by Caitlin Kenney

Matt from Manhattan writes:

Let me tell you about how paramedics get paid at my hospital. We're a non-union shop, and we nominally do in fact get paid for performance — but for the most trivial, stupid things. For example, we get performance reviews on our appearance, attendance and paperwork.

Do we get rewarded for providing good patient care, for saving lives? NEGATIVE. I could be killing people right and left, but so long as my paperwork is in order, I'm a fantastic employee in the hospital's eye.

 

In part, the problem is one of information. Our supervisors aren't out there on the ambo with us...ever. And it'd be hard to do, but not impossible. The other option is peer reviews. But this too is problematic, because of all the catty gossip and bad-mouthing that happens.

However, the bigger issue is something that affects the health care industry more generally: there is no reward for practicing good medicine. The only real incentive is risk, namely the risk of getting sued. Employees get punished for pissing people off, yet are NEVER rewarded for doing a good job. All this translates into a pretty dysfunctional corporate culture where managers don't even pretend to care about the substance of your work, only the appearance of errors. Paramedics learn to be entirely risk averse from a paperwork point of view, even when taking a risk might save a life.