A report that up to 1,500 FDNY EMTs and paramedics could leave in 2026 drew a wave of responses from EMS1 readers, many of whom said New York’s struggle is not just a New York problem.
Readers pointed to low pay, high housing costs and the long-standing feeling that EMS is still treated as an afterthought, even as call volume, training demands and expectations continue to grow. Others said the problem starts even earlier, with an outdated reimbursement system that leaves agencies fighting over limited dollars.
‘They should be able to live in the city they serve’
For many readers, one part of the problem is easy to understand: If EMTs and paramedics cannot afford to live where they work, keeping them on the job gets even harder.
One reader suggested that the state should look at housing support alongside salary changes.
“Make agreements with housing complexes or apartment buildings to accept EMS based on their stations, pay and time on the job. Also putting EMS on the top of NYCHA lists since income is so low.”
That same frustration showed up in comments from the EMS1 Facebook community.
“All city employees should be paid high enough, so they can afford to live in the same city they are serving.”
Readers say pay parity is still the biggest issue
Again and again, readers came back to pay.
Some said EMS wages need to better match the work itself. Others said parity with fellow public safety professionals should have happened long ago.
“Make the pay equal to nursing registered nursing salaries and you would see a boom in retention.”
Another Facebook commenter said the issue is not new and that many providers have long used FDNY EMS as a stepping stone to something that pays better.
“Nothing new it has been like that for decades. Some EMTs and medics apply and work there just for experience and move on to private hospitals EMS where they pay more. Also some of them just use FDNY as the quickest way to get into fire. If you ask me FDNY should pay the EMS side equivalent to the FDNY side.”
Another commenter looked back at earlier pay scales and questioned how the city can still be this far behind.
“That’s unconscionable. How is this possible? How is the city paying EMTs that much? Back in the early 2000s, I got an offer to lateral up to NYPD, and at the time, they were only paying $26,000 a year. You go up to 30 at the end of the academy. I was stunned by that low pay. It sounds like it’s even worse for medics. What the hell is the city thinking?”
The fire-EMS debate is still not going away
Some readers used the discussion to revisit a debate EMS has been having for years: whether being part of a fire department helps or hurts EMS in the long run.
One reader pointed to the history behind the FDNY merger and the resistance that came with it.
“In 1985 when I suggested merging NYCEMS and FDNY (based on intense study of such Fire-EMS models around the country) the resistance came from across the spectrum NYCEMS. No one from bosses to basic EMTs wished to lose their autonomy. The EMS union locals, the bargaining units and the overarching union DC37 fought tooth and nail. And they still did when the merger was pulled off a decade later, rather than ditching DC 37 and joining the fire union which was the quickest way to parity.”
A Facebook commenter argued that EMS should stand on its own.
“EMS needs to be a separate entity from fire, but that will never happen. EMS is the FD’s money maker like traffic is for the NYPD. There are some incredible people on FDNY EMS who deserve to make good money”
Some readers say the real problem starts with reimbursement
For one EMS1 reader, the retention crisis cannot be separated from how EMS is funded across the country.
“Generally speaking, most of the issues that EMS agencies experience are foundationally caused by low reimbursement for the services that we provide. We are stuck in a payment model that started in the 1970s and hasn’t changed much. We are still listed in the federal procurement system that CMS uses as ‘suppliers’ and not ‘providers.’ EMS is no longer run by funeral homes and law enforcement that had a ‘load and go’ mentality and were no better than a cab ride in many instances. We now have a rolling ICU that costs half a million dollars with highly trained and skilled paramedics and EMTs. We need to be reimbursed based on what we provide in 2026, not 1975. Once that happens, the conversations surrounding how to recruit and retain could be more robust. As it stands now, most conversations surrounding recruitment and retention are how to ‘rob Peter to pay Paul’ by moving budgets around just to be able to keep the lights on in many agencies, especially rural locations where property and sales tax struggle to cover even 50% of the budget.”
‘We are not ambulance drivers’
Several readers said pay is only part of what keeps dragging the profession down. Recognition matters too.
One reader said EMS has spent years being undervalued, both by the public and within the larger public safety system.
“EMS has been undervalued for a very long time. We did it to ourselves because we love to help people so much that we gave away our services for free through volunteering. EMS is a newest member of the public safety team and we are required to obtain more continuing education to maintain our certifications than other members of the team. EMS is not recognized by the general public as an essential service until they have a medical emergency. Then it is in our best interests to explain to the patient and their family what EMS is, what we do and where we are in the public safety system. Educating the voting public to the fact that EMS providers are leaving the field because they can not afford to be underpaid is our best option. EMS should be included in LODDB at the National level too.”
A Facebook commenter made the same point more bluntly:
“The final decision lies within NYC! Why is it, they keep shooting EMS down? There needs to be a public campaign in advertising, we are not ambulance drivers!”
For longtime providers, none of this feels new
Some of the most pointed comments came from readers who said they have watched the same cycle play out for decades.
“I have been in EMS for 50 years. While a lot of patient care technologies have improved, the treatment of EMS workers has not. The problems for FDNY-EMS personnel are nothing new to me. The reality is a lot of firefighters regard EMS as ‘scut’ work and the EMS workers as the same. Until EMS is regarded and receives equal pay, benefits and a public safety pension, nothing will ever change. But that means the hiring criteria must be the same as it is for police and firefighters.”
The comments varied in where they placed the blame — city leaders, fire-based structures, public perception or federal reimbursement — but they kept circling the same reality: EMS providers are being asked to do increasingly complex work while many still struggle to earn enough to stay.
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