I guess it's
a testament to Facebook's ingenious targeted advertising, but I am bombarded by
ads from various online schools offering to help me 'earn my RN in just a few months'. I'm sure I'm not the only
one in my circle of friends who receives this kind of thing in their ad strip.
I don't
typically pay it much attention, but a while back I was in the company of a
British Paramedic and was showing him some pictures on my Facebook when he
remarked about the ads in question. "Why would a Paramedic become a
Nurse?" he asked. A fair question.
For the
answer, one needn't look much further than the ads themselves. 'Increase your salary by 15% in as little as
12 months' is one of the recurring sales pitches.
I explained
to him that a newly minted RN, straight out of nursing school stands to earn 30-50%
more than a newly minted Paramedic, and that the Paramedic will start to
plateau after 15 years while the RN continues to creep up gently. This is a
generalization, but it's true on a macro level.
What I have
discovered throughout my experience of working all over the world, with
Paramedics from Singapore, the UK, Canada, South Africa, Australia and New
Zealand, is that this is almost exclusively an American phenomenon. In fact, in
multiple cases, including the case of my current co-worker Terrence
(Australian) I am seeing people who used to be Nurses and are NOW Paramedics -
a transition practically unheard of in the U.S., and for good reason . . . pay.
But why is
the American paradigm so starkly out of step with the rest of the world? What
is the factor that makes a newly minted RN more valuable than a newly minted
Paramedic?
Before I
tackle this question I want to be clear on something. I have zero disrespect
for the nursing profession.
None at all.
I have many
friends, some of whom will undoubtedly read these words who are Nurses. Some
that I've worked with in critical care transport, some I know through spending
too much time in emergency rooms and some are friends from my childhood who I
learned years later (thanks to Facebook)
went on to become Nurses.
I give this
long-winded qualification because when I've been proximate to this discussion
in the past, I've heard a few explanations from Nurses that are incorrect. I
want to address the incorrect-ness without appearing bitter or flippant.
To the
question "Why do Nurses make more?" I've heard:
"It's because we're
licensed."
. . . It's not because of licensure.
"It's because we're 'educated' as
opposed to 'trained'."
. . . This is a
fallacy, but even if it were true, it wouldn't explain anything about
pay. At the end of the day, the amount anyone gets paid comes down to a
basic question of supply and demand. This is true of everyone
from the janitorial staff to the CEO.
The CEO is
not paid more because he/she has a PhD or MD or whatever . . . pay is not a
reward for hard work or intelligence. The CEO is paid well because there aren’t
many people who possess the qualifications and experience necessary to do that
job effectively (low supply).
The
janitorial staff is paid poorly because the necessary qualifications to do that
job effectively do not exist. Therefore the vacancies are easier to fill;
therefore there is no need to pay more (high supply). If you go to monster.com
or careerbuilder.com or any of those sites and type in "Nurse", stand
back and watch the mountain of vacancies come rolling in. Type in
"Paramedic" and you needn't stand back. Your search results will likely
be far fewer and will be laden with lots of RN vacancies, but whose description
includes the word "Paramedic" somewhere in the text. Filter those out
and you may have a few dozen jobs nationally.
Simply put,
the demand for Nurses is just a whole lot higher. Why is that?
It all comes
down to billing.
If you're a
hospital or smaller medical center and you want to be able to bill
medicare/medicaid (and hence the rest of the health insurance industry) you
have to be accredited. The Joint Commission (JCAHO) pays close attention to
Nurse-Patient ratios and can close a hospital's doors if they don't have the
requisite number of duly qualified Nurses.
Consider
also, the multitude of different specialties that the newly minted RN can
gravitate towards and become an expert in. Then consider all the career paths
for Nurses who want to get out of the clinical setting; informatics, case
management, public health, on and on . . . So not only do you need nurses, you
need specialized nurses in many areas.
Has anyone
ever heard of JCAHO threatening to close a hospital because there weren't
enough Paramedics? Of course not. JCAHO would scarcely notice such a thing. So
if the bulk of the medical industry cannot utilize a Paramedic in a patient
care capacity, while still maintaining the type of staffing necessary to be
accredited - demand will be low. If there is no career ladder, and no clear
avenue into some "specialized" form of Paramedicine, the Paramedic
just stays put and hopes to hang in long enough to get promoted into a position
that won't destroy their back, knees and sanity. Sounds promising and
rewarding, right?
In any given
locality there are usually a scant handful of employers looking for Paramedics.
Back home I can think of three agencies in a 100-mile radius; three potential
places to ply your trade in a population center of about 300,000 people.
In North
Carolina, the Office of EMS says a Paramedic can only work for a legally
chartered EMS service under an approved medical director. Doctor’s offices,
clinics, urgent care facilities and the like couldn't hire a Paramedic - even
if by some miracle, the idea occurred to them in the first place. The law
limits our options by relegating us to one task - emergency response; which
according to medicare, is of no value at all unless we transport. What good
could we possibly do in a living room, right? What problems could a bunch of
ambulance drivers solve all by themselves? How could such services possibly be
billable?
And that's
the box we find ourselves in, literally and figuratively. It is the confinement
of role and the resulting lack of demand that constrains pay. There is no other
explanation.
Once you
leave the domestic setting and enter the international arena as I have, you
enter a whole new scale of demand. When you look at all of the governments,
NGOs, mining companies, seismic exploration companies, shipping lines and the
like, you have a pool of employers who have long been aware of the value of the
Paramedic skill set and are happy to pay a whole lot more for it than your
local ambulance company or fire department.
Right now,
in Queensland and Western Australia, Paramedics are
commanding $700 to $1300 per day in the mining sector, depending on additional
qualifications and experience. I'm not kidding.
For these
employers, a Nursing credential is a nice adornment, but it is seldom if ever
requested, let alone required. Since you are outside the confines of your home
jurisdiction, the legal significance of licensure is null. The employer's
insurance carrier is interested in the verifiable skill set of the provider
only. The legitimately credentialed and experienced Paramedic, with augmented
training in primary / occupational health and advanced trauma modalities has
that skill set.
But I did
not start writing this to bang the drum of remote duty paramedicine, and I did
not start writing this to throw down the gauntlet of spite before the throngs
of Nurses out there (whom I love . . . honest!)
I started
writing this note because these little Facebook ads are indicative of a tremendous
problem that appears to be unique to the American healthcare system. The
problem is this:
We have - in
the Paramedic, a wealth of capability and skill that translates into a public
health jackpot. A medical bargain of the century! And yet, because of the
narrow, antiquated thinking of the agencies responsible for accreditation and
compensation - we have been deemed utterly worthless, unless of course we drive
someone to a hospital, where the real professionals are located . . .
It is this
confinement of our role that suppresses our compensation and it's our tepid
compensation that makes us want to jump ship and become Nurses!!!!
If you're an
American Paramedic and you're reading this, ask yourself: Have you ever
considered the jump to nursing? Do you know anyone who has made the jump? Did any
of them do it for any reason other than:
a.) Pay
or
b.) "I'm
getting too old for this shit" . .?
Did any of
them do it because they felt they were legitimately improving themselves personally?
We all know the answer. So what does that tell us?
It tells us
that the international community is light years ahead of the United States of
America when it comes to valuing and utilizing the public health resource that
is the Paramedic. I contend that the country with the most expensive and least
comprehensive health care system in the civilized world has no excuse for
undervaluing or underutilizing ANY health resource.
No comments:
Post a Comment