Austin Travis County EMS hiring Paramedics and paying them as Basics

[RocketMedic]

We have a Keurig at every station.

Glorious.

 

[DrParasite]

I will also point out, a "problem child" is a very subjective description. I have been labeled a "problem child" by some of my past employers. For things like "not driving fast enough in the fog" or " not sounding panicked enough on the radio." I was even a "problem child" for pointing out that the billing practices at one agency might actually be medicare fraud. (only a few years after I left they "settled" the matter out of court)

Ever interviewed for a supervisory position? I did several years ago, and told how I wanted our company to be better and gave specific examples, and I didn't get the job. I was later told that they wanted someone who had their head in the sand, thought the agency was the best ever and people were lucky to be working there, and management's policies were perfect. Suffice it to say, I didn't get the job there.

a problem child is someone who speaks up when something is wrong, tries to makes a situation better, gets educated outside of their agency and tries to bring it back to raise standards, points out potential legal issues that management might not see (or might not want to see), and anyone who interrupts the status quo, or who doesn't drink the koolaid and thinks that the bosses are imperfect and will point out when they are wrong. personally, I consider it to be a good thing, as when everyone says the same thing there is no chance for progress in an organization.

 

[RocketMedic]

However, many agencies have low "problem children" tolerances and accept mediocrity as the standard- something I'm running into.

 

[NomadicMedic]

And many EMS agencies have supervisory staff with no management experience or training... And people who may just be ENTP are deemed "trouble children".

 

[Veneficus]

However, many agencies have low "problem children" tolerances and accept mediocrity as the standard- something I'm running into.

There is nothing that the incapable and mediocre resent more than a champion.

It is everything they will never be.

 

[46Young]

To be fair, $15/hr on a 48 hour/week work schedule is actually decent money for a medic in most places outside of expensive population centers such as LA and NY. This is compared to most other EMS systems, which typically pay from $30k/yr to $35k/yr for medics, and it's a 56 hour/week schedule, not 48. ATC-EMS is basically offering $40k/yr @ $15/hr. Not great, but better than a lot of places, particularly in the Southeastern U.S.

Many places do not pay for experience, but experience may give a hiring preference. In CCEMS (SC), they offered $38k/yr to start, up to $45k/yr after making Crew Chief, with a top of $68k/yr after ten years or so, for medics. That was basically $11.50/hr base, on a 56 hour schedule. I mis-understood the person interviewing me in that they had 12's and 24's, and a 48 hour schedule was mentioned. I thought it was a 48 hour schedule regardless if 12 hour or 24 hour shift, but I was wrong. I was naive in that the only systems I've worked previously were 40 hour places. I didn't know this was a 24/48 with no Kelly's type of place. I was burnt out in only three months with the 12-24 hour holdovers and busy call volume.

If CCEMS paid their medics $15/hr to start, I would have been making $50k/yr instead of $38k/yr. The sad thing is that they were the best paying third service municipal EMS provider in the region, so $15/yr at ATC-EMS doesn't seem so bad in comparison. I just hope that they have regular step increases, so that they're not stuck at $15/hr for more than a year if they can't promote.

 

[46Young]

Some questions about ATC-EMS out of curiosity:

What is the service requirement (how many years) for the defined benefits retirement? For example, is it 25/55? Does there have to be an addition of age to years of service?

What is the percentage multiplier for the pension benefit? For example, CCEMs only offered 1.8% @ 28 years of service, which only gives you a 50% yearly benefit.

Is your medical premium paid by the employer after your retirement, or do you have to pay the premium 100%? Is your medical insurance portable?

What are the bottom and top salaries for each position, and how many years does it take to reach that top pay?

Do you have a DROP (TERI in SC)? I've heard Houston fire has a ten year drop @ 20 years of service.

How much do you pay in bi-weekly medical premiums, and are there deductibles?

How many light duty positions are available for the injured and pregnant?

How many different positions are there for non -supervisory employees that do not involve field EMS transport?

How many supervisor positions are there in your organization, and what is your total headcount for the organization?

What criteria are used to fufill or deny leave requests?

What is your policy on mandatory recall and holdover? Also, if the employee has travel plans on their days off (plane tickets, hotel reservations, etc), can they be held or recalled?

Are CEU's given on duty, are they given off duty but mandated and compensated for, or are your employees on their own?

Are units automatically placed in-service as soon as they arrive at the hospital, or are they permitted to finish their report before having to go back in-service?

Is there a policy in place that lets an employee use their leave to go home during the overnight hours of their shift (or the next day if held over) if they feel they are too tired to drive or give pt care?

 

[46Young]

Hey, do you know what I just realized? If you work a 48 hour schedule (two 24's/week), you'll work 30 forty-hour work "years" after 25 calendar years.

If you work a 56 hour schedule (like I do, a 24/24/24/24/24/96, or a 24/48), you'll work 35 forty-hour work years.

