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The Legal Guardian
by David Givot

A deeper look at an EMS provider strike

Remember that you are not only gambling with your own livelihood, you may be gambling with the very lives you are supposed to protect

By David Givot

You went to school. You studied. You trained. You tested and you passed. You are either certified as an EMT or licensed as a paramedic. And you paid for it all by yourself — or are continuing to make payments all by yourself.

You have worked very hard to put yourself in a position to announce to the world: “We have never met, but I will be there for you when no one else can. I will be there for you when no one else will. I will risk my own life and safety to protect yours. And if I can do nothing else, I will try to make you a little more comfortable.”

That is what you will see when you break it down to its simplest terms and really take a close look at what it means to be in EMS.

Of course, not every provider actually feels that way, but you should. And in my humble opinion, if you don’t feel that way, you should get out of the business and out of the way of those who do. But, that’s just me.

For the context of this column, I will assume that you are reading because you agree; I will say to those of you who presently work for a private provider, your willingness to do it for barely minimum wage makes you a real-world superhero.

I get it. I truly do. My EMS career was spent working for a private provider and, after a decade, I don’t think I broke the $12.50 per hour threshold. (Secretly, I would have done it for free.)

I also get that at some point, enough is enough and it’s time to take a stand for what’s right and fair and proper. Sometimes you have to take it to the streets. Sometimes, you have to take it to the people who depend on you for the very protection and comfort you are willing and able to provide.

Sometimes, striking is all you can do.

However, that sword has two very sharp edges. Sure, one side cuts to the quick of the issues: private EMS providers rarely earn a living wage in comparison with what they actually do or are willing to do. 

The second side, though, cuts away the emotion of that issue to expose the reality of low reimbursements and high operating costs — as well as multiple layers of regulation compliance (always moving target). All of this creates an operational environment that prevents employers from offering and paying more to the employees who clearly deserve better.

The X-Factor
If the issues were as simple and clear as those painted above, resolution without striking would be easy. Unfortunately, there is an X-factor: All too often the message is irreparably distorted by the messenger.

In far too many circumstances, the very providers who are decrying the unfair labor practices of their employers at the greatest volume are the same employees who interfere the most with the delivery of service. Think about it — through delayed responses, incomplete documentation, destruction of equipment, and trash talking to facility and other ancillary personnel, they are aggressively creating the environment they detest.

Before the hate mail comes, let’s be clear. I know the percentage of providers who fit that description is relatively small, but they are disproportionately mighty. Think of it like this: Ebola is microscopic and sharks can be very large, nevertheless more people die from Ebola every year than from shark attacks.

Thanks to the folks who engage in this or similar counter-productive activity, Basic EMT's are essentially fungible and paramedics are only slightly less so. This remains true, because so many providers lack the maturity expected (and required) of a patient care provider . That is, many do not behave like professionals.

As a result, those who do lack the maturity are preventing companies from generating higher revenues and the industry as a whole from becoming a profession. And, as a result, the current pay scale reflects that.

Now look at a strike. When the employee body is represented by those who have higher volume levels than maturity levels, the message gets muddled. If there is evidence of unprofessional conduct, equipment tampering, or any other intentional deficiencies, who is going to take any of you seriously?

The Answer
In general, private EMS providers do not typically earn a wage commensurate with their responsibilities. Anyone who disagrees is either uninformed or unrealistic. Ironically, the power to change that fact rests almost entirely in their own hands.

When an employee body is sharp, professional, well-trained, self-regulating, and committed to excellence in all aspects of EMS, they will develop the leverage necessary to demand and receive higher wages. This is because they will have created the financial resources to accommodate it.

On the other hand, employees who engage in the kind of nefarious conduct discussed above forfeit the right to complain about the abysmal environment to which they have so recklessly contributed. Likewise, the other employees who stand as silent observers have earned their place in the muck.

By the same token, it is incumbent upon the employer to set a professional and consistent example; to reward good performance and behavior; to better compensate those who afford you the ability to do so.

On the other hand, employers who operate detached from reality and fail or refuse to do what’s right…well, you don’t get to complain when morale and profits tank.

Conclusion
​Sometimes, after all of the “T’s” have been crossed and the “I’s” have been dotted, employees must resort to that last option and strike.

Before that time comes, however, I hope you will take a very close and extra-objective look at how you got there.

Remember that you are not only gambling with your own livelihood, you may be gambling with the very lives you are supposed to protect.

