Show me the Money

Friend of the blog Bill Carey posted on Facebook wondering why so many in EMS think that salary is the one thing holding us back.

Curious, question for EMS folks on FB: It appears, based on comments to various news stories in the past, that the greatest solution to all that ills EMS is greater pay. Respect is restored, working conditions and staffing improve and the general idea of professionalism is better. Fire-based, hospital-based, third service, doesn’t matter, just pay us more and the service will get better.

No, not really.

The same issues I had when I got the paid gig for $4.35/hr are here at my current gig where medics average $65,000 to start (according to

EMS in general is paid what the market allows and what we are worth.  Keep in mind that EMS does not require a degree and Paramedics can get licensed in as little as 1 year in some places.  If some kid walked into my office and told me he went to school for something for a year my first question would be “When are you going back to finish?”

Pay is a result of our goals, not our goal.

Increasing our education standards and proving our worth to the industry is step number one.  But of course the stumbling block to education is how to pay for it.

If you think the reason you are not treated like a Professional is the size of your paycheck I think I know where your priorities are.  If your first concern is that you don’t have access to enough education I’ll ask where you live and why you’re still there.

There are high paying EMS jobs out there, folks, I’ve had one for 10 years, but you have to be willing to put the effort into it.  No one is going to wander into the station or yard one day and say “You guys are great, here’s a raise.”  Your employer has no incentive to increase your compensation unless they desire a particular set of skills that bring that kind of salary.

EMTs are entry level and their compensation reflects it.

Paramedics have more responsibility and therefore more compensation.

A flight medic has even more responsibility, so more compensation.

A Firefighter/Paramedic has a different skills set, different compensation.


You get the salary you’re getting because that’s what you’re worth to your employer.  If you started off at $10 an hour, got your degree, teach on the side, and are still making $10 you need to talk to your employer about the increased value you can bring to the organization.  Maybe you’re in line for a promotion or reassignment with your increased education and experience.

It all comes back to education.  If you learn more, not only can you increase the care you can give to your patients, but you become a more responsible care giver and show your manager that you’re not just in the seat for a thrill, but to make a difference.  Folks like that make less errors, collect less complaints and are more likely to collect extensive billing and demographic information.

That makes you a keeper and worth more to them.  You increased your value.  That is the only way you will increase your compensation.


Let’s imagine that I’m wrong and simply snapping our fingers and giving you more money is the solution.

Now you make twice what you did yesterday.  Now what?  Now will you go back to school?  Teach?  Where is the added value we’re paying for?

The patients are the same, your rig is the same, your protocols haven’t changed and you haven’t changed.  There isn’t much we as EMTs and Paramedics can directly control but our own attitude and education are the easiest to improve in a short amount of time.

Just raising your pay won’t improve your attitude or the attitude of your co-workers.  It won’t help your manager see the worker bees from the cling ons and it surely won’t help your patients.

If you think you’re worth more to your organization than you’re being compensated, tell them, and get ready to pack.  The high paying jobs are out there, but you’ll likely be in a busier system and competing against higher education and higher motivated applicants for the extra money.


Case in point: me.

When I left my last job I was a Firefighter/Paramedic serving a suburban area working on both the Engine and Ambulance.  I was making just under $10 an hour on a 24 hour schedule.

When I got my degree in EMS and began teaching I knew I could reach out an look around for something better and have a good chance of landing it.

When I got hired in San Francisco as a Firefighter/Paramedic assigned to a 24 hour Ambulance I had tripled my salary.  Tripled.  But the cost of living was double and my old shifts of sleeping most nights turned into 32 run paramedic pinball sessions that I loved, but took their toll.

I moved 800 miles to get that gig and I have the broken down UHaul story to prove it.

You can get a high paying EMS job.  They exist, but you have to work for it.

What are you willing to do to prove your worth to EMS?


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6 thoughts on “Show me the Money”

  1. “If you think the reason you are not treated like a Professional is the size of your paycheck I think I know where your priorities are.”

    Thank you Justin.

    Basically as it applies to every job, paid and volunteer, if you are repeatedly bitchy about the nuisances of your tasks then you need to change your vocation or volunteer work.

