A real EMS career ladder for the paramedic profession

Six different career ladders with compensation and rank based on experience, higher education and specialized training improves retention

It’s no secret – the EMS community is hemorrhaging people. As the economy improves, more and more opportunities, with better compensation, are available. Credentials such as registered nurse, physician assistant and several allied health professions – all of which typically pay 30-50 percent more than paramedic salaries in most communities – are within reach of motivated paramedics.  

I don’t see becoming a nurse or a physician assistant as part of EMS career development. Those professions, however noble and important, are different from EMS. My goal is, and always has been, for the EMS community to provide vehicles for career professional paramedics to earn a decent living – to be able to raise a family, buy a home and enjoy a decent standard of living – without having to work unreasonable amounts of overtime at multiple EMS organizations.

There is pretty good evidence that experience matters [2,3,4,5]. Think of your workforce – and who might show up at your house in response to a 911 call. Do you want that to be a brand-new paramedic, with the ink barely dry on their state license? Or a paramedic who is well-seasoned, who enjoys clinical medicine, and who has been successfully caring for patients in your system for 10 years?

If we are to provide excellent clinical care, we need to keep experienced practitioners working on our ambulances, and that means challenging them, providing them advancement opportunities and compensating them reasonably for the work that they do.


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