Guest guest Posted May 2, 2004 Report Share Posted May 2, 2004 Please explain in detail a Public Utility Model or give a reference on where to get a detailed explanation. Forgive me but I see only opinion about the Public Utility Model. Flame On BABY Danny L. Owner/NREMT-P Panhandle Emergency Training Services And Response (PETSAR) Office FAX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2004 Report Share Posted May 2, 2004 Please explain in detail a Public Utility Model or give a reference on where to get a detailed explanation. Forgive me but I see only opinion about the Public Utility Model. Flame On BABY Danny L. Owner/NREMT-P Panhandle Emergency Training Services And Response (PETSAR) Office FAX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2004 Report Share Posted May 2, 2004 Please explain in detail a Public Utility Model or give a reference on where to get a detailed explanation. Forgive me but I see only opinion about the Public Utility Model. Flame On BABY Danny L. Owner/NREMT-P Panhandle Emergency Training Services And Response (PETSAR) Office FAX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2004 Report Share Posted May 2, 2004 The original articles by Jack Stout on the " Public Utility Model " appeared in JEMS Magazine's May, June, and July issues in 1980. Reprints are available from the JEMS website. Here's an explanation of the PUM taken from SunStar EMS's website. SunStar is the contractee for the Pinellas County EMS Authority. " The Pinellas County EMS Authority was set up through a Special Act of the Florida Legislature in 1980, which was ratified by a Countywide referendum of all the voters. Pinellas County's EMS Authority provides a " One Tier " (all units are advanced life support (ALS) - level; meaning all paramedic), " Dual Response " (two paramedic units are sent to each 9-1-1 emergency call) system. We are a " Public Utility Model " EMS system. The Public Utility Model EMS system has certain unique characteristics which make it different from other systems. First, there must be a governmental oversight agency which coordinates the provision of emergency medical services throughout the entire service area. Second, the highest quality of patient care with a " patient comes first " attitude must prevail in the minds of the providers and administrators. Third, services are provided by contractors who are under " performance-based " agreements. These type of arrangements require results be achieved using the creativity and innovative methods of the providers. Fourth, sound business financial controls must be in place where the Authority controls all system funding. The ambulance system is designed to be funded through the collection of user fees and not reliance on tax dollars. Fifth, all Advanced Life Support (ALS) resources are sent to all calls. The Public Utility Model EMS system is designed where the government not only regulates and oversees system performance, but the contractors are held accountable to meet or exceed performance requirements under penalty of removal, as well as fines being imposed. It is a system where the patient and quality of care comes first and the comfort of providers comes second. In this design, the government is a purchaser of First Responder paramedic, and paramedic ambulance services through a competitive process insuring that the most cost-effective provision of EMS services is guaranteed for the benefit of our citizens. " Here's another description taken from MedStar's website. MedStar is the provider under the Fort Worth Area Ambulance Authority. " A Public Utility Model A public utility model is composed of 3 components. The components work together to provide excellent patient care, efficient operations, and a cost effective system. The Ambulance Authority provides oversight for MedStar. A six-member board provides policy and direction for the system. The Emergency Physicians Advisory Board (EPAB) and its Medical Director provide medical control for MedStar. An ambulance company is contracted by the Ambulance Authority to provide ambulance operations and transportation within MedStar's jurisdiction. A Little History Prior to 1986, private companies or volunteer systems provided the emergency medical services for most of the cities that are now part of the MedStar system. Cities such as Fort Worth contracted with a single private ambulance provider to respond to the emergencies in the city. The non-emergency activities occurring in the cities were open to free market competition, meaning any ambulance service could take the call. In an effort to develop cost-effective EMS services that are more accountable to the public, MedStar was structured as a Public Utility Model (PUM). This model is a quasi-governmental system that uses a government oversight body and a private contractor to supply EMS. A government-based ambulance authority is established to procure equipment, manage administrative expenses, handle billings, and contract for provision of services with an ambulance provider. The ambulance provider manages the delivery of EMS services in accordance with standards established by an independent medical control board. Common features of this model include provision of all paramedic care and single-provider provision of all emergency and non-emergency transportation. Another common provision of this model is a franchise fee (typically less than $15 per transport) charged to fund oversight by a medical control board. Member Cities Cities currently being served by MedStar include: Fort Worth Saginaw Haltom City Lake Worth Haslet River Oaks Forest Hills Sansom Park Lakeside Westover Hills Burleson White Settlement Westworth Village Blue Mound Ambulance Contractor On August 1st, 1999, Rural/Metro Ambulance began providing exclusive service in the MedStar system. Other companies that have provided ambulance services for MedStar include Texas Lifeline Corporation, MedTrans, and American Medical Response. " Hope these help to understand how PUMs work. Gene G. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2004 Report Share Posted May 2, 2004 The original articles by Jack Stout on the " Public Utility Model " appeared in JEMS Magazine's May, June, and July issues in 1980. Reprints are available from the JEMS website. Here's an explanation of the PUM taken from SunStar EMS's website. SunStar is the contractee for the Pinellas County EMS Authority. " The Pinellas County EMS Authority was set up through a Special Act of the Florida Legislature in 1980, which was ratified by a Countywide referendum of all the voters. Pinellas County's EMS Authority provides a " One Tier " (all units are advanced life support (ALS) - level; meaning all paramedic), " Dual Response " (two paramedic units are sent to each 9-1-1 emergency call) system. We are a " Public Utility Model " EMS system. The Public Utility Model EMS system has certain unique characteristics which make it different from other systems. First, there must be a governmental oversight agency which coordinates the provision of emergency medical services throughout the entire service area. Second, the highest quality of patient care with a " patient comes first " attitude must prevail in the minds of the providers and administrators. Third, services are provided by contractors who are under " performance-based " agreements. These type of arrangements require results be achieved using the creativity and innovative methods of the providers. Fourth, sound business financial controls must be in place where the Authority controls all system funding. The ambulance system is designed to be funded through the collection of user fees and not reliance on tax dollars. Fifth, all Advanced Life Support (ALS) resources are sent to all calls. The Public Utility Model EMS system is designed where the government not only regulates and oversees system performance, but the contractors are held accountable to meet or exceed performance requirements under penalty of removal, as well as fines being imposed. It is a system where the patient and quality of care comes first and the comfort of providers comes second. In this design, the government is a purchaser of First Responder paramedic, and paramedic ambulance services through a competitive process insuring that the most cost-effective provision of EMS services is guaranteed for the benefit of our citizens. " Here's another description taken from MedStar's website. MedStar is the provider under the Fort Worth Area Ambulance Authority. " A Public Utility Model A public utility model is composed of 3 components. The components work together to provide excellent patient care, efficient operations, and a cost effective system. The Ambulance Authority provides oversight for MedStar. A six-member board provides policy and direction for the system. The Emergency Physicians Advisory Board (EPAB) and its Medical Director provide medical control for MedStar. An ambulance company is contracted by the Ambulance Authority to provide ambulance operations and transportation within MedStar's jurisdiction. A Little History Prior to 1986, private companies or volunteer systems provided the emergency medical services for most of the cities that are now part of the MedStar system. Cities such as Fort Worth contracted with a single private ambulance provider to respond to the emergencies in the city. The non-emergency activities occurring in the cities were open to free market competition, meaning any ambulance service could take the call. In an effort to develop cost-effective EMS services that are more accountable to the public, MedStar was structured as a Public Utility Model (PUM). This model is a quasi-governmental system that uses a government oversight body and a private contractor to supply EMS. A government-based ambulance authority is established to procure equipment, manage administrative expenses, handle billings, and contract for provision of services with an ambulance provider. The ambulance provider manages the delivery of EMS services in accordance with standards established by an independent medical control board. Common features of this model include provision of all paramedic care and single-provider provision of all emergency and non-emergency transportation. Another common provision of this model is a franchise fee (typically less than $15 per transport) charged to fund oversight by a medical control board. Member Cities Cities currently being served by MedStar include: Fort Worth Saginaw Haltom City Lake Worth Haslet River Oaks Forest Hills Sansom Park Lakeside Westover Hills Burleson White Settlement Westworth Village Blue Mound Ambulance Contractor On August 1st, 1999, Rural/Metro Ambulance began providing exclusive service in the MedStar system. Other companies that have provided ambulance services for MedStar include Texas Lifeline Corporation, MedTrans, and American Medical Response. " Hope these help to understand how PUMs work. Gene G. