JEMS Salary & Workplace Survey" continues to provide the most comprehensive look at the work environment of the EMS industry available today. What's changed? What's staying status quo?" /> JEMS Salary & Workplace Survey" continues to provide the most comprehensive look at the work environment of the EMS industry available today. What's changed? What's staying status quo?" />


2008 JEMS Salary & Workplace Survey

So, remind me again why EMS is a good job?


 
 

David M. Williams, PhD | From the October 2008 Issue | Sunday, April 11, 2010


JEMS.com Editor's Note: Download a complete PDF at the bottom of this page to view all the figures and tables. Also, check out the bonus tables for more salary data.

This summer, a final report titled EMS Workforce for the 21 Century: A National Assessment was released. Jointly funded by the National Highway Traffic Safety Administration and the Health Resources and Services Administration’s EMS for Children program, the two-year investigation aimed to understand the current and emerging issues facing the EMS workforce.

In times of rising patient population and no hard evidence of a shortage of EMTs and paramedics, the report confirms commonly held beliefs about inadequate wages and benefits, safety concerns, and recruitment and retention issues. Sadly, there’s a paucity of research and data on the EMS work environment to get a handle on the challenges and adequately plan to turn the corner.

For over 25 years, JEMS has been surveying EMS agencies from across the U.S. about work­place issues in an effort to follow the trends in compensation from region to region and across call volumes. Today, the“ JEMS Salary & Workplace Survey” is the leading source for information on EMS salary and workplace practices. Although the survey isn’t perfect, what follows is the most comprehensive look into the work environment of the EMS industry available today.

Short Course
* A final report of the EMS Workforce for the 21st Century: A National Assessment was released this summer following a two-year investigation into the EMS workforce.

* In addition to reflecting salaries using the best practice percentile method, salaries are adjusted to 2,080 annual hours for easier comparison.

* Public and private organizations are offering large sign-on bonuses to attract candidates, but it’s too early to tell their effect.

* Almost two-thirds (62.5%) of organizations don’t survey their workforce to help the leadership identify factors of a satisfying workplace.

* The EMS attrition rate of 11.4% is almost four points below last year, the lowest in the past three years, and significantly lower than the national average.

* Less than a quarter (23.8%) of those with an attrition problem have any plan in place to address it.

* Shift schedules and length continue to be based on tradition, management ease and issues other than matching supply to demand, safety and efficiency.

* In spite of evidence to the contrary, 79.0% of organizations believe their EMTs and paramedics receive adequate live patient encounters and actual skill exposure to remain proficient.

* Paramedics earning in the 90th percentile ($45,598.77) still make less than a typical driver for United Parcel Services ($58,240).

About the Data
Survey invitations were e-mailed to 2,062 organizations. Two hundred and nine organizations (N=209) initiated the Web-based survey, reflecting a return rate of 10.2%. The Participant Distribution figure (Figure 1) shows the breakdown of provider types and their call volumes. Efforts were made to ensure a representative sample of participation from provider organizations in each region and across all system-model designs (see Figure 2). The survey included 138 questions, many of which asked for multiple pieces of information. It covered a broad base of subject areas, including recruitment, retention, benefits, employee safety and salaries. Each agency shared internal information that may not be publicly released or may be proprietary, and the confidentiality of the respondents is honored. The data analyses are reported in aggregate and do not isolate individual organizations. Although accuracy is a primary aim, this is not a scientific study and has limitations. As with any survey, the results are only as good as the data received. All qualifying surveys were included in the final data mining. In some instances, data was limited, not available or not applicable for all respondents. In other instances, questions asked respondents to “check all that apply,” so attempts to total some percentages will thus result in a tally greater than 100%.

Methodology
The current survey was developed from three sources. First, in 2007, a stakeholder input survey was distributed to 60 EMS leaders around the country to solicit and learn from input about the workforce and compensation challenges they see in the industry. Second, feedback from JEMS readers, especially administrators and human resources professionals who rely on the data to make workforce decisions and planning, was extremely influential. Finally, the editorial team at JEMS and the consulting staff at Fitch & Associates attempted to pull from emerging issues to ensure the final results are not only informative, but pushing the industry forward.

