What’s it worth to you?
Original Post Date:April 13, 2008


For the scientific among you, here's an experiment:

Find a paramedic. This might be the hardest part because, if s/he isn't running calls, s/he is probably at a second or third job, but that's a post for another day. Assuming you find one, ask him how much money he makes. Record that answer, then ask how much he should make. Jot that one down, then search the answers for a single word that you will almost surely find, most likely more than once.

Nurse. Or the plural thereof.

Finally, talk to a nurse who either used to be or began as a medic. These are pretty easy to find, so don't fret. Ask them why they went to nursing school. The word you'll be searching for on this page is…

Money.

Paramedics love to talk about their knowledge and skills, and that conversation is almost always either prefaced or followed by a negative comparison with nursing and the pay disparity that exists between the two. Those medics who have completed nursing school almost universally site money as the driving force behind that decision. All of this back-and-forth feeds two predominant illusions:

· Nursing is a promotion from EMS, and

· The only valid comparison for paramedic pay is nursing pay.

Each of these lines of thought is fraught with its own misconceptions that lie at the heart of the career paramedic debate.

During an instructor trainer course I attended recently, I the facilitator apologetically told us that the hospital paid part-time instructors $xx.xx/hour. I joked that I would love to make that kind of money every day because, in fact, it was more than my salary. A paramedic-turned-RN in the class looked at me with a smirk and said "Go to nursing school." Once my flash of anger dissipated, I recovered, smiled and said to him, "Just because you got a raise, don't think for a second that you got a promotion." That is really the crux of the argument that nursing or EMS is inherently better than the other: the idea that they are the only valid counterpoint to one another. News flash—they are entirely different jobs carrying different responsibilities and focused on different, if similar, goals. For reasons beyond my ability to articulate, nursing jobs have been in greater demand and thus have commanded higher wages, but this should never imply that a nurse is worth more. The honest truth is that we shouldn't have compared these careers in the first place.

I don't think anyone will say that he is paid all of what he's worth. Where this conversation goes awry with a paramedic is when the same guy says "I should make as much as a nurse". What they should say is "I should be paid what I'm worth" with no comparison to any other job because no logical comparison exists.

EMS is a funny business because there is no production quota or minimum order. We run the calls we're dispatched to and treat the patients we see. In short, we really are paid for what we know and the relatively few times we're called to do it. Therefore, it can be difficult to convince local governments, who usually pay us, that we should be well compensated for watching TV, eating and sleeping. Of course they don't see thousands of hours of education and shift after shift with no rest that supports or depends on what we know. A county commissioner suggested to me one time that paramedics should staff the county landfill during downtime to make better use of taxpayer money, but I digress. Point is, no one else does what we do. Not nurses, not physicians, not plumbers; so how can we compare any of their jobs, or pay, to ours. Can't. What you can do is recognize that and calculate the value of what we offer. Furthermore, this must be done in an articulate manner with measured data. Hyperbole is the language of the angry and theatrical, and neither of them is of any use to those writing the bottom line.

The sad truth is that most local governments simply lack the resources to pay EMS professionals a wage commensurate with their value and they know it. Rather, they take advantage of our love of the game, as it were, to keep us satisfied and getting back on the truck, or the aircraft.

The aircraft…that brings up perhaps the only valid comparison of nurse and paramedic pay: Critical Care Transport. In most CCT programs that employ nurses and medics side by side, the scope of practice is virtually the same, many times exactly the same. Yet, in these cases the pay is not. RN's still outpace medics on payday by as much as 50% and intangibly more so when it comes to promotion opportunities. However, the answer is still the same. We as professionals must define our own value and make the administrators answer for failing to compensate us at that level.

Or, you could always go to nursing school.