What Are You Worth?
Association Minutes features commentary from various EMS associations. In this issue, the National Association of EMTs addresses compensation in EMS.
In April of this year, an EMT appeared on the Oprah Winfrey Show-not as a representative of America's emergency medical services, but as a representative of America's working poor. This EMT was a 28-year-old single mother of two who earns $8.75 per hour for her EMS work.
Since the evolution of modern EMS, compensation for EMS work has been an issue of concern. When NAEMT surveyed 750 providers at EMS EXPO in 2002, respondents ranked pay and benefits as one of their top three concerns. Recently, the issue has been gaining momentum in the popular press as many ambulance services-especially those in rural areas-struggle to find enough personnel and funding for their operations. But understanding exactly how to address the compensation issue is complex.
"The whole issue of pay and compensation is difficult to get your arms around because of how EMS developed across the U.S.," says NAEMT President Jerry Johnston.
Johnston explains that EMS in America has evolved from a patchwork of public and private services using volunteers, paid employees or some combination of the two, and that "services have compensated workers differently-or not at all-making it difficult to generalize about pay. Whenever you discuss an EMS workforce issue, you need to consider three important factors: the level of certification, the type of service the person works for and the type of compensation the person receives. There are no workforce universals in EMS," he says.
An Information Deficit
Unlike the fire service and nursing, no organized EMS labor movement has focused on the issue of compensation, and little reliable information is available about pay and benefits. Some EMS workers, especially those working within paid unionized fire departments, are well paid, and some are not. In 2005, Firehouse Magazine reported top medic pay in the San Jose (CA) Fire Department at $93,650. It also reported top medic pay in the Monroe (LA) Fire Department at $19,860. A 2005 annual salary survey in an EMS trade journal reported starting pay for an EMT-B at $26,721 (maximum $39,778) and starting pay for a paramedic at $34,670 (maximum $50,183). The U.S. Department of Labor's Occupational Outlook Handbook reported the median annual earnings of EMTs and paramedics were $25,310 as of May 2004.
But these statistics do not paint the whole picture. Fire departments represent only a portion of transporting ambulance services. The aforementioned trade journal's salary survey is limited because it only surveys ambulance service managers who voluntarily want to participate and report what they are paying their staff (low-paying services may not want to participate, skewing the numbers). In the past, the Occupational Outlook Handbook has not separated EMTs and paramedics and has not collected data on EMS workers who are not compensated, making it difficult to chart trends and realistically reflect the situation for a majority of EMS workers. Overtime and other forms of compensation are often factors that complicate the issue.
"In preparing to speak out about pay issues, we want to speak from a position of understanding," says Johnston.
He explains that while NAEMT has historically been focused on professional development and clinical excellence, it is now funding research on workforce issues and participating in the NHTSA- and HRSA-funded Emergency Medical Services Workforce for the 21st Century Project being conducted by the Center for the Health Professions at the University of California, San Francisco. NAEMT is awaiting the completion of a report from that project later this year that will provide an assessment of the national EMS workforce, including primary data collection and a synthesis of existing research and data, and provide guidance for a future policy development phase of the project. In the meantime, NAEMT provides $5,000 annually to fund research on EMS workforce issues.
"Because reliable data about the workforce has been sketchy, we want to understand the state of the situation and then formulate NAEMT positions, research and action that can assist EMTs and paramedics in the right way," says Johnston. "To just say that the EMS worker should be compensated at rates comparable to public safety and other allied health professions in a geographic region may not take in the full picture that includes volunteers and all the various methods of compensation. However, I do want the EMS industry to know that we have our eye on this issue and will act on it. I hope the rest of the EMS community will join us in gaining an understanding of this complex issue and ensuring that EMS workers are treated fairly."
