Overtime: Thank you, sir, may I have another?


Antonio R. Fernandez, MS, EMT-P | Jonathan Studnek, PhD, NREMT-P | From the September 2008 Issue | Monday, September 15, 2008

We all dread hearing these words: "I'm also gonna need you to come in on Sunday," or, more appropriately for EMS, "Yeah we're gonna need you to stay late." This has likely happened to you, or maybe you volunteered your services to get a few extra bucks for that flat-screen TV. Either way, overtime in EMS is like hospital diversions. The question isn't "if," it's "when." So our bet is that most of you have worked overtime, but just how often?


It shouldn't surprise anyone reading this that overtime is pretty common in EMS. What might come as a surprise is there's no specific definition for overtime. That's right, not even the U.S. Department of Labor has an official definition of overtime. Interpretation is left to the states and, ultimately, employers.

So, how can we tell you how much overtime people work inEMS? Basically, we looked at LEADS data again (see The Hours, April JEMS). Specifically, we analyzed two questions asking EMTs and paramedics to report if they worked mandatory or voluntary overtime in the previous seven days.

Let's start off easy. Out of 1,379 participants, 28% reported that they didn't work any overtime in the preceding seven days. That's right, do a little math and you'll see that 72% of you worked some sort of overtime in the past week.

What's even more interesting is that 33% of you worked a combination of voluntary and mandatory overtime in the same week. The big boss told you that you had to come in on an off day and one-third of you stood up and proudly said, "Thank you, sir, may I have another?" Finally, just about 20% of participants reported working either voluntary or mandatory overtime.

Because the authors of this article are primarily visual learners, and we like comparing people against each other, let's look at some graphs. In Figure 1, we have the traditional EMT-B versus paramedic match-up. It shows the percentage of individuals by certification level who reported working mandatory or voluntary, both, or no overtime in the preceding week.

It appears as though paramedics are more likely to work both mandatory and voluntary overtime, while EMT-Bs tend to have not worked any overtime at all.

The overtime story doesn't end with certification level. You'll see in Figure 2, when we split certification levels by community size (rural or urban), a clearer picture of overtime appears. Regardless of community size, paramedics still report working overtime more often. However, we also see that urban EMT-Bs tend to work overtime nearly as often as the paramedics. The real difference appears to lie with rural EMT-Bs.

One last figure and then we'll get you out of here. In Figure 3, we were surprised to see that almost half of individuals working for private EMS agencies reported working both voluntary and mandatory overtime in the same week. County/municipal/hospital systems came in a close second for overtime worked. Interestingly, those working for fire departments were most likely to report working no overtime.

So, as always, the results of LEADS data may not represent the situations you face in your local systems. However, this data does provide a snapshot of overtime inEMS. The take-home message is that more than 70% of EMTs and paramedics reported working some sort of overtime in the preceding week whether they wanted to or not. That's a lot of overtime.

There's one obvious limitation to this analysis. Can you think of it? Are you thinking? All right, we'll just tell you: We didn't account for the volunteer status of the participants responding to this survey.

Remember, if you're a volunteer, it's all overtime, and you just don't get paid time-and-a-half, or sometimes at all. This may explain why rural EMT-Bs appear to have worked the least amount of overtime.

One final limitation is that we didn't actually count overtime hours. Participants who reported mandatory overtime were all treated the same regardless of whether they were forced to work one extra hour because their relief crew didn't show up on time, or six extra hours.

Most EMS providers are not forced to work overtime, but there's a lot of overtime being worked. We realize overtime can be good for the checkbook (think, new flat-screen TV), but it can also be quite disruptive to life in general. Should 70% of the EMS workforce be working overtime? Well, that's a topic for another day. As always, be safe and see you soon.

Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Administration and Leadership, Industry News, Operations and Protcols, Jems Columns

Author Thumb

Antonio R. Fernandez, MS, EMT-PAntonio R. Fernandez, MS, NREMT-P, is a research fellow for the National Registry of EMTs. He's currently pursuing a PhD in public health. Fernandez also has experience providing prehospital as well as in-hospital patient care as an EMT-B and a paramedic in urban settings.


Jonathan Studnek, PhD, NREMT-P

Jonathan Studnek, PhD, NREMT-P, is the quality improvement manager at Mecklenburg EMS Agency. His current research interests include understanding how reduction in the variation of care practices leads to better outcomes in healthcare.


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