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For the EMS side, it's run by clueless bean counters and med types that rode in the back once. Back in the day....EMS was well managed by aviation types, pay still sucked though.

The difference I found pulling into the FBO in a King Air or a Helicopter was the level of respect you received. They look at helo pilots like street walkers walking into a fine restuarant for a glass of free water. Pay was alot better also.

Go fixed wing if you can.