This is why I would never work a 56 hour schedule for much less money than I currently do. Sure, technically you get to sleep at night, exercise for an hour or two a day and take classes online of you want, but you're still away from home for 1/3 of your work-life

 

[ExpatMedic0]

AMR starts brand new paramedics with out experience at about $40,000 a year in Portland with no OT. I know guys in that system who do work a good amount of OT and pull 80,000.
So no, the ATC 15 bucks an hour wage for a paramedic is not so great. Portland's cost of living is not very high and I made 15 an hour an EMT there before I was even a Paramedic.
if you google McDonalds assistant manager, they make 15 bucks an hour in most places, which comes out to around 29k with no OT

 

[Veneficus]

I think something that needs to be remembered is EMS is still a vocation.

Some municipalities pay a rate considerably inflated compared to the private sector. (Excellent for employees, don't get me wrong, but it is still like hitting the job lottery to get that)

If you look at the lateral and upward advancement of other vocational jobs, it is basically nothing.

Afterall, what is the lateral transfer for a welder or carpenter?

What is the promotion? Site manager? Forman?

Many of these vocations do have a higher salary compared to EMS. Look at waste disposal.

Looking back, I would have taken that job over EMT anyday. Would have earned 2-3 times the salary even before benefits.

Unless you get hired in a stellar position like 46young, there simply is no future in EMS other than poverty. The self sacrifice maybe altruistic, but it certainly isn't going to give you much more than self satisfaction or a disability claim.

 

[46Young]

AMR starts brand new paramedics with out experience at about $40,000 a year in Portland with no OT. I know guys in that system who do work a good amount of OT and pull 80,000.
So no, the ATC 15 bucks an hour wage for a paramedic is not so great. Portland's cost of living is not very high and I made 15 an hour an EMT there before I was even a Paramedic.
if you google McDonalds assistant manager, they make 15 bucks an hour in most places, which comes out to around 29k with no OT

You might be right. I did some calculations:

Let's say that ATC was a 40 hour/week employer. The same goes for Portland AMR. ATC pays $15/hr, or $31,200. AMR pays $20/hr, or $41,600. Assume that ATC pays a 50% pension @ 25 years of service, a benefit of $15,600/yr. AMR has a 401k, but for the sake of argument, we'll assume that there's no employer match. We'll also assume that ATC does not require an employee contribution to the pension fund.

The difference in yearly salary is $10,400. If the AMR employee invests this sum every year, starting at year two have to earn the money first), they would need to amass $313k over the 25 years, that will give 5% interest, to match the pension benefit without touching the principal. To achieve this, the AMR employee simply needs to earn an annualized return of 1.8% over that term!

Now, the true yearly salary for ATC @ $15/hr on a 48 hour schedule is $40,560/yr. 50% of that as a pension is $20,280. The AMR employee needs to build up $406,000 over the same 25 years. The annual return needs to be only 3.66%, still easily doable.

So, $20/hr at a 40 hour employer with only a 401k without employer match easily trumps $15/hr plus 8 hours of built in OT assuming 50% @ 25 years.

I guess $15/hr isn't so great after all.

Another important lesson her is if you have the choice of a pension employer, and a non-pension employer that pays 33% more, you'll be able to build a much better retirement, given that you invest the entire difference in pay with deferred comp. Even 25% more should be sufficient, I think.

 

[RocketMedic]

There is nothing that the incapable and mediocre resent more than a champion.

It is everything they will never be.

This pretty much sums up today.

"Why are we responding code-3 to a known stable patient?"

"RESPONSE TIMES! EVERY CALL IS AN EMERGENCY AND DESERVES AN EMERGENT RESPONSE!"

"But you can literally get there in less than five minutes by following the normal flow of traffic."

"THEY ARE AN EMERGENCY! WE HAVE TO RESPOND EMERGENT!"

-Later-

"What emergent calls wouldn't you run hot to?"

"Lots of things- everything triaged as an Alpha-level call, falls for lift assists..."

"WE HAVE TO RUN HOT TO ALL OF THOSE! THEY'RE LIFE-THREATENING EMERGENCIES!"

Luckily, this isn't from a veteran medic, but it still underscores the point.

Yep. That sort of day.

 

[Fish]

(Most services with RSI probably shouldn't be doing it, including almost every service in TX.

Why do you not think services with RSI should be doing it?

 

[usalsfyre]

I could make broad, sweeping statements about medical students, but don't. Agree there are a lot if places that don't need to do RSI. Singling out one state that you haven't seen success rates on is a pretty clown move.

 

[Veneficus]

I could make broad, sweeping statements about medical students

and you would probably be right.

(I am not entering the RSI debate)

 

[medicsb]

Why do you not think services with RSI should be doing it?

I tend to think that paramedicine (and medicine, in general) requires education (didactic), training (hands on, overseen by an "expert"), and frequent experience to be proficient. Usually, in EMS, one (or 2) of those is deficient. Considering that most EMS systems with RSI do not restrict its practice to a small number of intubators, I am not confident that paramedics, even with great education and training, are able to become experienced enough to be proficient at the skill of intubation. I can only think of 2 studies where RSI was shown to be not harmful. One was a weak retrospective study and the other was a strong RCT that showed benefit by the skin of their teeth. Both of the paramedic populations/EMS systems studied were not in any way representative of the typical medic or EMS system in the US, particularly since one was performed in Australia.

