the product or service is entirely economically detached from the pay rate of providers. You are appropriating economic terminology you don’t understand to try to frame the workforce as being to blame for not providing a “product�? worthy of the pay they are demanding. A full explanation of market forces determining workforce pay is outside the scope of this letter, but I encourage you to read about it before insultingly opening your mouth again with things like “…so just shut up about it.“ I mean, clearly the workers in Apple factories are making fortunes since they are making a luxury, high quality product. At least by your logic.

“If we want higher pay, we need to make changes all around.�? – SE

This is called bad writing. It was easy to miss because you cleverly couched it in a lot of other really horrible writing and ideas, but I caught it. Your vague assertions illustrate what you really have to say: nothing. You don’t understand any of the topics in your list much less the bigger economic picture of American EMS and hence, your article doesn’t say anything. We’ll see that more clearly as you meander off on tangents and then struggle to conclude what isn’t a coherent string of thoughts. What “…changes all around.�? are you talking about? Change what? Be specific.

“We’re Not Looking At The Big Picture

We like to pretend that EMS financial problems begin and end with our paychecks. The fact is, we are an industry that’s still in its infancy. Our reimbursement structure has literally failed to the point of nearly collapsing the industry. Those services that don’t have the luxury of a nice tax base are forced to employ measures like cost-shifting in order to make ends meet. Plus, let’s not forget that payroll remains the single largest expense for most services. For the thousands of EMS services that are barely getting by with what little reimbursement they are getting, a massive increase in payroll expenses just isn’t feasible. We are barking up the wrong tree here.�? – SE

You keep saying that word [we]. I don’t think it means… never mind.

In reading the above statement it sounds like you think that the compensation rate of employees is somehow reflective of the payment structure or income of the company they work for. In fact, that’s not the case at all. That’s why clerks at the apple store and cashiers at Wallmart, despite working for some of the richest companies on the planet, aren’t getting a cut of those profits. However, according to you, it’s dishonorable or would be in some way “…going back on [their] word…�? to ask for more money as an employee. At a very basic level it is true that if a company doesn’t have enough money coming in they would be unable to cover labor costs. That doesn’t mean there is a causative relationship between corporate revenue and worker pay as you imply. Please enlighten the EMS world about how “looking at the bigger picture�? is why we don’t deserve better pay in a more concrete way for us.

“We Refuse To Give Up The “Life Saver�? Title�? – SE

This is so out of left field and irrelevant that I question whether you thought through this “writing�? at all before publishing it. Let me explain something to you Sean, not only do some of us save lives (I suspect you may not), but some people have even lost their lives in the pursuit of it. How many EMS helicopter crashes are we on this year so far? Now I’m not one to be melodramatic but your little “holier than thou�? preaching about how you are the humblest of providers and that anyone with the audacity to imagine they saved a life is a “…glory, hogging, selfish, simplistic…�? person was shameful. I’m very sorry that your glory is being “hogged�? by those people out there doing good work. And that your only recourse is to cry about it online, but I’m going to give you one guess as to who the narcissistic, glory-hogging, selfish… well, you get the idea. It’s the person who said this bit of self-serving, completely lacking in any actual information or content, blatant brag:

“Nobody owes me a thing and I’ll be damned if I’m going to stand in the streets with my hands out waiting for someone to throw me a bone. I took control of my life. I paid off debt, I learned how to budget, I quit buying things I couldn’t afford and I prepared for financial emergencies. And guess what? I did it all on a…wait for it…EMS SALARY. Now I do cool things like go on trips, take on new hobbies and actually enjoy life. Funny how that becomes possible when I take action rather than stand around crying and waiting for someone to fix all my problems.�? – SE

Aren’t you the bastion of self-congratulatory self-sufficiency that we should all emulate?! Or should we take a moment to point out that no, you didn’t? In fact, you failed to make it and had to move somewhere else, somewhere easier. Is your solution that everyone should just abandon their families homes, friends, and lives, to move somewhere “with a lower cost of living�? like you? That is after-all what you responded to a successful, financially stable, 20+ year career San Diego Paramedic with in this Facebook post:

“And I did live and work in California. Guess what? I quit and moved to a place with a better cost of living. I didn’t blame anyone. I took control of my situation and found a place that better suited my needs and goals. So, no, I reject your invitation, because that would be stupid.�?– SE[6]

I’m not going to address your comments about medical directors. Once again, they have no bearing on the topic at hand and are a desperate attempt at drawing a conclusion from sketchy and unclear associations that have no relationship in reality.

