The problem with private EMS

So, I happened across a quote from Dr. Steven Nessen while watching the film Escape Fire: The Fight to Rescue American Healthcare.  “When medicine became a business then we lost our moral compass.”(1)

It had a large amount that wasn’t really all that completely believable, including some leanings toward witchcraft voodoo alternative medicine.  That aside, in regards to the current system of reimbursement, I think he hit the nail on the head.  And I think that private for profit EMS is one of the best examples of being guilty of it.  That is one of those things that I wish we could find a way to change.  But so long as private EMS exists, and is reimbursed only for transporting, they puppy mills medic schools will keep churning them out by the dozen and we’ll keep just following the dictate of “You call, we haul” rather than actually providing good medicine.

Maybe someday we’ll be allowed to adequately care for our patients by having the right education, experience, leadership, resources and payments.  Just maybe….



(1) Escape Fire: The Fight to Rescue American Healthcare. Dir. Susan Froemke and Matthew Heineman. Perf. Dr. Steven Nessen. 2012. Online. Web.


2 thoughts on “The problem with private EMS

  1. I’ve seen Escape Fire, and I won’t go into a long-winded discussion on the movie. But I will say this: if our healthcare system is so broken, why do people routinely travel from other first-world countries to America to receive their care? Does anyone really think an 85 year old woman can fall, break her hip, and have a hip replacement surgery performed all within 24 hours in Canada? In England? No. Single-payer systems have to ration their care. It is the very nature of the beast.

    Regarding your view of private EMS: for every criticism of any EMS model, there is an equal, and opposite criticism for the others. I would argue that private EMS services are superior to Fire-based, because you have medics who actually want to be medics, as opposed to those who are medics because they have to be.

    Private EMS services are motivated by profits, sure. Every private enterprise is motivated by profits. If you risk your time and money, you should be rewarded with profits.

    I’ve worked in all different types of services in my career, and I can honestly say that the private EMS model in which I work is the better model.

    But that’s just me.

    • Fair enough, but just as there are many people coming to America for care, there are plenty of people traveling to Europe or elsewhere for the care, perhaps not in the same numbers, but sizable enough to notice.

      And this is just anecdotal, but at least in my experience, I almost never have seen an elderly patient fall and break a hip with no critical complications actually receive surgery within 24 hours. And I’ve been in rural, suburban and urban areas with the same results, so I think that argument is probably more a regional one.

      I agree that no one system is perfect, but the push by municipalities lately is to go after the easy targets, which are the unionized groups, firefighters, teachers, etc. who make easy headlines and it’s just easier to cut from their budgets(sometimes absolutely the right thing to do, sometimes not) to right the ailing ship that is much of our economy at this time.

      I hate making broad generalizations even though I’m just as guilty of it as everyone, but your statement that fire based is flawed because you don’t have medics that want to be medics. I’ve seen more than one fire based EMS system where they want so much more to be medics than they do firefighters, it’s just that they also have to be firefighters.

      However, using your theory of medics wanting to be medics. Let’s face it, with the current reimbursement system, prehospital emergency/911 calls don’t have a great reimbursement percentage, especially when compared to interfacility calls. That being said, I challenge you to find someone that went to school to be a paramedic that wanted to do interfacility calls. I’m not saying that they can’t be good at it, or don’t enjoy interacting with people that way, but let’s face it, 90%+ of those calls don’t require a paramedic despite many systems sending them instead of someone who can babysit someone who needs nothing more than transport in less than a sitting position at best.

      I have no problem with private enterprise being rewarded with profits, in fact that’s the whole point and often done better than the government can do.

      I’ve worked in all different types of systems and seen some unique versions of each in my experience as well as my travels. That’s being said, I don’t think that, as they stand now, there’s one delivery model that is inherently better than the others.

      But that’s my two thoughts and really has no bearing on anything of any consequence other than ranting so that I stay lightly toasted and not fulled burned.

      Ah, catharsis.

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