The survey was deployed electronically through a Web-based platform and was completed entirely online. Respondents had eight weeks to complete the survey and received frequent reminders. Grossly incomplete surveys were removed, and data was reviewed for input errors and outliers. Data was not independently verified with each agency.

Last year, a new method for presenting the salary data was implemented, which reflected the same approach used by the U.S. Bureau of Labor and Statistics, human resources professionals and such popular resources as Salary.com. Salary data is reflected at the 10th, 25th, 50th, 75th and 90th percentiles. Typical market range is between the 25th and 75th percentiles. The percentile method of reporting allows a much more accurate picture when attempting to benchmark salary data.

This year, the survey underwent another evolution. In years past, annual base salaries were averaged together without consideration of the number of hours that went into earning that salary. This meant that a paramedic earning $40,000 and working a base schedule of 48 hours per week was not differentiated from a peer making the same annual salary but working an average 56 hours per week. Presenting the data without this consideration led to apples-to-oranges comparisons.

In this year’s survey, base annual salaries were divided by the number of hours worked to achieve it in order to calculate an hourly rate. Then, hourly rates were multiplied by 2,080 annual hours for all the positions included in the survey (EMD to Executive Director), which equals a 40-hour workweek. Use of the 40-hour workweek was chosen because it could be used with every position and allowed the easiest starting point for readers to calculate salaries based on their own schedules. See Figure 3 to learn how to convert the salary data for a 48-hour or 56-hour average work week.

Recruitment & Diversity
The nationwide challenge of recruiting qualified EMTs and paramedics has been an emerging issue discussed at association meetings, in trade journal articles and around the local pub stools at the EMS Today Conference and Exposition. The prevailing beliefs seem to be that we have too few qualified applicants or that EMS isn’t an attractive career. However, many of these beliefs are drawn from personal opinion and not rooted in hard data.

A core focus area of the NHTSA work­force report included examining the current supply of EMS professionals against the expected demand of the patient population. Included was an examination of what factors may influence EMS provider recruitment and retention.

Of the organizations re-sponding to this year’s survey, more than a third (36.9%) have expanded their geographic coverage areas, and 85.9% have witnessed rising call volumes. With this growth, what are organizations experiencing when it comes to paramedic recruitment? Only 16.5% say there’s no shortage and they’re able to recruit and fill open positions (see Figure 4). This would be consistent with state certification data, which shows the number of certified paramedics more than doubled in about 10 years (see Figure 5).

More than half (58.2%) of respondents are having the opposite experience and perceive a paramedic shortage, while a quarter (25.3%) don’t believe there’s a shortage of paramedics, but rather that there’s more demand for their skills in diverse environments other than in the ambulance. The paramedic supply issue is driving 12.1% of organizations to tran­sition from double-paramedic staffing to an alternative crew configuration. An interesting shift emerging in recruitment strategies is the exponentially increasing use of signing bonuses for qualified applicants who join an organization and stay for a defined period of time. This includes public and private services, indicating all models are feeling the strain. For example, Acadian Ambulance Services Inc., a private service in Texas, Louisiana and Mississippi, currently offers $5,000 for EMTs and $10,000 for paramedics in select service areas for a 24-month commitment. An example in the public sector, Memphis (Tenn.) Fire Department made the news earlier this year when its higher starting wage and $10,000 signing bonus resulted in a hemorrhaging of more than a dozen paramedics from Cleve­land EMS. Use of steep incentives are new, and it will be interesting to see assessments of their success in two to three years.

With such a significant investment in getting qualified applicants to consider your organization, one would assume the same level of effort would be made to get the word out about career opportunities and use of dedicated, professional recruiting staff to welcome candidates through the door. However, nearly 60% (59.7%) of organizations report having no one dedicated to their recruitment initiatives. Almost a quarter (23.2%) use certified EMS personnel with no professional recruiting or human resources experience to lead recruitment and hiring. Just 17.1% engage professional recruiters to help maximize the recruiting effort. Although the number of organizations in the sample using dedicated recruiting staff is down (30.8% versus 23.2%), the distribution is more evenly split between reassigned EMS personnel and professional recruiters.

Survey respondents were asked what methods of recruitment have yielded the most qualified applicants. Three methods stood out as the primary approaches: the organization’s Web site, local EMS programs and employee referral.

