It’s Never About the Pay

Years ago, as a new attorney working in state government, I worked for a state agency that determined they had a problem retaining attorneys.  They did a lot of surveys, most of which revealed discontent with working conditions.  The reality was that management used junior attorneys as glorified paralegals and gave them little professional discretion and routinely micromanaged.  Of course, management did not want to hear this.  Instead, a new pay scale was issued, which gave everyone an immediate raise and also decreased the time before being eligible for the next promotion.  Management made the decision that it was easier (and possibly cheaper) to give everyone a raise than improve working conditions.  Needless to say, the retention improved, but only slightly.  At that point, I told one of my colleagues, “It’s never about the pay.  It’s about what people are willing to put up with for that pay.”  People know the salary when they accept a job.  What they don’t know is what the job is going to be like.

But my blog is (usually) about EMS and my EMS experiences.  What does this have to do with EMS?   Everything.  We routinely hear that there’s a shortage of EMS providers.  We regularly are inundated with stories about a shortage of volunteer EMS providers. There have been numerous committees studying the issue of a perceived shortage of providers.  Some states have done a terrible job of promoting becoming an EMT or paramedic.  The Pennsylvania “Roll With It” campaign comes to mind.

What remains is a shortage of EMS providers willing to put up with the working conditions made available to them at the salary offered.  And this is even more the case for EMS volunteers.  I will fully admit that as a volunteer medic, I will put up with relatively little BS in return for providing free paramedic care.

So, to those of you wondering where your volunteers are or why you aren’t keeping volunteers, I’ll ask you a few questions.

  1. How easy do you make it to volunteer?   Is your application online?  Do you have a point of contact?  Do you even have a webpage?
  2. How soon can you get people on shift?  Is the process tied up with committee meetings, orientations, and other obstacles?
  3. Do you provide the volunteer everything they need?  Or do you make them spend money out of pocket on uniforms?
  4. Do you have an open, transparent on-boarding and field training process?  Or does your training staff regularly play “hide the ball?”
  5. Do you truly make your volunteers part of the team?  Or do you make things difficult (even unintentionally) and say “we’re holding you to the same standards as everyone else?”
  6. Do you have some flexibility in the process?  Or do you rigidly refuse to deviate from your processes?
  7. Do you truly welcome new people?  Or do you have cliques and the “old guys” club at your station?
  8. Do you welcome those with prior experience? Or do you force them into a model of starting from scratch because your organization is “special?”
  9. Do you learn from previous issues?  Or do you act as if “this is the first time we’ve heard about this?”
  10. And finally, have you told your staff (both paid and volunteer) that they’re appreciated?  More importantly, do you back those words up with action?

There’s not a shortage of EMS volunteers.  I know many people with EMS certifications who’d like to get back on the truck.  The real shortage is the number of EMS organizations that truly want and appreciate providers, whether paid or volunteer.

Fight For $15

So, in a fit of rage, I was almost tempted to write a screed about how EMS providers don’t deserve the $15 per hour wage that fast food workers are protesting and clamoring for. My rationale was (and remains) simple.  After watching the attitudes from so many EMS providers, especially in the average online discussion, I’d be hard pressed to argue that many people in EMS deserve to be paid this much even.  Whether it’s the blind devotion to dogma (See also: Spinal motion restriction), the overinflated sense of self importance (See also: the usual t-shirt slogans about how under 200 hours of first aid training is equivalent to being a physician), or the culture that mocks education (See also: The usual claptrap about EMTs saving paramedics and/or “BLS before ALS”), it’s clear that many people in EMS are overpaid at minimum wage.

Today, though, I dug deeper into a recent EMS discussion about the priority between hemorrhage control and the classic “Airway, Breathing, Circulation” priorities that are drilled into almost every EMS provider.  I noticed that the majority of providers wanted a definite, absolute answer.  They wanted a clearcut answer.

Here’s the problem.  In any learned profession, whether it’s engineering or medicine, the answers are rarely clear.  Answers to most questions are heavily dependent on both the facts of the situation and the judgment of the professional.  As both an attorney and a paramedic, my favorite answer to any question is, “It depends.”  But too many of us in EMS want a definite answer.  We want a protocol or a flowchart to follow.  We claim that we want to be treated as professionals, but then we want someone to supply us the answers and make it easy for us.  Following the protocols or the skills sheet truly is the medical version of being a fry cook.  Congrats!  We’ve earned our $15.

 

 

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