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2004 Report Share Posted May 2, 2004 The original articles by Jack Stout on the " Public Utility Model " appeared in JEMS Magazine's May, June, and July issues in 1980. Reprints are available from the JEMS website. Here's an explanation of the PUM taken from SunStar EMS's website. SunStar is the contractee for the Pinellas County EMS Authority. " The Pinellas County EMS Authority was set up through a Special Act of the Florida Legislature in 1980, which was ratified by a Countywide referendum of all the voters. Pinellas County's EMS Authority provides a " One Tier " (all units are advanced life support (ALS) - level; meaning all paramedic), " Dual Response " (two paramedic units are sent to each 9-1-1 emergency call) system. We are a " Public Utility Model " EMS system. The Public Utility Model EMS system has certain unique characteristics which make it different from other systems. First, there must be a governmental oversight agency which coordinates the provision of emergency medical services throughout the entire service area. Second, the highest quality of patient care with a " patient comes first " attitude must prevail in the minds of the providers and administrators. Third, services are provided by contractors who are under " performance-based " agreements. These type of arrangements require results be achieved using the creativity and innovative methods of the providers. Fourth, sound business financial controls must be in place where the Authority controls all system funding. The ambulance system is designed to be funded through the collection of user fees and not reliance on tax dollars. Fifth, all Advanced Life Support (ALS) resources are sent to all calls. The Public Utility Model EMS system is designed where the government not only regulates and oversees system performance, but the contractors are held accountable to meet or exceed performance requirements under penalty of removal, as well as fines being imposed. It is a system where the patient and quality of care comes first and the comfort of providers comes second. In this design, the government is a purchaser of First Responder paramedic, and paramedic ambulance services through a competitive process insuring that the most cost-effective provision of EMS services is guaranteed for the benefit of our citizens. " Here's another description taken from MedStar's website. MedStar is the provider under the Fort Worth Area Ambulance Authority. " A Public Utility Model A public utility model is composed of 3 components. The components work together to provide excellent patient care, efficient operations, and a cost effective system. The Ambulance Authority provides oversight for MedStar. A six-member board provides policy and direction for the system. The Emergency Physicians Advisory Board (EPAB) and its Medical Director provide medical control for MedStar. An ambulance company is contracted by the Ambulance Authority to provide ambulance operations and transportation within MedStar's jurisdiction. A Little History Prior to 1986, private companies or volunteer systems provided the emergency medical services for most of the cities that are now part of the MedStar system. Cities such as Fort Worth contracted with a single private ambulance provider to respond to the emergencies in the city. The non-emergency activities occurring in the cities were open to free market competition, meaning any ambulance service could take the call. In an effort to develop cost-effective EMS services that are more accountable to the public, MedStar was structured as a Public Utility Model (PUM). This model is a quasi-governmental system that uses a government oversight body and a private contractor to supply EMS. A government-based ambulance authority is established to procure equipment, manage administrative expenses, handle billings, and contract for provision of services with an ambulance provider. The ambulance provider manages the delivery of EMS services in accordance with standards established by an independent medical control board. Common features of this model include provision of all paramedic care and single-provider provision of all emergency and non-emergency transportation. Another common provision of this model is a franchise fee (typically less than $15 per transport) charged to fund oversight by a medical control board. Member Cities Cities currently being served by MedStar include: Fort Worth Saginaw Haltom City Lake Worth Haslet River Oaks Forest Hills Sansom Park Lakeside Westover Hills Burleson White Settlement Westworth Village Blue Mound Ambulance Contractor On August 1st, 1999, Rural/Metro Ambulance began providing exclusive service in the MedStar system. Other companies that have provided ambulance services for MedStar include Texas Lifeline Corporation, MedTrans, and American Medical Response. " Hope these help to understand how PUMs work. Gene G. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2004 Report Share Posted May 2, 2004 So, , is there something that you disagree with? gg In a message dated 5/2/2004 5:36:04 PM Central Daylight Time, kenneth.navarro@... writes: Someone needs a nap. > What one must understand is that the so-called Public Utility Model is the product of one Jack Stout, an economist, and his wife, who have made a ridiculously good living from manipulating EMS services for the last 20 or so years. The PUM is founded upon the idea of system status management, a flawed doctrine that was never based upon anything other than economics. Patient care and public service were only incidental. The idea was to convince city councils, county commissioners, and city managers that a system constructed of smoke and mirrors would provide excellent patient care while expending the least amount of money possible. Clever enticements such as " all our medics will be NREMT " and other meaningless promises were used to mesmerize dumb city councilmen, county commissioners, and city managers into believing that contracts with private providers were the way to go. Artificial but high-sounding concepts such as responses within 8:59 90% of the time for urban responses and 12:59 90% of the time in rural responses came into being. They were based upon nothing other than Jack Stout's musings. None of the councilpersons, commissioners, or city managers ever had or now have even a clue about patient care issues, nor do they give a shit about those issues. Stop and think about it! What good will an 8:59 response do for a patient in cardiac arrest? Not much, even if good CPR has been done. But this figure was sold over and over to politicians who hadn't a clue and who fell for a great presentation, which Jack is perfectly capable of rendering. Thus emerged the concept of unit hour utilization which strives to force the maximum amount of work from each unit in the shortest amount of time, providing a stated amount of coverage for a very little expenditure, but not taking into consideration the level of care provided. Nobody who controls the finances actually gives a rats patoot about patient care. Care to challenge me on that? Git it on! Prove it to me. You can't. There are no considerations given by system status management to the personal comfort or needs of the employee; in fact, as Jack Stout once said to me over a lunch, the idea is to employ young people as medics, work the living shit out of them, burn them out in about 3 years, and replace them with new employees. That way you never have to give pay raises based on seniority and experience. Mr. Stout and his disciples fervently believe and adhere to this concept. Most of the people now running the big national EMS companies are Stoutians. The PUM combines the concept of SSM with a so-called " fail-safe " system where a pseudo public utility is formed which will control the provision of EMS through letting contracts to private contractors who will provide the services. The PUM typically has the ability toconfiscate the rolling stock and supplies of a company that goes belly up and thus ensure continuity of service. That appeals to county commissioners, who know nothing about medicine but want to cover their butts if the contractee collapses. There ARE some PUMs that have good executive management, but they are sparse. The private contractors who bid on these contracts, big players like AMR, R/M, and others, typically " low ball " the bid in order to get the contract and then engage in a scheme to demand increased subsidies from the PUM in order to continue service. The examples of this scheme are legion. Top level managers in these services are paid corporate salaries in the multiple 6 figure ranges, and their allegiences are to their owners rather than the public. They are no different from the CEO of Halliburtin, or General Electric. Their output and accomplishments are never designed to provide excellent care to those they serve; rather their entire set of goals are intended to make money for the company and perpetuate their jobs. Since street medics are traditionally anti-union and cannot be enticed to band together for the common good, they are a corporate manager's dream. The managers exploit the workers to the max, and they play the game to remain in power by providing service as the very lowest cost to the PUM but still making a profit for the corporation. Into this mix goes Medicare/Medicaid abuse and fraud, abuse of employees by enacting schemes to deprive them of overtime, and so forth. At one time paramedics were a glut on the employment market. However, now, there are fewer and there is a shortage. But corporate providers will never respond to the market by paying better wages; rather, they will find ways to use lower level certified medics such as EMT-I and EMT basic to do the bulk of the work in their systems. Since medics are reluctant to join trade organizations, and since there is a real rift between medics who work for private contractors and FD based EMS medics, there is no unified action by medics to improve their lot. Medics who are outside the fire service typically make much less money, enjoy much less benefits, and have no job security.Medics who work for Fire typically refuse to become members of non-fire department organizatons. They don't see the need to do it. And, practically speaking, they're right. The private, hospital based, and 3rs service paramedic community encourages this by refusing to join or even be interested in organizations that might represent them. So what does the PUM do for EMS? Little except huge salaries for its managers. Somebody else please post a list of the PUMs. I'm not going to put my neck on the line any more than I have, but wouldn't it be interesting to know who the surviving PUMs are and who their managers are and where they came from. You'll find out that they all came from services that Jack Stout was hired to build and structure. Would somebody please come forward and attempt to justify the PUM. You've got the stage. Can you do it? Let's see. GG. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2004 Report Share Posted May 2, 2004 So, , is there something that you disagree with? gg In a message dated 5/2/2004 5:36:04 PM Central Daylight Time, kenneth.navarro@... writes: Someone needs a nap. > What one must understand is that the so-called Public Utility Model is the product of one Jack Stout, an economist, and his wife, who have made a ridiculously good living from manipulating EMS services for the last 20 or so years. The PUM is founded upon the idea of system status management, a flawed doctrine that was never based upon anything other than economics. Patient care and public service were only incidental. The idea was to convince city councils, county commissioners, and city managers that a system constructed of smoke and mirrors would provide excellent patient care while expending the least amount of money possible. Clever enticements such as " all our medics will be NREMT " and other meaningless promises were used to mesmerize dumb city councilmen, county commissioners, and city managers into believing that contracts with private providers were the way to go. Artificial but high-sounding concepts such as responses within 8:59 90% of the time for urban responses and 12:59 90% of the time in rural responses came into being. They were based upon nothing other than Jack Stout's musings. None of the councilpersons, commissioners, or city managers ever had or now have even a clue about patient care issues, nor do they give a shit about those issues. Stop and think about it! What good will an 8:59 response do for a patient in cardiac arrest? Not much, even if good CPR has been done. But this figure was sold over and over to politicians who hadn't a clue and who fell for a great presentation, which Jack is perfectly capable of rendering. Thus emerged the concept of unit hour utilization which strives to force the maximum amount of work from each unit in the shortest amount of time, providing a stated amount of coverage for a very little expenditure, but not taking into consideration the level of care provided. Nobody who controls the finances actually gives a rats patoot about patient care. Care to challenge me on that? Git it on! Prove it to me. You can't. There are no considerations given by system status management to the personal comfort or needs of the employee; in fact, as Jack Stout once said to me over a lunch, the idea is to employ young people as medics, work the living shit out of them, burn them out in about 3 years, and replace them with new employees. That way you never have to give pay raises based on seniority and experience. Mr. Stout and his disciples fervently believe and adhere to this concept. Most of the people now running the big national EMS companies are Stoutians. The PUM combines the concept of SSM with a so-called " fail-safe " system where a pseudo public utility is formed which will control the provision of EMS through letting contracts to private contractors who will provide the services. The PUM typically has the ability toconfiscate the rolling stock and supplies of a company that goes belly up and thus ensure continuity of service. That appeals to county commissioners, who know nothing about medicine but want to cover their butts if the contractee collapses. There ARE some PUMs that have good executive management, but they are sparse. The private contractors who bid on these contracts, big players like AMR, R/M, and others, typically " low ball " the bid in order to get the contract and then engage in a scheme to demand increased subsidies from the PUM in order to continue service. The examples of this scheme are legion. Top level managers in these services are paid corporate salaries in the multiple 6 figure ranges, and their allegiences are to their owners rather than the public. They are no different from the CEO of Halliburtin, or General Electric. Their output and accomplishments are never designed to provide excellent care to those they serve; rather their entire set of goals are intended to make money for the company and perpetuate their jobs. Since street medics are traditionally anti-union and cannot be enticed to band together for the common good, they are a corporate manager's dream. The managers exploit the workers to the max, and they play the game to remain in power by providing service as the very lowest cost to the PUM but still making a profit for the corporation. Into this mix goes Medicare/Medicaid abuse and fraud, abuse of employees by enacting schemes to deprive them of overtime, and so forth. At one time paramedics were a glut on the employment market. However, now, there are fewer and there is a shortage. But corporate providers will never respond to the market by paying better wages; rather, they will find ways to use lower level certified medics such as EMT-I and EMT basic to do the bulk of the work in their systems. Since medics are reluctant to join trade organizations, and since there is a real rift between medics who work for private contractors and FD based EMS medics, there is no unified action by medics to improve their lot. Medics who are outside the fire service typically make much less money, enjoy much less benefits, and have no job security.Medics who work for Fire typically refuse to become members of non-fire department organizatons. They don't see the need to do it. And, practically speaking, they're right. The private, hospital based, and 3rs service paramedic community encourages this by refusing to join or even be interested in organizations that might represent them. So what does the PUM do for EMS? Little except huge salaries for its managers. Somebody else please post a list of the PUMs. I'm not going to put my neck on the line any more than I have, but wouldn't it be interesting to know who the surviving PUMs are and who their managers are and where they came from. You'll find out that they all came from services that Jack Stout was hired to build and structure. Would somebody please come forward and attempt to justify the PUM. You've got the stage. Can you do it? Let's see. GG. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2004 Report Share Posted May 2, 2004 So, , is there something that you disagree with? gg In a message dated 5/2/2004 5:36:04 PM Central Daylight Time, kenneth.navarro@... writes: Someone needs a nap. > What one must understand is that the so-called Public Utility Model is the product of one Jack Stout, an economist, and his wife, who have made a ridiculously good living from manipulating EMS services for the last 20 or so years. The PUM is founded upon the idea of system status management, a flawed doctrine that was never based upon anything other than economics. Patient care and public service were only incidental. The idea was to convince city councils, county commissioners, and city managers that a system constructed of smoke and mirrors would provide excellent patient care while expending the least amount of money possible. Clever enticements such as " all our medics will be NREMT " and other meaningless promises were used to mesmerize dumb city councilmen, county commissioners, and city managers into believing that contracts with private providers were the way to go. Artificial but high-sounding concepts such as responses within 8:59 90% of the time for urban responses and 12:59 90% of the time in rural responses came into being. They were based upon nothing other than Jack Stout's musings. None of the councilpersons, commissioners, or city managers ever had or now have even a clue about patient care issues, nor do they give a shit about those issues. Stop and think about it! What good will an 8:59 response do for a patient in cardiac arrest? Not much, even if good CPR has been done. But this figure was sold over and over to politicians who hadn't a clue and who fell for a great presentation, which Jack is perfectly capable of rendering. Thus emerged the concept of unit hour utilization which strives to force the maximum amount of work from each unit in the shortest amount of time, providing a stated amount of coverage for a very little expenditure, but not taking into consideration the level of care provided. Nobody who controls the finances actually gives a rats patoot about patient care. Care to challenge me on that? Git it on! Prove it to me. You can't. There are no considerations given by system status management to the personal comfort or needs of the employee; in fact, as Jack Stout once said to me over a lunch, the idea is to employ young people as medics, work the living shit out of them, burn them out in about 3 years, and replace them with new employees. That way you never have to give pay raises based on seniority and experience. Mr. Stout and his disciples fervently believe and adhere to this concept. Most of the people now running the big national EMS companies are Stoutians. The PUM combines the concept of SSM with a so-called " fail-safe " system where a pseudo public utility is formed which will control the provision of EMS through letting contracts to private contractors who will provide the services. The PUM typically has the ability toconfiscate the rolling stock and supplies of a company that goes belly up and thus ensure continuity of service. That appeals