The Internet has reshaped the recruitment landscape. Your Web site is the first place applicants will go for a firsthand look at your organization. Almost one in four (23.2%) of responding organizations report their Web site is an effective recruitment tool. Many haven’t caught on to the value of their Web presence, lack the talent to develop a modern site or are caught in local government bureaucratic restrictions limiting what can be done. Your Web site is your first impression to the new generation of workers and needs to be a priority for recruitment and for delivering public safety information to the community.

Another popular strategy involves going to local EMS certification programs and recruiting students just entering the industry. This strategy has been found effective for 26.8% of organizations. The approach offers the advantage of allowing organizations to start with a fresh applicant and shape them into ideal employees before they have opportunity to pick up negative habits and attitudes. The downside is that they’re brand new and will require additional mentoring and support to build them up for independent practice.

Almost a third (30.4%) have found one of the oldest prac­tices to be the most reliable—employee referral. What could be better than having your own employees, who know the job well, recommend a candidate or spread the word about career opportunities? They credibly know the realities of working for you and have an incentive—not looking bad—in attracting only solid colleagues.

Several other recruitment strategies were reported as successful, including mailing lists/list servers (5.4%), EMS job sites (1.8%), non-EMS job sites (1.8%), trade journal advertisements (1.2%) and a recruitment booth at trade conferences (0.6%).

Improving awareness of your organiza­tion’s career opportunities and increasing the number of qualified applicants is the first step in recruitment. The next step is sifting through the applications, resumes and interview notes and picking the best candidates. EMS has long used experience and credentials as a first-line filter and hired for attitude second. This is the case in 30.9% of those responding, but similar to last year, more than two-thirds (69.1%) model their selection after best-practice organizations, like Whole Foods Market, Southwest Airlines and Apple; they hire for attitude first, recognizing they can mentor and train for skill performance.

Look around the room at an EMS conference session and you’re struck by a lack of significant diversity and an industry still dominated by males. Women have been steadily increasing their representation, but the ethnic and racial tapestry of the industry is in no way representative of the communities served. The EMS Workforce assessment notes that some efforts have been made in the industry to recruit diverse candidates, but admits the motivation has been rooted more in filling staffing shortages with an untapped worker population than attempting to foster diversity within the organization. Last year was the first time the JEMS survey asked organizations about their diversity and efforts to improve it.

Almost two-thirds (60.5%) of organi­zations responding to the survey don’t feel the diversity of their workforce mirrors that of the community it serves. The other 39.4% of organizations aren’t necessarily diverse workforces, but their staff may be representative of the populations served. Just over half (54.0%) indicate that increasing organizational diversity is a strategic goal, but just a third (33.5%) have actively altered their recruiting methods to achieve it.

Diversity in the EMS workplace continues to be an issue. Organizations should ask themselves what real and artificial obstacles stand between large segments of the potential workforce and careers in EMS. The answers may reveal issues needing to be addressed and strategic opportunities that could change your organization forever.

Retention & Turnover
It’s one thing to get an employee in the door, but how do you hold on to them in an environment where other organizations are constantly offering sign-on bonuses, lower productivity (aka, easier workload), and all the bells and whistles? The first step is to try to understand how your staff perceives their job and, if they leave, where they go and why.

An emerging strategy to check the vital signs of the workforce is to survey employees at intervals. This method has been growing in popularity with the wide selection of low-cost, quality online survey platforms, and 23.5% report deploy­ing in-house em­ployee satisfaction surveys. Recognizing that employees may not be comfortable freely responding to an in-house survey or that it may be hard for managers to be objective in reviewing the results, 14.0% of responding organizations use an independent third party to conduct the survey. Sadly, almost two-thirds (62.5%) of organizations don’t survey their workforce to help the leadership foster a satisfying workplace.

Unfortunately, every organization loses people. In many cases, it’s on positive terms where employees head back to school, pursue another profession or chase another public safety career that’s their primary passion. EMS organizations have little influence on these choices, and managers should be supportive of their staff. Separations that should concern an organization, on the other hand, are those that are preventable and those involving the loss of an employee to a peer EMS agency because their needs weren’t met at yours.