Basically the potential for harm is greater than the potential for benefit given how the majority of EMS systems are set up in the US. I'd say this applies to ETI in general and not RSI, specifically.

Nothing I have read shows Texas services to be any different than the typical EMS service in the US (other than geography), despite what anyone from TX would like to say. Don't get me wrong, I'm totally open to the possibility of some of these services being as good as some would like to think. And, I do think there are some services that seem pretty good from what I have read.

Also, usalsfyre, pretty please show me the data. I've already checked pubmed, and there's nothing there. I'll accept abstracts for unpublished studies and yearly reports or ppt presentation by a representative of a service. I might even accept something on a website.

PS: I'd agree that broad, sweeping statements about medical students are probably true.

 

[usalsfyre]

Medicsb, I'm actually going to retract my earlier statement and say after thinking...your right. Part of the problem in the US is it's thought of as a "system skill" when in reality it needs to be an individual skill. I still disagree that it's useless in field (EBM hasn't ever looked at it outside of urban/suburban areas to my knowledge) but will agree it's overdone.

That said, you've still not offered a convincing reason for singling out Texas.

 

[medicsb]

I still disagree that it's useless in field (EBM hasn't ever looked at it outside of urban/suburban areas to my knowledge) but will agree it's overdone.

That said, you've still not offered a convincing reason for singling out Texas.

I don't think it is without potential use, I think that the average medic does not intubate enough for the benefits to outweigh the risks. The only systems that showed benefit from the procedure were systems with a small number of intubators, thus much much more frequent experience. Any system that is all-ALS should not allow RSI for every medic (as was done for the San Diego RSI study). Anyhow, we may have to agree to disagree or make another thread.

Anyhow, about my Texas remark...
What I said was in response to the criticisms of ATCEMS and the citation of another service (WilCO) as being better and more progressive, which seems to occur with any discussion of any well-known EMS system in TX ...

My remark was pointing out that RSI probably shouldn't be done anywhere in the US, even including these vaguely great, "progressive" services in TX since this discussion was mostly in regards to TX.

 

[Fish]

I don't think it is without potential use, I think that the average medic does not intubate enough for the benefits to outweigh the risks. The only systems that showed benefit from the procedure were systems with a small number of intubators, thus much much more frequent experience. Any system that is all-ALS should not allow RSI for every medic (as was done for the San Diego RSI study). Anyhow, we may have to agree to disagree or make another thread.

Anyhow, about my Texas remark...
What I said was in response to the criticisms of ATCEMS and the citation of another service (WilCO) as being better and more progressive, which seems to occur with any discussion of any well-known EMS system in TX ...

My remark was pointing out that RSI probably shouldn't be done anywhere in the US, even including these vaguely great, "progressive" services in TX since this discussion was mostly in regards to TX.

You think that because Wilco is an all ALS system they are causing more harm than good with RSI and should not be performing it? Just want to be sure what harm over good you are referring to, I know that in the San Diego study the system showed a large amount of time without ventilation and left their patient's hypoxic for a lengthy time.

 

[marshmallow22]

You might be right. I did some calculations:

Let's say that ATC was a 40 hour/week employer. The same goes for Portland AMR. ATC pays $15/hr, or $31,200. AMR pays $20/hr, or $41,600. Assume that ATC pays a 50% pension @ 25 years of service, a benefit of $15,600/yr. AMR has a 401k, but for the sake of argument, we'll assume that there's no employer match. We'll also assume that ATC does not require an employee contribution to the pension fund.

The difference in yearly salary is $10,400. If the AMR employee invests this sum every year, starting at year two have to earn the money first), they would need to amass $313k over the 25 years, that will give 5% interest, to match the pension benefit without touching the principal. To achieve this, the AMR employee simply needs to earn an annualized return of 1.8% over that term!

Now, the true yearly salary for ATC @ $15/hr on a 48 hour schedule is $40,560/yr. 50% of that as a pension is $20,280. The AMR employee needs to build up $406,000 over the same 25 years. The annual return needs to be only 3.66%, still easily doable.

So, $20/hr at a 40 hour employer with only a 401k without employer match easily trumps $15/hr plus 8 hours of built in OT assuming 50% @ 25 years.

I guess $15/hr isn't so great after all.

Another important lesson her is if you have the choice of a pension employer, and a non-pension employer that pays 33% more, you'll be able to build a much better retirement, given that you invest the entire difference in pay with deferred comp. Even 25% more should be sufficient, I think.

Thanks for ALL of your assumptions about a system that you do not even work for. I had a good laugh. I can't believe that you would actually compare a metropolitan city, civil service, 3rd service provider to a private ambulance. Say what you want, but ATCEMS is here to stay, and not only that, but will continue to get bigger. Oh, and we also have medics making 100k +. How many times has AMR changed hands over the years, lost contracts to the fire department, or have even sold out their own employees to cut a deal with fire departments? Yeah, rather have the $15/hr job and not have to worry about private ambulance antics.