There were side conversations during EMS week about pay, opportunity, and retention. We have two recent studies that provide data in place of speculation.
AAA/Avesta 2018 Ambulance Industry Employee Turnover Study.
While more than 700 EMS organizations were contacted, none of the respondents came from Public Sector – Fire Department organizations. About 93% of the respondents were spread between Private Sector – For-Profit, Public Sector – Stand Alone EMS, and Private Sector – Not-for-Profit/Nonprofit agencies.
The study obtained data from leaders of more than 100 ems organizations, The results are reported by job title and employment status. The “weighted” overall annual turnover rate for caregivers in this study showed:
- 31% Part-Time EMT
- 28% Part-Time Paramedic
- 24% Full-Time EMT
- 17% Full-Time Paramedic
The raw numbers were weighted by headcount for each job category before calculating turnover – making results more similar for job titles when looking at both large and small organizations. In terms of the size of the agencies that responded: 61% had less than 100 employees, 19% had 100 – 199 employees and 13% had 200-499 employees.
The AAA/Avesta study compared EMS turnover with Society for Human Resource Management’s (SHRM) 2017 Human Capital Benchmarking Report. SHRM report a turnover rate of 18% for all occupations. The study is available to American Ambulance Association and National EMS Management Association members.
Emergency Medical Services in California: Wages, Working Conditions, and
Industry Profile. February 2017
This report by the UC Berkely Labor Center and the UCLA Labor Center examines wages and working conditions for EMTs and paramedics in California. Some of their findings:
- In 2015, 16,720 EMTs and paramedics were employed in California.
- Eighty percent of EMTs and paramedics worked for private EMS providers.
Pay
- In 2014, the median hourly wage for private-sector EMTs and paramedics in California was $16.59.
- More than a third of California EMTs and paramedics were low-wage workers, defined as earning less than $13.63 an hour (which is two-thirds of the state median—a commonly used metric for low wages).
- Private-sector EMTs and paramedics earned 39 percent less than their public-sector counterparts. Even when controlling for age, gender, geography, education, and race and ethnicity, public-sector wages were still much higher than private-sector wages.
Turnover
- While we lack direct turnover data from private providers in California, key informants interviewed for this study reported that few workers stay with private providers for more than four years.
- EMS workers in the state are younger on the whole than the overall California workforce, and the private-sector workforce is significantly younger than the public-sector workforce. In 2014, 57 percent of private industry EMTs and paramedics were between the ages of 20 and 29.
WHAT DOES IT MEAN?
The details within the AAA/Avesta survey validates an observation by the California study of the turnover rate of caregivers working in the private EMS sector. The pay difference between private sector and public sector employers is troubling.
The AAA/Avesta report showed that the two primary reasons EMTs and Paramedics left Private Sector – For-Profit, Public Sector – Stand Alone EMS, and Private Sector – Not-for-Profit or Nonprofit agencies was for “career or occupational change” or “dissatisfaction with pay or benefits.” I recall discussions with young caregivers struggling to support a family on their private sector EMS wages.
EMS educator and consultant Jon Politis provided thoughtful commentary at the end of EMS Week 2018. Two of his observations resonated with me after reading these reports:
EMS must be treated with equity ! In too many places our EMS has atrocious working conditions while their fire/police colleagues do not. It’s not a “zero sum” game. What’s given to one should not be taken away from the other. Be fair!
Let’s NOT force our EMS to be like migrant workers…Exhausted EMTs and Paramedics working multiple PT jobs, with no benefits, to make ends meet. Exhausted providers are dangerous and the rash of ambulance crashes from providers falling asleep is the proof. Simply hiring a lot of part-time people just creates another set of workforce issues. No ownership-exhaustion-poor attitudes ! In the history of the world…Nobody ever washed a rented car. We need to take care of our people!
You can read the entire EMS Week 2018 commentary from Jon Politis here.
Low-wage workers end up working long hours at multiple EMS agencies. In addition to medical misadventures and ambulance crashes, I wonder if the stress of working up to 100 hours a week is a contributing factor to caregiver suicide. Read Are we working EMS providers to death? for more information.
Emergency medicine and out-of-hospital care were low-value services in the 1960’s. Other groups involved in the delivery of emergency medicine have improved pay, working conditions, and career paths since modern EMS started in 1973. In a later article, we will look at what our healthcare colleagues have accomplished and what EMS can learn from them.