The most recent Bureau of Labor and Statistics data (2007) estimates total annual separations across all sectors at 39.7%. That includes voluntary and involuntary separations across all sectors. The attrition rate in EMS for full-time employees reported by this year’s respondents was 11.4%, which is almost four points below last year and the lowest in the past three years. It’s also significantly lower than the national average.

One of the conclusions drawn in the EMS Workforce assessment report was EMS providers have a high satisfaction related to the work they do. Further study would be needed to determine if this satisfaction attributes to the much lower attrition rate and may be a leverage point for further reducing attrition and improving overall job satisfaction.

The majority (84.1%) of respondents report the turnover rate is as expected and consistent with traditional separations for relocations, returning to school, transitioning careers and retirements. Only 15.9% reported high em­ploy­ee turnover and that employees are separating for better opportunities. Interestingly, org­­ani­zations that don’t perceive an unusually high turnover have an average turnover rate more than half of those that do perceive a problem (8.9% versus 22.0%). Less than a quarter (23.8%) of those with a perception of an attrition problem have any plan in place to address it compared with nearly a third (30.3%) of those with lower attrition rates.

A common strategy to learn why people leave your organization is the exit interview. Nine out of 10 (91.8%) organizations report conducting exit interviews either in person (71.8%) or using a paper or electronic survey instrument (13.6%). Surprisingly, less than half (44.2%) report the data is stored with human resources. Twenty-five percent (24.6%) regularly report the data in aggregate to the management team, and only 11.6% report using the data to change employee processes, begging the question, “Why ask if you’re not going to act on what you learn?”

Employees report they’re leaving to go back to school (11.5%) or changing professions (20.6%), and almost half (48.1%) are potential­ly preventable losses to other EMS agencies (15.3%) or fire departments (32.8%). Higher pay (44.3%) was the leading reason employees report leaving for somewhere else other than going back to school (see Figure 6).

An issue that continues to be a major consideration for all private industry and city and county governments is the approaching retirements of the baby boomer population. Not only may this be an issue in staffing, it’s also a major concern because of the organizational knowledge and expertise expected to be lost, especially if sound mentoring and succession planning aren’t in place. Respondents reported more than half (50.3%) of their managers are baby boomers and 40.8% are eligible to retire in the next 10 years. To minimize disruption, organiza­tions need to be recruiting, grooming and mentoring the leaders of tomorrow today.

Not Just Any Workplace
Whether we like to admit it or not, we spend more waking hours at work than at home. It’s understandable that our everyday work environment is important to our job satisfaction and that specific aspects, like shift schedules and staffing, would be of interest to benchmark.

Ambulances staffing traditionally fol­lowstwo models: 1) one size fits all or, 2) matching supply to demand. The one-size-fits-all model often involves fixed stations based on geographic coverage, population density or perceived call density, and staffing is the exact same 24-hours a day. This approach is used by nearly three-quarters (72.9%) of the organizations responding to the survey (see Figure 7). The remaining 27.1% use historical data to develop their schedules and actually match the supply of resources (staffed ambulances) to the demand (calls) and avoid periods of the day with too little or too much capacity.

Shift schedules are central to an employee’s life balance. Several methods can be used to determine who gets what shift. Responding organizations were evenly split between three prevailing methods for assigning shifts: 1) an objective shift-bid process based on performance and seniority (27.8%), 2) a solely seniority-based process (29.8%), or 3) management just makes the decision (33.1%).

The electronic tools used to manage and track scheduling are diverse. The most common programs used include: Telestaff (20.0%), Rescue Net Crew Scheduler (10.0%), Microsoft Excel or Access (22.5%), commercial calendars (e.g., Microsoft Outlook) (5.8%), and 4.2% used either When to Work, ePro Scheduler, Schedule Force, or EMS Manager.

EMS providers work varying shift lengths and average weekly work hours. This year’s salary data is calculated based on 2,080 annual work hours (a traditional 40-hour workweek), but average workweeks can be 36 hours (10.7%), 40 hours (17.5%), 48 hours (21.5%), 56 hours (28.2%) or a whole host of other lengths (22.2%).

