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Fair exchange: 10 things your agency should be paying for

EMS agencies can spread goodwill by compensating providers for the extras, from skills enhancement to personal medical equipment


Almost every non-exempt EMS employee earns a paycheck based on two things: time and expertise.

Photo/Wikimedia Commons

To all you hardworking paramedics and EMTs out there: What are you getting paid for? Patient care? Nope. Public health? Not even close. Transports? Unless you get paid by the mile, no.

Almost every non-exempt EMS employee earns a paycheck based on two things: time and expertise. They usually go together, as in expertise applied over a period of time. Once I accept an hourly wage to provide paramedic-level care, that should cover most of what I do for my employer.

But what if I incur job-related expenses? Is it fair for me to expect reimbursement? And what about constructive, non-clinical uses of my time – skills enhancement, housekeeping, public relations, administration – that benefit the company, but aren’t even in my job description? Should I be compensated for those contributions, or are they just part of being a good employee?

To answer those questions, let me begin by telling you about one EMS agency I worked for. I’ll call it HappyCare.

Doing more, earning less

On my first day at HappyCare, a guy in a suit assured me that as long as I took good care of our customers (my patients), I’d be a cherished part of the HappyCare family and could count on the deep, multi-faceted resources of the parent company for support.

Things didn’t work out that way. Although my years at HappyCare weren’t unpleasant, there were many instances when I had to extend myself well beyond my official duties to meet the needs of various managers. I got paid nothing extra for those accommodations. To put it another way, by donating a portion of my time and expertise to HappyCare, I lowered my effective hourly wage while adding to my agency’s profit. That didn’t seem fair.

I do believe in cooperation, and think business works best when there’s flexibility on all sides, but there’s also a need for demonstrable balance – a kind of unwritten contract between employer and employee that says, “You do for me and I’ll do for you.” I did not sense such synergy at HappyCare.

Extras worth asking for

I mention my HappyCare experience as an example of why rank-and-file employees can get a little defensive about unrewarded extra effort. We seek more than words to cement mutually beneficial relationships. One way management can show good faith is by covering more of our costs. Here are 10 things your agency should be paying for:

  1. Recertification. At its most elementary level, we’re talking less than $200 per employee every 2-3 years. Adding reimbursement for alphabet courses and other CME would be nice, but might be too expensive for small agencies. Cost sharing is an option.
  2. Uniforms and laundering. Off-the-rack shirts, pants, shoes and outerwear should be a given. Tailoring is optional. Laundering is not.
  3. Industry publications. Subscriptions are cheap, if not free.
  4. Personal protective equipment. Risks vary by region. Not every EMS provider needs a ballistic vest, but picking up the tab to protect employees from foreseeable harm should be non-negotiable.
  5. Personal medical equipment. Go ahead, be the first boss on your block to pay for duty belts, holsters and real stethoscopes (not the toys packaged with other cheap buff stuff).
  6. Skills enhancement. The focus should be on supplementing training to improve workers’ capabilities in their current positions; for example, a paramedic who passes a critical-care course. It’s fair for employers to expect immediate returns on those investments.
  7. On-site, non-clinical activities or expertise. Employees called in for meetings, training and any other mandated activities should be paid for their time.
  8. Incidental travel. A per-mile allowance should accompany use of personal vehicles for company business, other than commuting to and from work. IRS guidelines are a good place to start.
  9. Community outreach, public relations and recruiting. Before pressuring hourly personnel to volunteer their time checking blood pressures at a shopping mall, managers should ask themselves if they’d give back prorated salary to do the same.
  10. Workplace safety and security. Unsecure facilities, beat-up ambulances and ergonomically unsound equipment make employees feel expendable.

Most of the above is merely payback for professional time and out-of-pocket business expenses, including just about anything that enhances performance of workers in their current jobs. That’s the norm in many industries. Yes, reimbursements carry an administrative burden, but much less of one than, say, processing thousands of PCRs annually. Plus, goodwill tends to bounce right back at you.

Employers don’t have to do any of this. Maybe margins are so thin, there’s no room for extras. Or, perhaps, corporate priorities channel discretionary funds in other directions. HappyCare, for example, covered only two of the 10 items I listed.

By the way, they don’t provide EMS anymore.

What other things should your agency pay for? Add your comments below.

Mike Rubin is a paramedic in Nashville, Tennessee. A former faculty member at Stony Brook University, Mike has logged 28 years in EMS after 18 in the corporate world as an engineer, manager and consultant. He created the EMS version of Trivial Pursuit and produced Down Time, a collection of rescue-oriented rock and pop tunes. Contact him at