to county commissioners, who know nothing about medicine but want to cover their butts if the contractee collapses. There ARE some PUMs that have good executive management, but they are sparse. The private contractors who bid on these contracts, big players like AMR, R/M, and others, typically " low ball " the bid in order to get the contract and then engage in a scheme to demand increased subsidies from the PUM in order to continue service. The examples of this scheme are legion. Top level managers in these services are paid corporate salaries in the multiple 6 figure ranges, and their allegiences are to their owners rather than the public. They are no different from the CEO of Halliburtin, or General Electric. Their output and accomplishments are never designed to provide excellent care to those they serve; rather their entire set of goals are intended to make money for the company and perpetuate their jobs. Since street medics are traditionally anti-union and cannot be enticed to band together for the common good, they are a corporate manager's dream. The managers exploit the workers to the max, and they play the game to remain in power by providing service as the very lowest cost to the PUM but still making a profit for the corporation. Into this mix goes Medicare/Medicaid abuse and fraud, abuse of employees by enacting schemes to deprive them of overtime, and so forth. At one time paramedics were a glut on the employment market. However, now, there are fewer and there is a shortage. But corporate providers will never respond to the market by paying better wages; rather, they will find ways to use lower level certified medics such as EMT-I and EMT basic to do the bulk of the work in their systems. Since medics are reluctant to join trade organizations, and since there is a real rift between medics who work for private contractors and FD based EMS medics, there is no unified action by medics to improve their lot. Medics who are outside the fire service typically make much less money, enjoy much less benefits, and have no job security.Medics who work for Fire typically refuse to become members of non-fire department organizatons. They don't see the need to do it. And, practically speaking, they're right. The private, hospital based, and 3rs service paramedic community encourages this by refusing to join or even be interested in organizations that might represent them. So what does the PUM do for EMS? Little except huge salaries for its managers. Somebody else please post a list of the PUMs. I'm not going to put my neck on the line any more than I have, but wouldn't it be interesting to know who the surviving PUMs are and who their managers are and where they came from. You'll find out that they all came from services that Jack Stout was hired to build and structure. Would somebody please come forward and attempt to justify the PUM. You've got the stage. Can you do it? Let's see. GG. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2004 Report Share Posted May 2, 2004 Someone needs a nap. > What one must understand is that the so-called Public Utility Model is the product of one Jack Stout, an economist, and his wife, who have made a ridiculously good living from manipulating EMS services for the last 20 or so years. The PUM is founded upon the idea of system status management, a flawed doctrine that was never based upon anything other than economics. Patient care and public service were only incidental. The idea was to convince city councils, county commissioners, and city managers that a system constructed of smoke and mirrors would provide excellent patient care while expending the least amount of money possible. Clever enticements such as " all our medics will be NREMT " and other meaningless promises were used to mesmerize dumb city councilmen, county commissioners, and city managers into believing that contracts with private providers were the way to go. Artificial but high-sounding concepts such as responses within 8:59 90% of the time for urban responses and 12:59 90% of the time in rural responses came into being. They were based upon nothing other than Jack Stout's musings. None of the councilpersons, commissioners, or city managers ever had or now have even a clue about patient care issues, nor do they give a shit about those issues. Stop and think about it! What good will an 8:59 response do for a patient in cardiac arrest? Not much, even if good CPR has been done. But this figure was sold over and over to politicians who hadn't a clue and who fell for a great presentation, which Jack is perfectly capable of rendering. Thus emerged the concept of unit hour utilization which strives to force the maximum amount of work from each unit in the shortest amount of time, providing a stated amount of coverage for a very little expenditure, but not taking into consideration the level of care provided. Nobody who controls the finances actually gives a rats patoot about patient care. Care to challenge me on that? Git it on! Prove it to me. You can't. There are no considerations given by system status management to the personal comfort or needs of the employee; in fact, as Jack Stout once said to me over a lunch, the idea is to employ young people as medics, work the living shit out of them, burn them out in about 3 years, and replace them with new employees. That way you never have to give pay raises based on seniority and experience. Mr. Stout and his disciples fervently believe and adhere to this concept. Most of the people now running the big national EMS companies are Stoutians. The PUM combines the concept of SSM with a so-called " fail-safe " system where a pseudo public utility is formed which will control the provision of EMS through letting contracts to private contractors who will provide the services. The PUM typically has the ability toconfiscate the rolling stock and supplies of a company that goes belly up and thus ensure continuity of service. That appeals to county commissioners, who know nothing about medicine but want to cover their butts if the contractee collapses. There ARE some PUMs that have good executive management, but they are sparse. The private contractors who bid on these contracts, big players like AMR, R/M, and others, typically " low ball " the bid in order to get the contract and then engage in a scheme to demand increased subsidies from the PUM in order to continue service. The examples of this scheme are legion. Top level managers in these services are paid corporate salaries in the multiple 6 figure ranges, and their allegiences are to their owners rather than the public. They are no different from the CEO of Halliburtin, or General Electric. Their output and accomplishments are never designed to provide excellent care to those they serve; rather their entire set of goals are intended to make money for the company and perpetuate their jobs. Since street medics are traditionally anti-union and cannot be enticed to band together for the common good, they are a corporate manager's dream. The managers exploit the workers to the max, and they play the game to remain in power by providing service as the very lowest cost to the PUM but still making a profit for the corporation. Into this mix goes Medicare/Medicaid abuse and fraud, abuse of employees by enacting schemes to deprive them of overtime, and so forth. At one time paramedics were a glut on the employment market. However, now, there are fewer and there is a shortage. But corporate providers will never respond to the market by paying better wages; rather, they will find ways to use lower level certified medics such as EMT-I and EMT basic to do the bulk of the work in their systems. Since medics are reluctant to join trade organizations, and since there is a real rift between medics who work for private contractors and FD based EMS medics, there is no unified action by medics to improve their lot. Medics who are outside the fire service typically make much less money, enjoy much less benefits, and have no job security.Medics who work for Fire typically refuse to become members of non-fire department organizatons. They don't see the need to do it. And, practically speaking, they're right. The private, hospital based, and 3rs service paramedic community encourages this by refusing to join or even be interested in organizations that might represent them. So what does the PUM do for EMS? Little except huge salaries for its managers. Somebody else please post a list of the PUMs. I'm not going to put my neck on the line any more than I have, but wouldn't it be interesting to know who the surviving PUMs are and who their managers are and where they came from. You'll find out that they all came from services that Jack Stout was hired to build and structure. Would somebody please come forward and attempt to justify the PUM. You've got the stage. Can you do it? Let's see. GG. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2004 Report Share Posted May 2, 2004 Someone needs a nap. > What one must understand is that the so-called Public Utility Model is the product of one Jack Stout, an economist, and his wife, who have made a ridiculously good living from manipulating EMS services for the last 20 or so years. The PUM is founded upon the idea of system status management, a flawed doctrine that was never based upon anything other than economics. Patient care and public service were only incidental. The idea was to convince city councils, county commissioners, and city managers that a system constructed of smoke and mirrors would provide excellent patient care while expending the least amount of money possible. Clever enticements such as " all our medics will be NREMT " and other meaningless promises were used to mesmerize dumb city councilmen, county commissioners, and city managers into believing that contracts with private providers were the way to go. Artificial but high-sounding concepts such as responses within 8:59 90% of the time for urban responses and 12:59 90% of the time in rural responses came into being. They were based upon nothing other than Jack Stout's musings. None of the councilpersons, commissioners, or city managers ever had or now have even a clue about patient care issues, nor do they give a shit about those issues. Stop and think about it! What good will an 8:59 response do for a patient in cardiac arrest? Not much, even if good CPR has been done. But this figure was sold over and over to politicians who hadn't a clue and who fell for a great presentation, which Jack is perfectly capable of rendering. Thus emerged the concept of unit hour utilization which strives to force the maximum amount of work from each unit in the shortest amount of time, providing a stated amount of coverage for a very little expenditure, but not taking into consideration the level of care provided. Nobody who controls the finances actually gives a rats patoot about patient care. Care to challenge me on that? Git it on! Prove it to me. You can't. There are no considerations given by system status management to the personal comfort or needs of the employee; in fact, as Jack Stout once said to me over a lunch, the idea is to employ young people as medics, work the living shit out of them, burn them out in about 3 years, and replace them with new employees. That way you never have to give pay raises based on seniority and experience. Mr. Stout and his disciples fervently believe and adhere to this concept. Most of the people now running the big national EMS companies are Stoutians. The PUM combines the concept of SSM with a so-called " fail-safe " system where a pseudo public utility is formed which will control the provision of EMS through letting contracts to private contractors who will provide the services. The PUM typically has the ability toconfiscate the rolling stock and supplies of a company that goes belly up and thus ensure continuity of service. That appeals to county commissioners, who know nothing about medicine but want to cover their butts if the contractee collapses. There ARE some PUMs that have good executive management, but they are sparse. The private contractors who bid on these contracts, big players like AMR, R/M, and others, typically " low ball " the bid in order to get the contract and then engage in a scheme to demand increased subsidies from the PUM in order to continue service. The examples of this scheme are legion. Top level managers in these services are paid corporate salaries in the multiple 6 figure ranges, and their allegiences are to their owners rather than the public. They are no different from the CEO of Halliburtin, or General Electric. Their output and accomplishments are never designed to provide excellent care to those they serve; rather their entire set of goals are intended to make money for the company and perpetuate their jobs. Since street medics are traditionally anti-union and cannot be enticed to band together for the common good, they are a corporate manager's dream. The managers exploit the workers to the max, and they play the game to remain in power by providing service as the very lowest cost to the PUM but still making a profit for the corporation. Into this mix goes Medicare/Medicaid abuse and fraud, abuse of employees by enacting schemes to deprive them of overtime, and so forth. At one time paramedics were a glut on the employment market. However, now, there are fewer and there is a shortage. But corporate providers will never respond to the market by paying better wages; rather, they will find ways to use lower level certified medics such as EMT-I and EMT basic to do the bulk of the work in their systems. Since medics are reluctant to join trade organizations, and since there is a real rift between medics who work for private contractors and FD based EMS medics, there is no unified action by medics to improve their lot. Medics who are outside the fire service typically make much less money, enjoy much less benefits, and have no job security.Medics who work for Fire typically refuse to become members of non-fire department organizatons. They don't see the need to do it. And, practically speaking, they're right. The private, hospital based, and 3rs service paramedic community encourages this by refusing to join or even be interested in organizations that might represent them. So what does the PUM do for EMS? Little except huge salaries for its managers. Somebody else please post a list of the PUMs. I'm not going to put my neck on the line any more than I have, but wouldn't it be interesting to know who the surviving PUMs are and who their managers are and where they came from. You'll find out that they all came from services that Jack Stout was hired to build and structure. Would somebody please come forward and attempt to justify the PUM. You've got the stage. Can you do it? Let's see. GG. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2004 Report Share Posted May 2, 2004 Remember when I started the prairie fire saying private companies had no business providing 911 service? A lot of you were incensed because you thought I was taking a shot at medics who work for private companies (oh the hate mail over that!) The medics aren't the problem....the system....the PUM system is. When a manager says " The only difference between a 2 year medic and a 10 year medic is we are paying the 10 year guy more money " that says all you need to know about the priorities of the system. When the EMS manager says " our system isn't designed to retire from " you know what the problem is. Somebody needs a nap? Somebody needs to wake up. magnetass sends Re: Public Utility Model > Someone needs a nap. > > > > What one must understand is that the so-called Public Utility Model > is the product of one Jack Stout, an economist, and his wife, who > have made a ridiculously good living from manipulating EMS services > for the last 20 or so years. > > The PUM is founded upon the idea of system status management, a > flawed doctrine that was never based upon anything other than > economics. Patient care and public service were only incidental. > The idea was to convince city councils, county commissioners, and > city managers that a system constructed of smoke and mirrors would > provide excellent patient care while expending the least amount of > money possible. Clever enticements such as " all our medics will be > NREMT " and other meaningless promises were used to mesmerize dumb > city councilmen, county commissioners, and city managers into > believing that contracts with private providers were the way to go. > Artificial but high-sounding concepts such as responses within 8:59 > 90% of the time for urban responses and 12:59 90% of the time in > rural responses came into being. They were based upon > nothing other than Jack Stout's musings. None of the councilpersons, > commissioners, or city managers ever had or now have even a clue > about patient care issues, nor do they give a shit about those issues. > > Stop and think about it! What good will an 8:59 response do for a > patient in cardiac arrest? Not much, even if good CPR has been > done. But this figure was sold over and over to politicians who > hadn't a clue and who fell for a great presentation, which Jack is > perfectly capable of rendering. > > Thus emerged the concept of unit hour utilization which strives to > force the maximum amount of work from each unit in the shortest > amount of time, providing a stated amount of coverage for a very > little expenditure, but not taking into consideration the level of > care provided. Nobody who controls the finances actually gives a > rats patoot about patient care. Care to challenge me on that? Git > it on! Prove it to me. You can't. > > There are no considerations given by system status management to > the personal comfort or needs of the employee; in fact, as Jack Stout > once said to me over a lunch, the idea is to employ young people as > medics, work the living shit out of them, burn them out in about 3 > years, and replace them with new employees. That way you never have > to give pay raises based on seniority and experience. Mr. Stout and > his disciples fervently believe and adhere to this concept. Most of > the people now running the big national EMS companies are Stoutians. > > The PUM combines the concept of SSM with a so-called " fail-safe " > system where a pseudo public utility is formed which will control the > provision of EMS through letting contracts to private contractors who > will provide the services. The PUM typically has the ability > toconfiscate the rolling stock and supplies of a company that goes > belly up and thus ensure continuity of service. That appeals to > county commissioners, who know nothing about medicine but want to > cover their butts if the contractee collapses. There ARE some PUMs > that have good executive management, but they are sparse. > > The private contractors who bid on these contracts, big players > like AMR, R/M, and others, typically " low ball " the bid in order to > get the contract and then engage in a scheme to demand increased > subsidies from the PUM in order to continue service. > > The examples of this scheme are legion. > > Top level managers in these services are paid corporate salaries in > the multiple 6 figure ranges, and their allegiences are to their > owners rather than the public. They are no different from the CEO of > Halliburtin, or General Electric. Their output and accomplishments > are never designed to provide excellent care to those they serve; > rather their entire set of goals are intended to make money for the > company and perpetuate their jobs. > > Since street medics are traditionally anti-union and cannot be > enticed to band together for the common good, they are a corporate > manager's dream. The managers exploit the workers to the max, and > they play the game to remain in power by providing service as the > very lowest cost to the PUM but still making a profit for the > corporation. > > Into this mix goes Medicare/Medicaid abuse and fraud, abuse of > employees by enacting schemes to deprive them of overtime, and so > forth. > > At one time paramedics were a glut on the employment market. > However, now, there are fewer and there is a shortage. But corporate > providers will never respond to the market by paying better wages; > rather, they will find ways to use lower level certified medics such > as EMT-I and EMT basic to do the bulk of the work in their systems. > > Since medics are reluctant to join trade organizations, and since > there is a real rift between medics who work for private contractors > and FD based EMS medics, there is no unified action by medics to > improve their lot. Medics who are outside the fire service typically > make much less money, enjoy much less benefits, and have no job > security.Medics who work for Fire typically refuse to become members > of non-fire department organizatons. They don't see the need to do > it. And, practically speaking, they're right. > > The private, hospital based, and 3rs service paramedic community > encourages this by refusing to join or even be interested in > organizations that might represent them. > > So what does the PUM do for EMS? Little except huge salaries for > its managers. Somebody else please post a list of the PUMs. I'm not > going to put my neck on the line any more than I have, but wouldn't > it be interesting to know who the surviving PUMs are and who their > managers are and where they came from. You'll find out that they all > came from services that Jack Stout was hired to build and structure. > > Would somebody please come forward and attempt to justify the PUM. > You've got the stage. Can you do it? Let's see. > > GG. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2004 Report Share Posted May 2, 2004 -- " Magnetass " wrote: " ...When a manager says " The only difference between a 2 year medic and a 10 year medic is we are paying the 10 year guy more money " that says all you need to know about the priorities of the system. When the EMS manager says " our system isn't designed to retire from " you know what the problem is....Somebody needs a nap? Somebody needs to wake up. " Part of developing a profession is the accumulation of experience, that is disseminated to future members of the profession. When there is no hope of a satisfying career, with a reasonable expectation of promotion and self fulfillment, the average person votes with their feet. They move out of EMS and on to a perceived 'greener pasture'; and generally, they are right! Gene's description of intentionally induced burnout indicates to me there is no interest in establishing a profession; pure bottom line is the bottom line. That is penny wise and pound foolish; turnover will eventually destroy morale, dry up the source of future medics (a contributory factor to today's shortage), stunt quality care and for the 'bottom-liners', even profit, is negatively effected. Why do governmental EMS agencies have success in maintaining their staffs? Generally, the only time you see these organizations advertise is when they are adding a station or units. People actually get promoted and retire. The longevity is not measured in weeks and months, but in years. Because there is hope ...hope for a personal future, hope that someone cares about quality care, and hope for a profession. Larry Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2004 Report Share Posted May 2, 2004 Here's the link you requested regarding PUMs: http://www.emsmagazine.com/emsmythology/emsmyth8.html There's also a wealth of information on the Internet by doing a keyword search on Google and the like. Regards, Alfonso R. Ochoa > Please explain in detail a Public Utility Model or give a reference on where > to get a detailed explanation. Forgive me but I see only opinion about the > Public Utility Model. > Flame On BABY > > Danny L. > Owner/NREMT-P > Panhandle Emergency Training Services And Response > (PETSAR) > Office > FAX > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2004 Report Share Posted May 2, 2004 Here's the link you requested regarding PUMs: http://www.emsmagazine.com/emsmythology/emsmyth8.html There's also a wealth of information on the Internet by doing a keyword search on Google and the like. Regards, Alfonso R. Ochoa > Please explain in detail a Public Utility Model or give a reference on where > to get a detailed explanation. Forgive me but I see only opinion about the > Public Utility Model. > Flame On BABY > > Danny L. > Owner/NREMT-P > Panhandle Emergency Training Services And Response > (PETSAR) > Office > FAX > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2004 Report Share Posted May 2, 2004 Unfortunately, in a lot of EMS systems, it isn't about service, or the people out there making it happen, it's about the bottom line. As I have stated many times, public service cannot be about making money, and the second you interject a profit motive into the equation, the system will become one that creates a lot of turnover, has poor morale and retention and will ultimately fail to provide what it has contracted to provide. My biggest gripe in EMS since I started is the lack of professional mangerial training. We do not develop leaders, we take street medics who have managed to hang around longer than everybody else and put them in charge of something. I have worked for very few " supervisors " who had the first clue about managing people, and only 1 EMS manger who knew how to manage people. They were good medics, but were in way over their head in the people department. This is a huge detriment to our profession, and leads to many of the problems you mentioned. Successful major firms develop effective mangers, as do the other branches of public service, police and fire. They pay attention to the training and development of the people who are most directly in charge of the things that affect an organization. In a PUM, for sure none of this happens. I'm about average, I've worked for four 911 systems, and 5 or 6 privates during my career. Most of the people I know with my time in have worked about that same number of jobs, except the ones who catch on with a fire dept. The major reason most of us leave a job is poor leadership. You all want to move EMS into a " profession " . Great, one of the first things we need are professional leaders. magnetass sends Re: Re: Public Utility Model > > -- " Magnetass " wrote: > " ...When a manager says " The only difference between a 2 year medic > and a 10 year medic is we are paying the 10 year guy more money " that says all you need to know about the priorities of the system. When the EMS manager says " our system isn't designed to retire from " you know what the problem is....Somebody needs a nap? Somebody needs to wake up. " > > > Part of developing a profession is the accumulation of experience, that is disseminated to future members of the profession. When there is no hope of a satisfying career, with a reasonable expectation of promotion and self fulfillment, the average person votes with their feet. They move out of EMS and on to a perceived 'greener pasture'; and generally, they are right! > > Gene's description of intentionally induced burnout indicates to me there is no interest in establishing a profession; pure bottom line is the bottom line. > > That is penny wise and pound foolish; turnover will eventually destroy morale, dry up the source of future medics (a contributory factor to today's shortage), stunt quality care and for the 'bottom-liners', even profit, is negatively effected. > > Why do governmental EMS agencies have success in maintaining their staffs? Generally, the only time you see these organizations advertise is when they are adding a station or units. People actually get promoted and retire. The longevity is not measured in weeks and months, but in years. Because there is hope ...hope for a personal future, hope that someone cares about quality care, and hope for a profession. > > Larry > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2004 Report Share Posted May 2, 2004 Unfortunately, in a lot of EMS systems, it isn't about service, or the people out there making it happen, it's about the bottom line. As I have stated many times, public service cannot be about making money, and the second you interject a profit motive into the equation, the system will become one that creates a lot of turnover, has poor morale and retention and will ultimately fail to provide what it has contracted to provide. My biggest gripe in EMS since I started is the lack of professional mangerial training. We do not develop leaders, we take street medics who have managed to hang around longer than everybody else and put them in charge of something. I have worked for very few " supervisors " who had the first clue about managing people, and only 1 EMS manger who knew how to manage people. They were good medics, but were in way over their head in the people department. This is a huge detriment to our profession, and leads to many of the problems you mentioned. Successful major firms develop effective mangers, as do the other branches of public service, police and fire. They pay attention to the training and development of the people who are most directly in charge of the things that affect an organization. In a PUM, for sure none of this happens. I'm about average, I've worked for four 911 systems, and 5 or 6 privates during my career. Most of the people I know with my time in have worked about that same number of jobs, except the ones who catch on with a fire dept. The major reason most of us leave a job is poor leadership. You all want to move EMS into a " profession " . Great, one of the first things we need are professional leaders. magnetass sends Re: Re: Public Utility Model > > -- " Magnetass " wrote: > " ...When a manager says " The only difference between a 2 year medic > and a 10 year medic is we are paying the 10 year guy more money " that says all you need to know about the priorities of the system. When the EMS manager says " our system isn't designed to retire from " you know what the problem is....Somebody needs a nap? Somebody needs to wake up. " > > > Part of developing a profession is the accumulation of experience, that is disseminated to future members of the profession. When there is no hope of a satisfying career, with a reasonable expectation of promotion and self fulfillment, the average person votes with their feet. They move out of EMS and on to a perceived 'greener pasture'; and generally, they are right! > > Gene's description of intentionally induced burnout indicates to me there is no interest in establishing a profession; pure bottom line is the bottom line. > > That is penny wise and pound foolish; turnover will eventually destroy morale, dry up the source of future medics (a contributory factor to today's shortage), stunt quality care and for the 'bottom-liners', even profit, is negatively effected. > > Why do governmental EMS agencies have success in maintaining their staffs? Generally, the only time you see these organizations advertise is when they are adding a station or units. People actually get promoted and retire. The longevity is not measured in weeks and months, but in