MSM 009 Is EMS a good career choice?

“Choose a job you love, and you will never have to work a day in your life.”

-Confucius

            We all have our reasons for joining EMS. Some of wanted to simply help our communities, some of us just wanted to make a difference, and I would submit that most us joined EMS to help others. EMS workers have a very unique sense of need to help other people. Often when I’m teaching a class I’ll ask the class why they joined this industry, and often the go-to answer is “I want to help people.” Obviously, we all have our own motivations to join this field, but more and more it seems that EMS is becoming an industry that is not sustainable as far as membership is concerned. Behind closed doors and in our offices or ambulance we ask ourselves why we joined the industry, and we joke with new employees, or students and ask why in their right mind they would choose to work in EMS when there are so many other options in the world.

EMS, more than most other industries has a very diverse group of people that come to work for us. I’ve worked with plumbers, accountants, former VPs of Fortune 500 companies, and more. But often I find that the EMTs and Paramedics I meet came into this industry by accident, or by what seemed like a logical progression of their career. This logical progression tends to be that the individual joined a volunteer agency, became and EMT, liked it for a while and decided to expand their practice by pursuing paramedic school. These motivations are admirable, but it leads to a further progression in the field, almost always to nursing school, or pursuing a career as a PA or going to medical school. None of these endeavors are necessarily to be criticized, as we should always want people to better themselves and move ahead in their lives. However, it invariably leads to a shortage of EMTs and paramedics in the field. So why do people leave? EMS is an exciting and dynamic field where no two days are alike, and with all the advances in medicine, there is certainly more we can provide for patients now than there ever has been.

The decision to stay or leave EMS most likely comes down to economics. The median income of paramedics in the United States is $39,785[1], a full $5,000 less annually than the median income of the population in general[2]. It is true that people in the United States with a high school education make approximately half of those that have a college degree, and this paradigm is something that has negatively affected EMS workers nationwide. EMS workers don’t fit the classic model of attaining a high school or college degree and then moving into the work force. Upon completion of EMT or paramedic school, the provider must continue to obtain education credits throughout their career to maintain their certification and keep working. Given this dynamic, a paramedic that has acquired a national registry certification and has been in the field for 5 years without a college degree will have obtained at least 144 continuing education credits over the course of their career, and will still make less than a college graduate who obtained 120 credits for their bachelor’s degree. It is true that some college and universities have higher credit requirements than others, but the numbers still hold true. If an EMT or paramedic already has a college degree, they may be offered a pay differential for their education, but this differential may amount to little more than a dollar and hour.

This dynamic leads to EMTs and paramedics pursuing careers that will allow them to better provide for themselves and their families. According to the bureau of labor statistics, the average salary of a registered nurse in the United States was $67,490 per year[3], and it is difficult to say no to an additional $20,000 per year. Since 2014, the BLS reports that nursing degrees increased by almost half a million from 2014-2015, and with the availability or nursing programs, it is easy to imagine that these numbers will continue to increase.

There is an additional problem in EMS with the culture that we have created when it comes to career longevity. The combination of long hours, on the job stress, and the lack of upward mobility in the industry also leads to attrition. Many people may enter EMS excited at the prospect of working 3 days a week, while maintaining full-time employment and benefits. This is an attractive offer, however as noted above with salaries being as low as they are, a significant amount of EMS providers work overtime shifts, or at multiple projects. It is not uncommon to hear stories of paramedics that regularly work over 60 hours per week. The cumulative effect of working so many hours and dealing with the job stressors that we face inevitably leads to a short career span and the want to move on to something different and more lucrative.

Aside from economics, we also breed a culture that is unsustainable as far as our mental health is concerned. In addition to the long hours and low pay, the job itself leads to a higher rate of depression, PTSD, and suicidal ideations than most careers[4]. We have decided as an industry that we need to always keep a straight face and “be strong” or “get through it” which causes providers to ignore the symptoms of stress or PTSD, and can contribute significantly to burnout and reduce career longevity. While one of the advantages to working in EMS is that every call is different, a significant drawback is that when we are affected by a particular patient or scene, we are expected to move on to the next call as if the last one never happened. We do not handle our co-workers experiencing stress well either, often citing anecdotes like “I had this bad call, and it never bothered me” which perpetuates the cycle of non-reporting of stress, and in the long run contributes to shortening of careers.

There is also little in the sense of career mobility. EMS workers will tend to obtain their certification and remain in field as a staff EMT or paramedic for most their careers. Those that work for a fire service may see an increase in upward mobility when compared to private or hospital-based services, which is significant but most providers do not work for such organizations. When a provider receives a promotion, it is usually to join a small contingent of clinical or operations management. The availability of those positions tends to be few and far between, with the providers filling those roles staying their position for a significant amount of time. Career mobility is a significant enough issue in EMS that a cursory Google search will show numerous articles giving advice on how to pursue an “alternative” EMS career that involves safety management or EMS consulting (or blogging!).

So, what can be done? How do we address these problems? The first issue is clearly economical, and as an industry, we have very little control over how we’re paid. EMS reimbursement for services tends to rely on tax payer dollars or on Medicare/Medicaid reimbursement, both of which turn into a political football that no one wants to touch. Hospital-based services may be able to provide more money for their providers, but that would generally mean having to find the funds from another service line, and with so many people vying for financial disbursement in a hospital it is difficult for EMS to ask for better compensation. A hospital that bills $10,000 for a neuro consultation will likely not be enthusiastic to parse that money out to the EMS providers that recognized a stroke in the field. Beyond that, there is little to no value in encouraging people to not pursue fields that will compensate them more. Any job that will offer a provider better compensation, a more regular schedule, and less stress will always be preferable to working in the field.

What’s needed is a significant culture shift. We, as EMS professionals need to learn how to stand up for ourselves when it comes to job compensation and safety. We must encourage organizations to fairly compensate the EMS providers that work for them, and we need to work to foster a culture that encourages the well-being of our peers. There is an illusion that EMS can be a long-term career field that is largely perpetuated by television and media, and without the public being made aware of the plight of EMS workers, there is little that can be done to ensure the sustainability of our industry.

We all entered EMS because we found a field and a culture that we love. We all want the profession to grow and get better. We must stand up and fight for the culture and people we love so much. It is likely that if you’re reading this, you feel that EMS is the best job you’ve ever had. It is time that we fight to make that a reality for ourselves and for the next generations of providers.

[1] http://www1.salary.com/Paramedic-Salary.html

[2] https://www.thebalance.com/average-salary-information-for-us-workers-2060808

[3] https://www.bls.gov/ooh/healthcare/registered-nurses.htm

[4] http://www.emsworld.com/article/12009260/suicide-stress-and-ptsd-among-emergency-personnel