About the author

David Givot, Esq., graduated from the UCLA Center for Prehospital Care (formerly DFH) in June 1989 and spent most of the next decade working as a Paramedic responding to 911 in Glendale, CA, with the (then BLS only) fire department. By the end of 1998, he was traveling around the country working with distressed EMS agencies teaching improved field provider performance through better communication and leadership practices. David then moved into the position of director of operations for the largest ambulance provider in the Maryland. Now, back in Los Angeles, he has earned his law degree and is a practicing Defense Attorney still looking to the future of EMS. In addition to defending EMS Providers, both on the job and off, he has created TheLegalGuardian.com as a vital step toward improving the state of EMS through information and education designed to protect EMS professionals - and agencies - nationwide. David can be contacted via e-mail at david.givot@ems1.com.
Comments
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Charles Purpura Charles Purpura Friday, August 23, 2013 9:44:26 AM Having worked in both public and private ems I agree with your overall point, but consider this... another way to look at this complex intertwined issue is to perhaps ponder why this same problem usually doesn't exist in the public sector. I believe the answer is clear. Higher prevailing wages attract better and more competant employees in general. If a company is looking for a new CEO to take control of its operations in a time of need to better itself and move it forward they don't do so by offering the smallest salary and benefits package it would take to hire someone with the minimum education and experience required. They offer a package that consists of a balanced approach to work environment, hours, wages, benefits, supporting staff, and bonuses that would make a qualified individual WANT the position as opposed to a person who is willing to SETTLE for that position simply because they are in need of a job. My point is that if you are paying department store or fast food wages then you are going to get department store and fast food applicants, just ones with a piece of paper that says they took some classes. I believe a large part of the problem in private EMS is the inability to attract "professional" applicants in the first place by offering wages and work environments ( faulty inadequately maintained or long overdue for replacement vehicles/medical equipment) that are clearly not at a "professional" level.
David Shrader David Shrader Friday, August 23, 2013 3:00:17 PM David: (begin Simon Legree imitation) If only I had known many years ago that you would have worked for free! (imitation concluded). Your article is right on point. Usually, when the relationship between management and labor fails, both sides and lots of people are at fault. You touched on the economic environment in which the business has to survive, but that point needs some expansion. In an environment where half of the patients are paid for below cost by Medicare and Medicaid, costs are shifted to other payers. In California, MediCal pays around $125 per emergency transport. That's probably less than a quarter of the cost for a fairly efficient provider in much of the state. If 5-15% of the other payers don't pay anything, that loads a lot of costs on somewhere around 35% of the accounts. And, not all of those payers will pay the full amounts. This cost shift is insidious. Its a hidden federal tax. One reason that public providers are likely to have higher wages is that they are more often subsidized with local tax funds. In some (but not all) cases, that takes away the incentive to improve productivity and efficiency. After watching a series of cities enter bankruptcy and try to modify or abandon their union agreements and pension responsibilities, the future may be bleak for some public agencies as well. In the long run, we need to fix the reimbursement system to adequately fund the service. Otherwise, look at Detroit and DC and see what the future has in store for us. But, unfortunately the road we are headed down in the name of "healthcare reform" will likely make things worse.
Ernie Sharp Ernie Sharp Sunday, August 25, 2013 12:50:21 PM There is more to it than that. In a 911 system, more than half of the patients never pay their bill, and only about 10% of your patients have a true emergency. The rest are looking for concierge medical services, or are plain out drug seekers. The opportunity to make a difference is rare. In a private IFT system, the goal is profit. The way that the provider does this in an environment where the Feds set absurdly low prices is two fold: they hold wages down, and they force employees to be complicit when they commit medicare fraud. The facts speak for themselves: Paramedic wages are less than they were ten years ago (in central Florida, a paramedic makes $13.23 an hour to start, and EMTs make only $10) but the number of fraud claims are WAY up. The biggest companies, including AMR and Rural Metro, have all settled fraud claims out of court for MILLIONS of dollars, yet they keep doing it. Why? Because fraud is big business. In the meantime, they tell the employees that they can replace you tomorrow. Why? Because the kids coming out of school still think the business is all about saving lives.
Nathan Stanaway Nathan Stanaway Sunday, August 25, 2013 3:51:34 PM Im excited that this issue is gaining more and more attention. I enjoyed your article! I have to also agree with Charles's point. One cannot expect high quality applicants who are looking to EMS as a long term career option when wages are inconsistent with that. It is a complicated issue that I think a good degree level education would do wonders to address.
Bob Sullivan Bob Sullivan Monday, August 26, 2013 6:34:30 PM Well said, David. The company covering my home town went on strike recently. I've moved twice in search of greener EMS pastures because I thought I was worth more then $10. an hour, and my family deserved me to be home instead of working 70 hours a week. Winning a 3% raise or an extra $50 a month towards health insurance comes at a huge cost after a strike. Patients may die and public support for underpaid people. I believe that ff more people left these low paying services or refused to work overtime, the law of supply and demand would negate the need for strikes.

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