Almost two-thirds (60.7%) report the majority of their shift lengths are the same. This finding would be consistent with the earlier mention that a majority of the systems rely on static, fixed scheduling. Having fixed shift lengths is also common because it’s simpler to manage and deeply rooted in tradition. The most common shift lengths include 8- (8.3%), 10- (2.8%), 12- (34.3%), and 24-hour (55.3%) shifts. The high utilization of 24-hour shifts remains concerning from a safety perspective (see Safety Section to follow). The decision to use extended shift lengths is not a patient-centered decision and puts crews and those they care for at risk.

Training & Skill Proficiency
As today’s providers watch reruns of Emer­gency! on Netflix, it may not be immediately obvious, but the training, advanced skills and responsibilities of today’s prehospital provider are much greater. The result is a need for increased attention to initial training, continuing education and skill competency.

When an employee enters your organiz­ation, it’s likely they’ll participate in orienta­tion to learn about human resources, policies, overall field operations, and to confirm skill proficiency before being cut loose on customers. This initial training and assess­ment is usually a combination of classroom, ride-along and direct-care experiences. The average reported number of total orientation training hours is 203, or a little more than five weeks (based on a 40-hour workweek). The subjects receiving the most attention include life-threatening clinical care (35.1 hours), non-life-threatening clinical care (22.2 hours), critical thinking skills (20.5 hours), emergency driving (20.0 hours), navigation (15.6 hours), policies and procedures (14.5 hours), patient documentation (13.4 hours), and customer service (12.1 hours). Orientation also includes preparedness training on disasters, hazmat and weapons of mass destruction. Where was the least number of hours committed? Ambulance billing (9.5 hours).

In just more than half (55.6%) of EMS systems, new employees are partnered with a field training officer versus a senior provider who may not have received training in adult education or mentoring. In addition, nearly three out of every four (73.5%) paramedics will be cleared to independent duty without going through a final sit-down with their medical director.

In addition to initial training, EMTs and paramedics require ongoing con­tinuing education (CE) to maintain their certifications and hopefully receive on­going development that challenges them to become better practitioners. About half (50.7%) of organizations conduct the majority of their CE in-house with existing staff trainers. Forty-three percent (42.6%) do a relatively equal distribution of in-house training and outsourced programming. Less than one in 10 (6.7%) outsource their entire CE programming to a training organization or community college versus managing it in-house.

Slightly more than half (51.3%) report that CE is evenly distributed between face-to-face classroom learning and online or video-based methods. Forty-two percent still rely completely on traditional classroom instruction and have not evolved to complement their programming with other methods of learning. Only 6.7% use only distributive methods like online or video-based learning. The small number may not be a reflection of the quality of distributive learning, but rather the rules and regulations of certification bodies that often mandate the amount of CE allowable through alternative methods.

Continuous learning is essential to the younger generations working the streets. The majority of organizations responding to the survey must recognize this concept because 51.7% report offering training at least monthly. Almost a third (32.0%) report offering training even more frequently, including 12.3% who offer on-demand or asynchronous training.

A common trend in a different direction is to move to quarterly training, which is less frequent, but allows for more focused time to be committed. A tenth (10.9%) of respondents report using this approach. Unfortunately, 5.4% of responding organizations report training only every six months to a year. This frequency may make sense from a budgetary (CE is largely funded by organizations in 84.5% of organizations) or convenience stance, but it’s likely ineffective at staff development.

In addition to CE considerations, it’s important to maintain high-acuity skills that may not be used with great frequency (e.g., intubation). In spite of several published studies, trade journal articles, and peer-reviewed papers arguing the contrary, 79.0% of survey respondents believe their EMTs and paramedics receive adequate live patient encounters and actual skill exposure to remain proficient at performing their clinical skills. Of those, however, 21.7% are guessing, as they don’t track skill exposure rates. In spite of the apparent confidence, 83.2% report having a program in place to confirm skill proficiency, and nine out of 10 (92.1%) confirm proficiency at least annually, with the majority doing monthly (11.4%), quarterly (21.1%) or biannual checks (14.0%).

Safe Workplaces & OJIs
Last year, the survey asked respondents to provide information about efforts to reduce workplace risk and improve safety based on the most recent peer-reviewed studies related to EMS work-related injuries. In addition, recognizing that on-the-job injuries (OJIs) reduce productive time and can be career-ending, the survey asked for specific data on a list of common injuries identified in peer-reviewed literature. This year’s survey repeated that inquiry.