years. Because there is hope ...hope for a personal future, hope that someone cares about quality care, and hope for a profession. > > Larry > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2004 Report Share Posted May 2, 2004 Unfortunately, in a lot of EMS systems, it isn't about service, or the people out there making it happen, it's about the bottom line. As I have stated many times, public service cannot be about making money, and the second you interject a profit motive into the equation, the system will become one that creates a lot of turnover, has poor morale and retention and will ultimately fail to provide what it has contracted to provide. My biggest gripe in EMS since I started is the lack of professional mangerial training. We do not develop leaders, we take street medics who have managed to hang around longer than everybody else and put them in charge of something. I have worked for very few " supervisors " who had the first clue about managing people, and only 1 EMS manger who knew how to manage people. They were good medics, but were in way over their head in the people department. This is a huge detriment to our profession, and leads to many of the problems you mentioned. Successful major firms develop effective mangers, as do the other branches of public service, police and fire. They pay attention to the training and development of the people who are most directly in charge of the things that affect an organization. In a PUM, for sure none of this happens. I'm about average, I've worked for four 911 systems, and 5 or 6 privates during my career. Most of the people I know with my time in have worked about that same number of jobs, except the ones who catch on with a fire dept. The major reason most of us leave a job is poor leadership. You all want to move EMS into a " profession " . Great, one of the first things we need are professional leaders. magnetass sends Re: Re: Public Utility Model > > -- " Magnetass " wrote: > " ...When a manager says " The only difference between a 2 year medic > and a 10 year medic is we are paying the 10 year guy more money " that says all you need to know about the priorities of the system. When the EMS manager says " our system isn't designed to retire from " you know what the problem is....Somebody needs a nap? Somebody needs to wake up. " > > > Part of developing a profession is the accumulation of experience, that is disseminated to future members of the profession. When there is no hope of a satisfying career, with a reasonable expectation of promotion and self fulfillment, the average person votes with their feet. They move out of EMS and on to a perceived 'greener pasture'; and generally, they are right! > > Gene's description of intentionally induced burnout indicates to me there is no interest in establishing a profession; pure bottom line is the bottom line. > > That is penny wise and pound foolish; turnover will eventually destroy morale, dry up the source of future medics (a contributory factor to today's shortage), stunt quality care and for the 'bottom-liners', even profit, is negatively effected. > > Why do governmental EMS agencies have success in maintaining their staffs? Generally, the only time you see these organizations advertise is when they are adding a station or units. People actually get promoted and retire. The longevity is not measured in weeks and months, but in years. Because there is hope ...hope for a personal future, hope that someone cares about quality care, and hope for a profession. > > Larry > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2004 Report Share Posted May 2, 2004 Well said magnetass... However, I cringe at the very thought of someone holding a TDH certificate that says they are a certified EMS Manager... Texas Tech and UHSCSA both have created a bacclareate degrees for EMS professionals, with the former concentrating on management according to their respective websites. Time will tell if they will be effective. However, based on the current state of affairs of EMS that you have described, probably not. Regards, Alfonso R. Ochoa > > " ...When a manager says " The only difference between a 2 year medic > > and a 10 year medic is we are paying the 10 year guy more money " that says > all you need to know about the priorities of the system. When the EMS > manager says " our system isn't designed to retire from " you know what the > problem is....Somebody needs a nap? Somebody needs to wake up. " > > > > > > Part of developing a profession is the accumulation of experience, that is > disseminated to future members of the profession. When there is no hope of a > satisfying career, with a reasonable expectation of promotion and self > fulfillment, the average person votes with their feet. They move out of EMS > and on to a perceived 'greener pasture'; and generally, they are right! > > > > Gene's description of intentionally induced burnout indicates to me there > is no interest in establishing a profession; pure bottom line is the bottom > line. > > > > That is penny wise and pound foolish; turnover will eventually destroy > morale, dry up the source of future medics (a contributory factor to today's > shortage), stunt quality care and for the 'bottom-liners', even profit, is > negatively effected. > > > > Why do governmental EMS agencies have success in maintaining their staffs? > Generally, the only time you see these organizations advertise is when they > are adding a station or units. People actually get promoted and retire. The > longevity is not measured in weeks and months, but in years. Because there > is hope ...hope for a personal future, hope that someone cares about quality > care, and hope for a profession. > > > > Larry > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2004 Report Share Posted May 2, 2004 Well said magnetass... However, I cringe at the very thought of someone holding a TDH certificate that says they are a certified EMS Manager... Texas Tech and UHSCSA both have created a bacclareate degrees for EMS professionals, with the former concentrating on management according to their respective websites. Time will tell if they will be effective. However, based on the current state of affairs of EMS that you have described, probably not. Regards, Alfonso R. Ochoa > > " ...When a manager says " The only difference between a 2 year medic > > and a 10 year medic is we are paying the 10 year guy more money " that says > all you need to know about the priorities of the system. When the EMS > manager says " our system isn't designed to retire from " you know what the > problem is....Somebody needs a nap? Somebody needs to wake up. " > > > > > > Part of developing a profession is the accumulation of experience, that is > disseminated to future members of the profession. When there is no hope of a > satisfying career, with a reasonable expectation of promotion and self > fulfillment, the average person votes with their feet. They move out of EMS > and on to a perceived 'greener pasture'; and generally, they are right! > > > > Gene's description of intentionally induced burnout indicates to me there > is no interest in establishing a profession; pure bottom line is the bottom > line. > > > > That is penny wise and pound foolish; turnover will eventually destroy > morale, dry up the source of future medics (a contributory factor to today's > shortage), stunt quality care and for the 'bottom-liners', even profit, is > negatively effected. > > > > Why do governmental EMS agencies have success in maintaining their staffs? > Generally, the only time you see these organizations advertise is when they > are adding a station or units. People actually get promoted and retire. The > longevity is not measured in weeks and months, but in years. Because there > is hope ...hope for a personal future, hope that someone cares about quality > care, and hope for a profession. > > > > Larry > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2004 Report Share Posted May 2, 2004 Well said magnetass... However, I cringe at the very thought of someone holding a TDH certificate that says they are a certified EMS Manager... Texas Tech and UHSCSA both have created a bacclareate degrees for EMS professionals, with the former concentrating on management according to their respective websites. Time will tell if they will be effective. However, based on the current state of affairs of EMS that you have described, probably not. Regards, Alfonso R. Ochoa > > " ...When a manager says " The only difference between a 2 year medic > > and a 10 year medic is we are paying the 10 year guy more money " that says > all you need to know about the priorities of the system. When the EMS > manager says " our system isn't designed to retire from " you know what the > problem is....Somebody needs a nap? Somebody needs to wake up. " > > > > > > Part of developing a profession is the accumulation of experience, that is > disseminated to future members of the profession. When there is no hope of a > satisfying career, with a reasonable expectation of promotion and self > fulfillment, the average person votes with their feet. They move out of EMS > and on to a perceived 'greener pasture'; and generally, they are right! > > > > Gene's description of intentionally induced burnout indicates to me there > is no interest in establishing a profession; pure bottom line is the bottom > line. > > > > That is penny wise and pound foolish; turnover will eventually destroy > morale, dry up the source of future medics (a contributory factor to today's > shortage), stunt quality care and for the 'bottom-liners', even profit, is > negatively effected. > > > > Why do governmental EMS agencies have success in maintaining their staffs? > Generally, the only time you see these organizations advertise is when they > are adding a station or units. People actually get promoted and retire. The > longevity is not measured in weeks and months, but in years. Because there > is hope ...hope for a personal future, hope that someone cares about quality > care, and hope for a profession. > > > > Larry > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 2, 2004 Report Share Posted May 2, 2004 Well, it's not really even that. I am starting Texas Tech's degree plan this summer, but what I mean is professional development courses, like they have in the military and in in police and fire. You have to test for promotions, and