EMS: Calling, Job, or Prison Sentence?


Thanks to our good friends at ACEP, More Than a Job. A Calling is the theme of this year’s EMS week.  For me it started with Roy and Johnny, then Rescue 911, police scanners, and chasing ambulances on my bike.  My reservation about getting into EMS was whether I could do it, and then whether I wanted to live at the poverty line, not whether I wanted to do it.

I’ve been so lucky.  After 13 years I still enjoy different challenges each day I go to work, connecting with patients, and helping people feel better.  There’s no other work I would find as fulfilling, or that I would as good at as a paramedic. There’s a dark side to this calling, however, that probably won’t be mentioned at the barbecues next week.

EMS work starts out being fun, even more fun than non-EMS hobbies. There’s always an open shift out there that needs to be filled, too.  Why sleep at home when you can get paid to be at a slow station?  And you had nothing important to do the next day, so it’s no problem staying over when your relief calls off.

As Thom Dick wrote in his excellent book People Care:

EMS is a wonderful thing to devote your life to.  But it can become an addiction, and there’s no such thing as a good addiction… EMS will take everything you have to give, chew you up and spit you out, and then come asking for more.”

Pretty soon mortgages and car payments depend on you working 80 hours each week. When your marriage is falling apart, it seems much easier to manage other people’s short-term problems than your long-term ones.  And that’s fine with the people who need those shifts filled.

But then those slow stations get busier, and running all night is much easier when you’re 25 than when you’re 40.  There’s no time to sleep, exercise, or spend time with non-EMS people – such as your family.  EMS isn’t so fun anymore, especially when patients smell bad and don’t meet your definition of an emergency.  The calling seems more like a job now, only working overtime is no longer a choice.

The calls just seem to run together, and getting them over quickly seems more important than providing good care.  You don’t want to be there and your patients know it.  When you’re worried about working an extra shift to pay your mortgage, becoming a better caregiver and advocating to make EMS a profession isn’t on the radar.  It seems impossible to change careers, and that job seems like a prison sentence now.

EMS is a calling, but it takes work to keep it that way.  Start by reading People Care.  Resist the temptation to make it your life.  If your employer pays less than a living wage, leave and work for someone who does. Building a lifestyle around 80-hour work weeks is unsustainable, and it is not your responsibility to fill every open shift.

If you’re already in the EMS prison, you need to break out.  You’re killing yourself, hurting your family, unhelpful for your patients, and dragging the rest of us down.  Here are some suggestions on how to start.  After People Care, do a Dave Ramsey Total Money Makeover.  In the process, get yourself well.  If there’s no time for the gym, Bryan Fass has tips for EMS people to stay healthy.  A therapist may help with healing strained relationships, re-discovering the EMS calling, or finding fulfillment in something else.

EMS is a calling, but if we’re not careful it becomes a job we hate.

 

 

Comments

  1. So true, and I think other helping professions are susceptible to this as well. It’s all about setting limits- with ourselves, with others, and around our families.

  2. Paul Bazzoli says:

    So true. It seems that is where I am now after 21 years as a medic, 30 years as a BLS provider and at the age of 50. It is time to move on.
    Paul

    • emspatientperspective says:

      Sorry to hear that Paul, but I understand. Nursing, law enforcement, and the fire service seem to have diverse career opportunities down more than we do. I’m hoping to be part of making EMS more like those professions.

  3. Paul Bazzoli says:

    So true. It seems that is where I am now after 21 years as a medic, 30 years as a BLS provider and at the age of 50. It is time to move on.
    Paul

  4. Skip Kirkwood says:

    It is entirely possible to get in too deep. We need to pay a lot of attention to emotional health, emotional maturity, and a reasonable perspective on life.

    One thing that we don’t do very well in EMS is “take care of each other.” And we perversely value “dedication” – as witnessed by being supportive of someone who has 3 EMS jobs and volunteers at 4 different places. Could be not a sign of mental health – somebody ought to say something, but rarely will anyone speak up.

