Though Ambulnz says it “exists to improve the lives of EMTs,” EMTs who spoke to OneZero were skeptical of its promises. Emergency medical service is dangerous and grueling work. It’s also poorly paid: many paramedics and EMTs take multiple jobs to make a living. As noted in a 2018 Money story, the median pay for EMT and paramedics is $16.50 per hour ($34,320 per year), or “about 40% less than the average employed American earns, [making it] one of the worst-paying medical jobs out there.”

Amy Eisenhauer has been an EMT since 1995, and advocates for providers as a regular EMS conference speaker and writer. She notes that IFT work can be rewarding, but admits that often “[IFT providers] try to push in as many calls as possible, because they need to make money, to keep the doors open, and so sometimes that becomes money-making is the key, not necessarily doing the right thing.”

“We entrust our loved ones into their care, but pay them like they’re flipping burgers.”

Private IFT services like Ambulnz often pay less than their public counterparts. Saba Waheed, research director at the UCLA Labor Center, co-authored an extensive paper detailing the wage and working conditions of emergency medical services in California. The paper notes that private ambulance companies “minimize capital and labor intensity of operations, often with adverse impacts to workers.” In an interview with OneZero, Waheed said, “in the private workforce, [EMTs] make 40% less than the public sector, [and] the median wage has fallen 12%, between 2007 and 2013. Workers are tending to be more part-time and part-year. So everything has been signaling a decline in the job quality and wages.”

In its informational videos, Ambulnz tries to capitalize on the industry’s poor compensation. “EMTs make a fraction more than minimum wage,” says the narrator in a 2017 video by Ambulnz. “We entrust our loved ones into their care, but pay them like they’re flipping burgers.”

Read more An Ambulnz promotional video that promises Ambulnz EMTs can “make a lot more money” and “the people are cooler here.”

The company often cites the opportunity for EMTs to make up to $72,000 with Ambulnz. “At my old job, I was making pennies. Peanuts. Here at Ambulnz, I’m making filet mignon,” says one unnamed Ambulnz EMT in a promotional YouTube video.

The company runs optional incentive programs — called “model programs.” EMTs who enroll in the program are paid in part based on the number of calls they respond to, and in some markets, when model EMTs are not running calls, they are trained to “act as sales associates.” The different incentive programs are based on revenue, customer satisfaction, and on-time performance, says Vashovsky. These EMTs are encouraged to stop by different outpatient centers, such as nursing homes, to introduce themselves, explain Ambulnz, and drop off a business card. The model programs vary from state to state, in order to comply with the laws and conditions of that specific market, according to the company’s CEO.

An Ambulnz EMT who worked for the company in 2017 credits the model program for giving him “an idea of how to be an entrepreneur,” he told OneZero. The employee claimed to have exceeded $72,000 in his first year’s salary. Vashovsky said he could not discuss the specifics of compensation, as the company considers that part of Ambulnz’s corporate intellectual property, and a competitive differentiator.

Other former Ambulnz employees were more critical of the company’s incentive programs. Reviews on Glassdoor indicate that EMTs who sign up for the model program and do not meet the minimum of number of six calls per shift receive a base hourly rate at or near minimum wage. Based on 18 reviews, average total pay as an Ambulnz EMT is $28,000 per year.

Paul, who requested anonymity so he could speak freely of his experience, is a former Ambulnz dispatcher. In the recruiting materials, Paul said the company marketed itself “like Uber for ambulances.”

Despite being on the East Coast, Paul dispatched Ambulnz vehicles on the West Coast, which he said was “incredibly disorienting.” He eventually quit, frustrated by his schedule changes, and “constantly having to educate ourselves about California labor law and EMS protocol because nobody trained us properly.” He says teams were grossly overworked, with over 30 dispatch assignments sometimes split between just two ambulances. Complaints from patients, providers, and overworked EMTs were common. “I wouldn’t trust them as medical providers at all,” he says of Ambulnz.

EMTs are encouraged to stop by different outpatient centers, such as nursing homes, to introduce themselves, explain Ambulnz, and drop off a business card.

UCLA Labor Center’s Waheed was also suspicious of Ambulnz’s claims that EMTs stand to make $72,000 per year with the company. In response to that figure, Waheed says, “Our data doesn’t show [wages] anywhere near that.”

“If they are actually able to provide that for a full-time worker, that’s awesome, because these are very important jobs, and they deserve to be compensated well,” Waheed says. “I would want to ensure that 72 [thousand] comes from a place where you’re not driving this person into the ground.”

David Fifer, a paramedic and assistant professor at Eastern Kentucky University’s Emergency Medical Care program, says that Ambulnz fulfills a need in the United States, as “many parts of the country are underserved by ambulances in general,” but he also has concerns with Ambulnz’s fundamental model.

“It’s [sic] seems like there’s a moral hazard that needs to be addressed: an employee who earns more money the more transports they conduct might see an incentive to cut corners, falsify patient care records, or even drive recklessly,” he says. “Pay for performance models aren’t inherently bad, but they require a strong culture of excellence and strong quality assurance metrics to ensure performance means more than just volume.”

In its report earlier this year, Axios noted that Ambulnz’s business prospects are uncertain, stating that it has a “high cost, narrow purpose,” and there are more affordable options coming online. For example, both Uber and Lyft stated they will be pursuing seniors with Medicare Advantage (MA) plans after the Centers for Medicare and Medicaid Services (CMS) announced additional MA benefits for 2020. Patricia Pittman, a professor of health policy and management at Milken Institute School of Public Health at the George Washington University, as well as the director of Fitzhugh Mullan Institute for Health Workforce Equity, says there is a movement for ambulance services to integrate into larger health systems, such as Accountable Care Organizations, which seek to maximize positive health outcomes instead of optimizing for billing.

“Most stand-alone ambulance services have the opposite interest: increasing trips to the hospital,” says Pittman.

If there’s one thing observers can agree on it’s that the emergency medical service needs an overhaul: EMTs need higher pay, better career opportunities, affordable benefits, and less grueling schedules. As aging populations increase, these needs will only become more apparent. Unfortunately, Ambulnz, a company focused on commoditizing and optimizing an already precarious workforce, is not likely to alleviate these issues.