Ask any EMT or paramedic what he or she finds most satisfying about EMS work and you’ll likely find that helping others, the excitement and challenges of the job, and the camaraderie with co-workers are near the top of the list. In fact, nearly all NREMT-Bs and NREMT-Ps listed these very factors when surveyed in 2005 for the Longitudinal Emergency Medical Technician Attributes & Demographics Study (the LEADS project), which is analyzing data collected between 1999 and 2008.
At the same time, there are some constants when it comes to sources of discontent. “EMS professionals are constantly least satisfied with pay and benefits,” says Jonathan Studnek, Ph.D., NREMT-P, a LEADS investigator and director of prehospital research at the Center for Prehospital Medicine at Carolinas Medical Center and Mecklenburg EMS Agency in Charlotte, N.C.
Indeed. May 2008 data from the U.S. Department of Labor Statistics indicate the combined average pay for the 207,610 EMTs and paramedics employed in the U.S. was $15.38 per hour. The mean annual wage for this group was $31,980. And despite suggestions of continued attempts for increased benefits in about 39 percent of the 273 EMS organizations that responded to the 2009 JEMS Salary and Workplace Survey, 21 percent of these agencies reported reduced major medical plans. Another 9 percent reported reduced tuition reimbursement.
Meanwhile, estimates suggest that about 6 percent of EMS professionals consider leaving the profession due to discontent with advancement opportunities or with the EMS profession as a whole.
Still, some agencies—like the four featured here—report little difficulty in attracting or holding on to EMS workers. While they may not be able to offer the pay or benefits they’d like to, they seem to compensate by treating staff with respect and professionalism.
Integration in Memphis
Pay and benefits are not the only motivating factors for staying or leaving emergency services, notes Gary Ludwig. As deputy fire chief for Memphis Fire Department in Memphis, Tenn., Ludwig has a long list of paramedic applicants. Yet in 2009, he had to hire only three to fill his department’s vacant slots.
Ludwig is responsible for all EMS programs, operations and training for his department, which serves the area’s 860,000 residents. He thinks the excellent career opportunity Memphis Fire offers keeps staff turnover low: Every paramedic becomes cross-trained as a firefighter, and each works 12 hours on an engine or truck, with the next 12 hours on an ambulance. These changing responsibilities allow people to keep their skills honed and their horizons expanded. Plus, this structure helps prevent complacency.
Ludwig also works to ensure that his workers have the tools and equipment needed to do their jobs. He empowers staff to design vehicles, select disposable supplies, or research and choose the department’s monitor/defibrillators. He is always available to sound out issues or ideas that might improve the workings of the department, and he holds an annual EMS roundtable where anyone can discuss or propose ideas. To ease the acclimation of new hires coming in from out of state, Ludwig has initiated an “ambassador program,” in which he assigns a current employee to provide the new one with information on everything from local schools, restaurants and utilities, to how and where to get a new driver’s license.
“Employees are your most valuable asset,” Ludwig says. “Treat them this way.”
Personal recognition in Missouri
Combining EMS and fire into a fully cross-trained service also works for the all-volunteer Central Polk County Fire and Rescue, where turnover is about 2.5 people annually. The agency responds to approximately 300 calls a year in the 86-plus square-mile area surrounding Bolivar, Mo. To keep his 19 volunteers interested in continued service, Chief Ken Witt finds it most effective to recognize a job well done.
Witt and his command staff use an individual reward system to maintain optimal participation levels. All volunteers receive a gift card based on the number of training sessions and calls they participated in during the previous year. The department also hosts an annual appreciation dinner that includes Firefighter, Rookie and Officer of the Year honors. And when Witt learns of exemplary work in his department, he personally offers a pat on the back.
After serious calls, rather than critique responders as a group, Witt communicates individually with them to ensure they “get their feelings out in the open.” He also tries to obtain patients’ outcomes so responders have some knowledge of how their actions played out.
When individuals are happy with their performance and recognized by those in charge, Witt says he finds them more willing to contribute and perform as a team.
Character in Colorado
Summit County EMS, the sole 911 response and inter-hospital transfer service in this ski resort area 70 miles west of Denver, has an annual turnover rate of 12 to 16 percent. At times workers leave for the opportunity to make more money, but more often it’s to further their education or relocate, often because they tire of the snow, notes manager Sean Caffrey. His 25 full-timers generally come from the cadre of about 25 part-timers and stay in their positions for four to five years, despite Summit County’s pay being somewhat less than in neighboring ski-resort areas.
“People know your reputation,” Caffrey notes. “If it’s crummy, any agency will have trouble recruiting and retaining staff.”
Experienced EMS people are good at going into a chaotic situation, organizing it, then coming up with and executing a plan of action, Caffrey says; they therefore come with pretty high expectations of management. Caffrey and his management team respond to these expectations by taking the time to explain policy and organizational procedures. In turn, they expect and seek out employee-generated ideas on how to improve Summit County’s service. Caffrey’s team also takes note of any employee issues or concerns noticed by their scheduling person, a senior paramedic who keeps tabs on the pulse of the Summit County crew.
Since pay competitiveness is an ongoing issue and the agency’s benefits package has slowly eroded, Caffrey’s team focuses on maintaining professionalism and quality of care. The team addresses employee-generated ideas on how to improve the agency’s service and strives to draw staff into the Summit County EMS “family.”
Sincerity seems to be the bottom line at Summit County. “I would not want to run a place I didn’t want to work for,” Caffrey says. “Experienced people know when you’re blowing smoke, so the secret is not to.”
Matching people to place in Minnesota
No doubt, once you have your employees, you have to treat them fairly, says Darel Radde, director of Ridgeview Ambulance Service, which operates in a 730-square-mile area in and around Waconia, Minn. His approach seems to be working: Prior to the agency’s growth spurt about two years ago, 35 percent of the staff had more than 20 years of service with Ridgeview; 65 percent had worked at the agency for more than 10 years.
Ridgeview Ambulance Service responds to about 9,000 calls annually using eight ambulances staffed by 64 paramedics and 39 EMTs, mostly paid. The service’s pay, benefits and uniform allowances match those of nearby EMS agencies, so when Radde does have to hire, he has a large pool of potential employees to draw from. From this pool he picks people with attitudes that fit the culture of the organization, which helps to keep turnover low.
But Radde thinks Ridgeview’s notable staff longevity is also due to management’s willingness to adapt to the times. For example, while staff members bid for schedules according to seniority, each schedule has equal numbers of weekend, night and holiday shifts. Staff also can request time-off with less than 24 hours’ notice and have high probability their requests will be honored. In addition, Ridgeview has very involved medical directors who guide the service’s testing of new patient care programs and data-collection systems.
“All this keeps staff morale up,” Radde notes.
So does respecting staff members as professionals and trusting they will operate according to the guidance and work ethic of the organization. Staffers who lack respect for the job or their co-workers, or who don’t warrant trust, cannot continue to work. “It’s better to lose an arm than kill the whole body,” Radde says.