    • emspatientperspective says:

      After paying more attention to the quality of care delivered by the zombies in the seats, I’m afraid the next step is to put trucks out of service. If EMS providers were restricted to a 50, maybe even 60 hour work week, people would have to wait an awfully long time for ambulances. Then the public might get mad enough to change this. I certainly hope a rule like this is not prompted by a tragedy.

  5. Skip Kirkwood says:

    …..If EMS providers were restricted to a 50, maybe even 60 hour work week, people would have to wait an awfully long time for ambulances…..

    No….if EMS providers would restrict THEMSELVES to 50-60 hours per week, and stop working for free, salaries would rise to attract more people to staff those ambulances. The citizens wouldn’t stand still for “awfully long time” – changes would occur, if EMS providers themselves would stop serving as barriers to those changes!

  6. ” If your employer pays less than a living wage, leave and work for someone who does. Building a lifestyle around 80-hour work weeks is unsustainable, and it is not your responsibility to fill every open shift.”

    Bob, I agree completely. Too many good EMS personnel work themselves into burnout. I try to remind people that they NEED time away from the job, in order to be rested and reduce stress. I wish more employers would pay a living wage (usually pay is similar across the region), but if people keep accepting jobs at $14/hr then there is no reason for the employer to offer a higher wage. Unfortunately we can’t all go work for Skip, especially if the state is not a national registry state.

    • emspatientperspective says:

      Thanks Joel. I made almost minimum wage at my first job as an EMT (but you can make lots more with overtime, they told me), and now I make enough to have a comfortable middle class lifestyle. Sometimes I work extra, but I don’t have to. What’s interesting is that people seem to work just as much at my high paying EMS job than at the low-paying ones I’ve had, which makes me wonder if the money is an excuse for a bigger problem.
      BTW, email me if your interested in learning more about where I work now.

  7. Skip Kirkwood says:

    My organization doesn’t pay significantly better (or worse) than other agencies in the region. We’re rarely (if ever) the highest in the region. But we offer a good place to work, where the focus is on medicine, and where we appreciate our people.

    What do people consider a living wage? EMTs $25-40K, paramedics $34-55K, plus retirement and a 5% 401k. Not much higher than $14/hour to start. I see EMTs and paramedics able to buy houses and nice rides, which apparently is living. Now I understand that if you are entry-level with 4 kids, things could get a little tight. But those are choices. The scales are all here: http://www.wakegov.com/employment/countyjobs/classification.htm

    The reason that salaries and benefits are comparable in this region (much of the state) is that we have pretty good-sized county EMS organizations, because by state law counties are responsible for providing EMS.

    THAT is a goal that everyone could work toward. When EMS is a mandatory service, then EMS folks can get organized and shape a system that utilizes career personnel, provides a career path, etc. But that means working together, and historically we have been unwilling to do that. Maybe it will change sometime soon?

    • emspatientperspective says:

      Amen about working together. In my area there are two dozen BLS ambulance empires. People go from one to another with no time off in between hoping to sleep at work. This perpetuates the non-stop work culture we’ve developed. Ambulances I’m in the back of are often driven by zombies, and this is sited as a safety concern in the state EMS report every year. Stil, there’s a strong incentive for the kings of each empire to keep it this way, to the detriment of patient care and moving forward as a profession.

  8. Been on the ambulance 9 years. working 70hours every week to scrape by, zombie to my family on my days off and never having enough free time ot money to enjoy anything. I’m done, 24s get old and I’m hating the career I once loved more then anything

    • emspatientperspective says:

      I’m sorry to hear about your situation. Working nights and fatigue on my days off contributed to my decision to teach full-time. Sean Eddy from Medic Madness has a series with advice on how to break the cycle you describe. He’s been in a situation like yours and has done it.

Trackbacks

  1. […] Bob Sullivan over at The EMS Patient Perspective also had some thoughts in his post, EMS: Calling, Job, or Prison Sentence? […]

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