promotions mean leadership training. Granted, it doesn't assure quality leaders, but fire and police do a damned sight better job at training the people who lead than we do in EMS....which is squat. If you hang around long enough, and stab enough people in the back, eventually somebody will put you in charge of something. Most EMS managers and supervisors I have encountered seemed like they took the first page from management 101, where it says " Top 20 things not to do " and use that as their management style! It's really not their fault, nobody trained them how to lead, and it sets them up for failure. It's a vicious cycle. Paramedics are notoriously difficult to manage anyway, yet we just continue to do the things that have proven ineffective in the past. magnetass sends Re: Public Utility Model > Well said magnetass... > > However, I cringe at the very thought of someone holding a TDH > certificate that says they are a certified EMS Manager... > > Texas Tech and UHSCSA both have created a bacclareate degrees for EMS > professionals, with the former concentrating on management according > to their respective websites. > > Time will tell if they will be effective. However, based on the > current state of affairs of EMS that you have described, probably not. > > Regards, > > Alfonso R. Ochoa > > > > > " ...When a manager says " The only difference between a 2 year > medic > > > and a 10 year medic is we are paying the 10 year guy more money " > that says > > all you need to know about the priorities of the system. When the > EMS > > manager says " our system isn't designed to retire from " you know > what the > > problem is....Somebody needs a nap? Somebody needs to wake up. " > > > > > > > > > Part of developing a profession is the accumulation of experience, > that is > > disseminated to future members of the profession. When there is no > hope of a > > satisfying career, with a reasonable expectation of promotion and > self > > fulfillment, the average person votes with their feet. They move out > of EMS > > and on to a perceived 'greener pasture'; and generally, they are > right! > > > > > > Gene's description of intentionally induced burnout indicates to > me there > > is no interest in establishing a profession; pure bottom line is the > bottom > > line. > > > > > > That is penny wise and pound foolish; turnover will eventually > destroy > > morale, dry up the source of future medics (a contributory factor to > today's > > shortage), stunt quality care and for the 'bottom-liners', even > profit, is > > negatively effected. > > > > > > Why do governmental EMS agencies have success in maintaining their > staffs? > > Generally, the only time you see these organizations advertise is > when they > > are adding a station or units. People actually get promoted and > retire. The > > longevity is not measured in weeks and months, but in years. > Because there > > is hope ...hope for a personal future, hope that someone cares about > quality > > care, and hope for a profession. > > > > > > Larry > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2004 Report Share Posted May 3, 2004 Gene, What category does the Port Arthur system come under, that accepts a fee from the ambulance companies to operate as a 911 system for that City. Do they have a board or just the city council to oversee those ambulance calls? They pay or paid $25K a year to the City to operate in their City. I do not believe they operate with dual paramedics. It is the only system I know that does this but there could be others I am not aware of. Andy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2004 Report Share Posted May 3, 2004 Keep in mind, even though there are not many PUMs left the overwhelming majority of private contracted EMS providers still utilize the complete PUM model without calling themselves PUMs. Esquire Gandy's notion should be forwarded to all governmental grand poobaas while making decisions to contract or continue to contract EMS. Being on both sides of this issue for years, I can tell you that rarely if ever does the bad side of contracting reach the ears of those elected poobaas who make the decisions. >>> wegandy1938@... 5/1/04 1:06:43 AM >>> What one must understand is that the so-called Public Utility Model is the product of one Jack Stout, an economist, and his wife, who have made a ridiculously good living from manipulating EMS services for the last 20 or so years. The PUM is founded upon the idea of system status management, a flawed doctrine that was never based upon anything other than economics. Patient care and public service were only incidental. The idea was to convince city councils, county commissioners, and city managers that a system constructed of smoke and mirrors would provide excellent patient care while expending the least amount of money possible. Clever enticements such as " all our medics will be NREMT " and other meaningless promises were used to mesmerize dumb city councilmen, county commissioners, and city managers into believing that contracts with private providers were the way to go. Artificial but high-sounding concepts such as responses within 8:59 90% of the time for urban responses and 12:59 90% of the time in rural responses came into being. They were based upon nothing other than Jack Stout's musings. None of the councilpersons, commissioners, or city managers ever had or now have even a clue about patient care issues, nor do they give a shit about those issues. Stop and think about it! What good will an 8:59 response do for a patient in cardiac arrest? Not much, even if good CPR has been done. But this figure was sold over and over to politicians who hadn't a clue and who fell for a great presentation, which Jack is perfectly capable of rendering. Thus emerged the concept of unit hour utilization which strives to force the maximum amount of work from each unit in the shortest amount of time, providing a stated amount of coverage for a very little expenditure, but not taking into consideration the level of care provided. Nobody who controls the finances actually gives a rats patoot about patient care. Care to challenge me on that? Git it on! Prove it to me. You can't. There are no considerations given by system status management to the personal comfort or needs of the employee; in fact, as Jack Stout once said to me over a lunch, the idea is to employ young people as medics, work the living shit out of them, burn them out in about 3 years, and replace them with new employees. That way you never have to give pay raises based on seniority and experience. Mr. Stout and his disciples fervently believe and adhere to this concept. Most of the people now running the big national EMS companies are Stoutians. The PUM combines the concept of SSM with a so-called " fail-safe " system where a pseudo public utility is formed which will control the provision of EMS through letting contracts to private contractors who will provide the services. The PUM typically has the ability to confiscate the rolling stock and supplies of a company that goes belly up and thus ensure continuity of service. That appeals to county commissioners, who know nothing about medicine but want to cover their butts if the contractee collapses. There ARE some PUMs that have good executive management, but they are sparse. The private contractors who bid on these contracts, big players like AMR, R/M, and others, typically " low ball " the bid in order to get the contract and then engage in a scheme to demand increased subsidies from the PUM in order to continue service. The examples of this scheme are legion. Top level managers in these services are paid corporate salaries in the multiple 6 figure ranges, and their allegiences are to their owners rather than the public. They are no different from the CEO of Halliburtin, or General Electric. Their output and accomplishments are never designed to provide excellent care to those they serve; rather their entire set of goals are intended to make money for the company and perpetuate their jobs. Since street medics are traditionally anti-union and cannot be enticed to band together for the common good, they are a corporate manager's dream. The managers exploit the workers to the max, and they play the game to remain in power by providing service as the very lowest cost to the PUM but still making a profit for the corporation. Into this mix goes Medicare/Medicaid abuse and fraud, abuse of employees by enacting schemes to deprive them of overtime, and so forth. At one time paramedics were a glut on the employment market. However, now, there are fewer and there is a shortage. But corporate providers will never respond to the market by paying better wages; rather, they will find ways to use lower level certified medics such as EMT-I and EMT basic to do the bulk of the work in their systems. Since medics are reluctant to join trade organizations, and since there is a real rift between medics who work for private contractors and FD based EMS medics, there is no unified action by medics to improve their lot. Medics who are outside the fire service typically make much less money, enjoy much less benefits, and have no job security.Medics who work for Fire typically refuse to become members of non-fire department organizatons. They don't see the need to do it. And, practically speaking, they're right. The private, hospital based, and 3rs service paramedic community encourages this by refusing to join or even be interested in organizations that might represent them. So what does the PUM do for EMS? Little except huge salaries for its managers. Somebody else please post a list of the PUMs. I'm not going to put my neck on the line any more than I have, but wouldn't it be interesting to know who the surviving PUMs are and who their managers are and where they came from. You'll find out that they all came from services that Jack Stout was hired to build and structure. Would somebody please come forward and attempt to justify the PUM. You've got the stage. Can you do it? Let's see. GG. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 3, 2004 Report Share Posted May 3, 2004 Andy, I don't know the particulars of the Port Arthur system. Are the two services GoldStar and MetroCare? It would be intriguing to know how it works. Anybody? GG Quote Link to comment Share on other sites More sharing options...
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