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Making more money in EMS

How prehospital care providers can get the compensation they deserve


According to the most recent Willis Towers Watson Global Workforce and Global Talent Management and Rewards studies, one in five employees doesn’t believe they are being paid fairly.

Photo/Baldwin Emergency Medical Services

Compensation of prehospital care providers has long been a point of contention in the EMS industry, but gained national attention with the #TheWorkIsDifferent social media campaign for pay equity.

In January, 2019, New York City Mayor Bill de Blasio was asked about the base pay gap between employees of FDNY’s EMS branch and FDNY’s suppression branch. Mayor de Blasio response was that he respects EMS providers, but that the “work is different.” FDNY EMTs make approximately $40,000/year less in their base pay rate than FDNY firefighters, police officers and sanitation workers. Of course, this problem isn’t isolated to New York City.

According to the most recent Willis Towers Watson Global Workforce and Global Talent Management and Rewards studies, one in five employees doesn’t believe they are being paid fairly.

A 2018 study by EMS human resources consultants Avesta, in partnership with the American Ambulance Association, looking at turnover in EMS agencies found part time employees were leaving their companies at a rate of 27-28%. That’s more than a 100% turnover of employees every four years. The survey cited dissatisfaction with pay as a top reason that employees leave EMS agencies.

Fortunately, there are a number of steps that employees can take to help turn things around. Here are 10 ways to increase your salary in EMS.

1. Work more hours

When it comes to increasing your paycheck, one factor that is most often under employee control is working more hours. For some EMS providers, this will increase the total amount in their paycheck, though not the rate of pay.

But for many, the hours worked beyond the full-time total are compensated at an increased rate, often 1.5 times normal pay rate.

Beyond that, some employers offer bonuses for working less-desirable shifts, such as overnights, weekends and holidays.

2. Ask for a raise

The first step towards getting what you want is asking for it. If your pay is agreed-upon on an individual basis, seek out the person in your organization with the power to raise your pay and ask them.

If employee pay is not agreed upon on an individual basis, make pay increases a priority in the next contract negotiation or otherwise petition your employer in the appropriate way that a raise in pay is warranted.

Whether you are negotiating individually or as a group, it is crucial to have the facts supporting your position that a pay rise is not simply something you want, it is possible, necessary and warranted.

When seeking to justify a pay increase, consider pointing to the rates of pay of comparable employees in other organizations and in other regions, as well as the tangible benefits that you provide for your organization. Be specific and identify the value that is added to the agency by your performance as an individual or a group.

3. Do a great job continually and reliably

Most EMS agencies provide some type of incentive for employee longevity. It makes sense since there is a significant cost incurred by the company every time they hire and have to orient a new employee.

While some are employers provide a regular, yearly stepwise pay increase up to a certain limit, in many cases, annual pay increases are tied to employee performance through regular performance evaluations and reviews.

The overall idea is simple; employees will strive for better performance to obtain more money. However, the details of exactly what is valued, how much it is valued and what the measurement criteria are should all be made very clear to employees. These evaluation systems typically take into account performance across the entire time period since the last evaluation, so there is limited value gained by employees who decide to “step up their game” just prior to their annual review.

4. Move to another agency

It can be hard to pull the plug, but if an employer won’t accommodate a reasonable pay raise, then employees can seek other employers with better compensation. This can certainly be a challenge in some areas where there is little competition between EMS providers, but if you can’t find what you want where are you, are you can always expand your search.

Consider all of the employers that may have positions open for certified or licensed EMS providers. These can include fire departments and rescue services, hospitals and healthcare agencies, summer camps, recreational centers and more.

5. Move to another region

Compensation for EMS providers varies significantly from state to state and often even from city to city within the same region. When adjusted for the cost-of-living, pay rates can vary from state to state by as much as $30,000 per year. While relocation presents its own costs and challenges, a big increase in pay and the change of pace may make it well worth your while.

6. Seek improved education/certifications

Another great way to earn a better rate is to raise the value you provide to your employer. One of the simplest, if not always the easiest, paths is through education, raising your level of certification or licensure.

Keep in mind that if your primary motivator for taking the class is to get a raise in pay, it may seem like a great idea when you sign up, but may be more of a challenge when you have to meet all the course requirements.

Also, if a pay raise is your goal, make sure that the courses you are taking will actually result in a direct increase in pay. This can be a challenge, especially when considering the near-future and concrete costs associated with higher education degree programs versus later, potential increase in earnings that may not materialize.

Think outside the box. Beyond simply moving to a “higher” level of certification, consider moving into a specialty that may provide better employment opportunities. Hazmat, technical rescue, tactical EMS and community paramedicine specialists may be sought out in your area. Likewise, EMS educators including CPR, first aid, and resuscitation may provide both additional work opportunities and increased rates of pay.

7. Seek promotion

While upgrading your certification or licensure is one path to better pay, climbing the ladder to another rank or position is another option. Even if your longevity, great performance, and additional education pursuits may not have led directly to the pay increase that you were seeking, they are usually significant factors in helping you obtain a promotion.

As with your education, if increasing your pay is your primary motivator for obtaining a promotion, beware. Surveys have shown that, especially when changing positions, the increases in pay quickly begin to feel “normal” while additional job responsibilities can weigh heavily. While taking a promotion can be a great way to raise your salary, always make sure it is one for which you are both qualified and passionate.

8. Be frugal

Ben Franklin said, “a penny saved is a penny earned,” and your financial advisor would agree. While few people would disagree that prehospital providers earn less than they should for their training, work and responsibilities, simply living within your means is important for financial stability, freedom and happiness no matter what your pay rate.

Key concepts include making a budget and sticking to it, saving rather than borrowing for both fun extravagances and unexpected expenses, and purposely spending your budgeted money on those things that you most value rather than burning cash on what is simply available.

9. Seek a different job

It’s no surprise that in a profession that is widely known to be underpaid, that some EMS providers decide to simply change careers. While some pathways from EMS provider to nursing or allied health professions currently exist, others, such as paramedic to physician assistant are being developed.

Keep in mind that just because you are taking on a new career, doesn’t mean you have to leave emergency services behind completely. Many providers continue to work in some aspect of emergency medical services even as they change primary careers.

10. Be an advocate to move your profession forward

For prehospital providers who are in it for the long-haul and are seeking to leave a lasting legacy on their profession, opportunities abound to move our profession forward.

With U.S. unemployment rates the lowest in many years, a competitive job market demands competitive compensation. Furthermore, the recent changes to EMS reimbursement by the Center for Medicare and Medicaid Services from fee for transport to fee for services has the potential to open up a world of opportunities to EMS innovators.

Rom Duckworth is a dedicated emergency responder, author and educator with more than 30 years of experience working in career and volunteer fire departments, hospital healthcare systems, and private EMS. He is a career fire captain and paramedic EMS coordinator for the Ridgefield (Connecticut) Fire Department and the founder of the New England Center for Rescue and Emergency Medicine. Duckworth is recipient of the American Red Cross Hero Award, Sepsis Alliance Sepsis Hero Award, and the EMS 10 Innovators Award in addition to numerous awards and citations for excellence in education and dedication to service. Duckworth is a member of numerous national education, advisory and editorial boards, as well as a contributing author to more than a dozen EMS, fire and rescue books, including the IFSTA Pumping Apparatus Driver/Operator textbook as well as over 100 published articles in fire and EMS journals, magazines and websites. Duckworth has a bachelor’s degree in public safety administration from Charter Oak State College in Connecticut. Connect with Duckworth via or or on LinkedIn.