  2. Right on target – hit the nail on the proverbial head.

    Another consideration – too many folks approach this discussion with one more misconception. They say something like “Pay me more and then I will learn more and do more.”

    Wrong! Not how it works. First, it is mostly not an individual thing – it’s a professional group thing. Just getting more education doesn’t move you forward. When the whole PROFESSION gets more education, it limits the supply of those professionals and salaries rise.

    Second – you don’t get the reward first and then do the work. You do the work (raise the bar, get the addition, move the whole profession to a higher standard), and THEN the higher compensation comes.

    If you don’t believe it, look at the histories of any of today’s recognized professions – nurses, physicians, physical therapists, etc. FIRST comes the increasing standards, THEN comes the additional rewards – money, respect, what have you.

  3. This is ridiculous. I spent ten years in EMS (with a BS in a STEM field) and finally went for a teaching position- to be beaten out by some firefighter who was able to get his online MS degree. After sucking down six figures with his fire department as a captain, AND mooching off the county community college system, he finally got the job that I wanted. One guy, not satisfied with one salary, now holding down three jobs. Reminds me of a medic I worked with who beat his kids because he didn’t get enough sleep, trying to work 80 hours of overtime every paycheck so he could afford his house payments.

    Anyone who thinks that EMS pay is merit-based is delusional, and needs to get out into the real world and see managers that can’t manage, medics that can’t medic, and overqualified EMTs with bachelor’s degrees- and often more- that fill a seat because the market is so crappy they can’t get jobs in what they spent years training for, and receive a salary that is but a fraction of what their equivalent in commerce and industry would be making.

    Meanwhile, we get more requirements piled on every year, with no commensurate salary differences. Corporate buy-outs locally have led to just one service for the entire metropolitan area. Go somewhere else? Sure- another state, maybe.

    Another crass reminder of the “I’ve-got-mine, so you must be stupid and lazy” mentality of the wealthy in this country.

    1. CJ,
      Sorry you missed out on the only teaching gig in town. My post was meant to remind folks that simply getting their degree or spending time in the field does not automatically warrant an increase in salary and benefits. It does make us more marketable and valuable.
      You mention this lazy firefighter holds down a 6 figure job, a gig at the community college AND swiped your teaching job.

      Was there something else to it?

      A lot of promotions in EMS are indeed political, I won’t turn a blind eye to that, but the key to your reply is near the end,
      “Another crass reminder of the “I’ve-got-mine, so you must be stupid and lazy” mentality of the wealthy in this country.”
      So because I worked my ass off, took a chance, went up against hundreds of others and got my dream gig that makes me an IGMer? I don’t think those who haven’t promoted or studied are lazy, I just think that those who don’t study, don’t go back to school, don’t want to promote and just want to keep their head down don’t deserve the salary they think they deserve.
      Want 100k as a medic, go and get it.
      You may indeed have to move states.

      The point of my post is that simply increasing your pay will not make things better. It’s more important to understand the role we play in our organizations. If the managers don’t get promoted on merit is that really a place you want to keep working?

      Thanks for reading,

  4. No one is going to wander into the station or yard one day and say “You guys are great, here’s a raise.”

    Isn’t that the whole point of a CBA, other than job protection? The Justins and the slugs all get the same pay.

  5. Bargaining for a raise is one thing – the CBA route cuts two ways, so those that think the union solution is a good one, today, takes their chances.

    I don’t hear too many people say, “I’ve got mine so you must be stupid.” When I hear that, it almost always comes from people on the other side of the transaction – they don’t have theirs, they feel entitled to something, they didn’t get it, so the guy who did must be a bad guy. There are plenty of legitimate distance-delivered degrees for which the recipients work their tails off – so let’s not assume that the firefighter in question didn’t earn what he won.

    Personally, I’ve found that mobility is one key to advancement. You can’t have everything, so the question is “What am I willing to trade for what I want.” EMS is geography based, and the trend (a good one, I think) is toward larger, more professional organizations – which increasingly offer more opportunities for more people.

    We have to be careful about “the anecdote of one.” Evidence-based doesn’t apply just to the clinical side of EMS…..

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