In reference to fast food workers you say:

“I guarantee you that your paycheck FAR exceeds what they’re making, so just shut up about it.�? – SE

Gee, thanks Sean. This is going to feed a lot of people and pay a lot of bills, I see where your wisdom really impacts the community. Despite your guarantee, which I can only imagine is worth about as much as your “word�? that binds you into indentured servitude, I don’t feel comfortable just trusting you on this.

“Most of them are only employed part-time, don’t enjoy the “time-and-a-half�? that we see working long-hour shifts, and don’t have near the benefits package we do�? – SE

Ok, you forced me into it:

“You keep using that word [we], I do not think it means what you think it means.�? – Inigo Montoya, The Princess Bride

Let’s just get one quick point about this out of the way before we get in to “we�?. You’re telling us: “You make more than “part time�? fast food workers while working full time as EMT’s and Paramedics with “long-hour�? shifts.�? And your entire point is that this is proof that we are paid adequately? You’re arguing that we should improve our “product�? so that we can compete economically with part time fast food workers and you thought it was a good idea to write that down, put your name on it, and publish it? Do you read your own writing? How is the sentence you wrote above a logical statement about anything at all? It’s once again gibberish.

When you say “we�? who exactly are you talking about? What is “our�? benefits package that you’re referring to? This is literally gibberish as well. You are alluding to some uniform system that “we�? all get benefits from in order to trick the inattentive reader into thinking we are all part of some organization that provides an apparently awesome “benefits package�?. See, this is some of that horrible writing that I was talking about that you were able to use to camouflage some of the just bad writing. The only word for the above sentence is gibberish, literally. What we call this in the literate community is intellectual dishonesty.

In closing I would just like to summarize your, Sean Eddy’s, opinion on “Why EMS Doesn’t Deserve Higher Pay�?:

1) “EMS doesn’t deserve higher pay because [they] don’t deserve anything.” This is a meaningless filler statement with no traction in reality Sean. Even with your misunderstanding the definition of demand and its relationship to what we do or do not deserve it’s hard to glean an actual idea from this statement.

2) “EMS doesn’t deserve higher pay because [they] need higher education standards.” An Interesting opinion supported by an assured “guarantee�? from Sean Eddy himself. Although, the Economic Policy Institute and every class of successful 7th grade social studies graduates ever have relatively concrete proof he’s wrong, please draw your own conclusions.

3) “EMS doesn’t deserve higher pay because [they] are (aren’t?) responsible for our own actions.“ This is literally an incoherent statement Sean.

4) “EMS doesn’t deserve higher pay because [they] aren’t looking at the big picture.“ Well, I don’t think I could have made up a better statement that represents what your actual hurdle to understanding economics is; you have no idea what the big picture is.

5) “EMS doesn’t deserve higher pay because [they] are glory-hogging, selfish, and simplistic.” Oh… sorry, you wanted me to quote the earlier part, where you said “[They] refuse to give up the ‘Life Saver’ label.“ Oh well, that’s how it goes, I hope I’m not hogging your glory now.

With all sincerity Sean, take your own advice: “…do the industry a favor and just quit.�? Both EMS and writing. Especially any writing having to do with economics, a topic you clearly have zero understanding of.

-Adam Smolensky, NR-P

1. Community Support for San Diego EMS Facebook Page (https://www.facebook.com/groups/467869550055343/)

2. NBC San Diego Local News “Paramedics, EMT’s Picket For Higher Wages�? (http://www.nbcsandiego.com/news/local/Paramedics-EMTs-Picket-for-Higher-Wages- 305406521.html)

3. Wikipedia Page of “Ignoratio Elenchi�? (http://en.wikipedia.org/wiki/Ignoratio_elenchi)

4. Economic Policy Institute “Causes of Wage Stagnation�? (http://www.epi.org/publication/causes-of-wage-stagnation/)

5. Duke Law “The A.M.A and the Supply of Physicians�? [PDF] (http://scholarship.law.duke.edu/cgi/viewcontent.cgi?article=3288&context=lcp) 7. Facebook Comment From Sean Eddy (https://www.facebook.com/EMSWorldFans/posts/897310160310734? comment_id=897477680293982&notif_t=like&hc_location=ufi)

6. Facebook Comment From Sean Eddy ()