Sunday, May 18, 2008

-The Interesting Art of Career Suicide

This post was not the original I planned on posting. I was going to comment on my somewhat childish penchant for what I refer to as "Le Sabotages" in my head. Lately this has consisted of me, while at a red light, stealthily opening the window the back of the ambulance, turning the fans in front on 'high', and passing all the gas I can muster before the light turns green. I then stealthily close the window, and then put on my concerned, good partner face when Red tells me she can't figure out why all of her patients smell like they're coming back from the 24 Hour All Bean Buffet.

That's what I was going to post on.

But instead Ambulance Driver's column at caught me eye and got the old gears turning. I want you guys to head over there can read the damn thing. Don't just skim it. I'll wait.

While I can't comment (except some light snark) on Le Drama ala Fire and EMS, I can comment on something I have had some experience with - his mention of for profit ambulance service, like AMR and Rural Metro.

Have you ever heard the saying "The Road to Hell is Paved with Good Intentions?"

Yeah, I know after that it's hard for me to convince you I can look at this at an objective point of view, and maybe I can't, but god dammit, I'm making the effort. It's really not that bad working for one of these companies, as long as I keep my thoughts locked in a box all day.

Companies like this, I feel, mostly started out as concerned efforts by community minded citizens that were concerned with their neighbors as much as they were with profit. But once they got their services up and running, the Companies, like any good capitalists should, began to look for ways to improve profit. My company is very fond of mentioning to us that if each unit got one less refusal per week, it would make a one or two million dollar impact in our bottom line. This money, they are then very quick to remind me, would then be available for things that us day laborers might like - raises, new equipment, and things of that ilk.

Well, one might say, that makes 'cents' (oh, MM, you so punny!). Why not motivate your workers to that end? It seems like a win win for everyone.

The thing is, I don't get refusals for funsies. I get them when I and the patient agree that said patient doesn't need to go to the hospital in the ambulance.

"Well, we understand that," says Company. "But how can you be sure that something isn't wrong with that patient, and the doctors could find it if you took the patient to a Hospital? (Hospital is always said with a near mythical quality- to get the same ring at home, I recommend you repeating 'hospital' to yourself in a reverent and hushed tone while making jazz hands). Besides, MM, you're not a doctor, LOLZ!"

That is correct companies, I am not a doctor. Very astute observation....although....Dr Medic March does have a wonderful lilt to it.

No, I am not a doctor. I am a medic. But I am a medic that you have trained to be able to assess for injuries and to look for the whole picture of this patient's emergency. I do not think this patient needs to go to the hospital. The patient agrees and is willing to sign away any right to legal recourse.

"But MM, our company survives on its profits LOLZ!"

And there is my sticking point. The line about finding something wrong with the patient I might have missed is just cover for that.

Somewhere along the line, patients became only cosmetic - all it seems we care about, sometimes, is that 3 inch by 8 inch flap of leather in the patient's back pocket.

My company introduced a way to track us though stats, telling us it would help develop us as medics and give us feedback about our performance-funny thing is, the categories are things like how many refusals we get, how often we make billing mistakes. There are about nine different categories and only one of them has anything to do with actual patient care - our time on scene with extremely sick/injured patients. The rest, variously, all have to do with how fast our reports get processed and whether we have collected insurance information.

If this was the end of the line, fine. But now, during raise time, the numbers come back out, and low and behold, some people didn't get a raise they deserved because of an arbitrary set of numbers a bean counter out back who's never had ANY Field experience decides we can squeeze a bit more money out of the system.

I wish, I wish, I wish, I could make my company put patient care and their medics in front of the profits.

Remember earlier, when they said the money we would make could be used for raises? In the two years of having this system, the only raise we've gotten was on to bring us to the minimums of industry standards and to comply with federal minimum wage law.

Oh, and the reason I've titled this entry "The Interesting Art of Career Suicide"? The employees at my company are not allowed to have any sort of online profile, blog, or entry that says anything about the company.

Basically, if they trace this back to me, I'm a done tom turkey.

But to me, it's worth saying and getting out, and letting the consequences fall where they may. I'm not going to compromise myself anymore for something I shouldn't have to compromise myself about in the first place.

I'll expand on this latter. I'd love to hear what you guys have to say.



Billy Sparks said...

I can feel your pain. For a short period of time while in college I worked for the local ambulance company. Any kind of injury patient got oxygen, because they needed it? No but because there was a upcharge for oxygen. At night and weekends the local VRS caught calls if all (the only) EMS units were tied up. If two call came out close (within 5 minutes of each other) one to an affluent address and the other one to a less affulent address (read my not be able to pay the bill) guess which one the squad got regardless of which one came in first.

Chris in SE TX said...

Dammit, you sound just like a medic working for me! If I find out it's you, you and your ass are GONE!!!

(he he he, I bet that got your attention)

Actually, I sure hope that your post doesn't come back to bite you. I think it shouldn't, you did NOT write about the company you work for. You did not mention any names, or locations.

Just to be on the safe side, if asked, deny it. Tell them you absolutely do not have a blog. Ask them what is a "blog". Hell, ask them what this "internet thingy" you've been hearing on the news is, and if it will play on your VCR.

I think if you deny everything, they won't be able to do anything.

Good luck!

Chris in SE TX said...

I guess my plan to scare you (above) would have been more effective if I posted is A NONY MOUSE..... Oh, well....

Stretcher Jockey said...

MM remember...ask them "Which hospital do you want to go to?" not "Do you want to go the hospital?"

Do they still preach that same line of bull?

Medicmarch. said...

aw god. EVERY DAY. Directly into my ear.

Jen said...

I'm a bit late in commenting here, but I have the unfortunate experience of watching what used to be a good company to work for go down this same path. It is depressing to hear the stories of perfectly reasonable assessments/treatments being questioned for billing reasons. All those wonderful "benchmarks" are also coming into play, some of them based on dispatch priority where a monkey with a list of questions has decided which patients are "serious" while they are on the phone with 911. Just plain depressing.

Rogue Medic said...

You may not be Dr. Medic March, but you are also not Kidnapper Medic March. You are protecting the company from charges for abducting the patient (what is the billing code for abduction?).

As far as the time on scene is concerned, what leads you to believe that this is a quality of care indicator? They are only interested in how quickly you are available for another call.

Career suicide is my motto. :-)