For many years, organizations have reported they were safety-focused, but their actions were not reflective. Frequently, tracking, assessing and minimizing safety risks has been “everybody’s job,” which translates to “nobody’s job” or it was one of several responsibilities that a designated manager may have. This year, three-quarters (74.8%) of responding organizations report they have a designated safety officer.

OJIs: To gain perspective on the significance of EMS safety as it relates to OJIs, the survey asked respondents how many injuries were reported in their organization in 2007. The mean number of injuries per year reported for full-time providers was 36, or more than one per two-week pay period. Respondents report their organizations lost an average of 652 hours and 132 employee days due to injuries. The most common injuries reported were sprains, strains and tears (70.8%), cuts and lacerations (5.0%), fractures (1.3%), wounds (2.7%) and multiple trauma (1.0%). The most common injury location was the back (48.4%), followed by knees (17.8%), fingers (17.2%), shoulders (15.6%), multiple body parts (9.8%), and ankles (7.6%) (see Figure 8, p. 58). The troubling fact is that the majority of the injuries aren’t the result of dangerous calls, but routine lifting and moving, driving and other factors.

Provider fatigue: Can you guess which of the following professions have a legally man­dat­ed maximum of 14 hours of continuous work before a required break for recovery? Flight attendant, firefighter, EMS provider, long-haul truck driver, or airline pilot? Hint: It’s not the EMS workers or firefighters. Shift lengths were discussed earlier, and the results continue to show a high usage of 24-hour shifts even in busy urban centers, which raises a concern for crew safety.

Considering the widespread use of long shifts that can result in provider fatigue and increased safety risks, survey respondents were asked if they had a self-imposed policy restricting consecutive hours worked by an employee. Just under a third (27.8%) report not having a policy. Of those that do, the reported mean maximum allowable hours was 40 consecutive work hours, or the average citizen’s full workweek. The survey also asked if a policy existed establishing the minimum amount of time an employee must have off to recuperate before returning to duty. A third (33.6%) had no policy. Of the majority that did have some kind of policy, the mean was just 11.1 hours.

OJIs and a work culture that includes risky potential for fatigue continue to be an issue. Organizations are dedicating staff hours to a safety role, but is the industry able to change the status quo to reduce injuries and ensure staff are rested and ready to support each other and serve patients safely?

Employee Benefits
Although great attention is paid to the comparison of hard dollars an employee makes each pay period, what’s often overlooked is that the benefits package can be valued at as much as 30% of an employee’s total compensation package. Benefits include health and dental insurance, coverage for short- and long-term disability, tuition reimbursement, and retirement plans. This year’s survey asked responding agencies about the benefits they offer their employees—especially any benefits beyond the norm.

Figure 9 presents the benefits out­lined in the survey. Comparison with recent years doesn’t indicate any major shift that couldn’t be attributed to a change in the sample of respondents.

Respondents were asked again this year if their organization offered benefits that were unique or different than the norm, and again the majority reported traditional benefits. However, some of the more unique benefits include coordinated discounts with cell phone and other service vendors for employees, free cab rides, one-time loans to purchase a personal computer, pre-paid textbooks for school, and a bonus program for recertification.

More than two-thirds (64.8%) of respond­ing organizations report their employees take less than their accrued vacation leave each year. Vacation time can be taken anytime, but 67.4% admitted the time must be submitted well in advance through an inflexible process. Employee time off is critical in a stressful job like EMS and making it easy to use adds the “benefit” back to “benefit time” and is valuable to the younger generation of workers.

Salary Report
The survey continues to present salary data in the percentile approach used by the U.S. Bureau of Labor and Statistics and by human resources professionals (e.g., Salary.com). This method of reporting allows for better appreciation of how your salary compares with that of the survey respondents and what the median salary is by call volume and region.

In addition, discussion of the “market range” is included. This represents the normal range between the 25th and 75th percentile. In addition to using percentiles, the salary data has been recalculated using a uniform annual base hours of 2,080. This will allow the reader more of an apples–to-apples comparison, and Figure 3 is provided to help you convert any salary into an alternative shift (e.g., 56 hours). The changes in data presentation and calculation are intended to provide you the greatest ability to interpret the information and have it accessible to guide your organization’s compensation decisions.

Last year, the editorial team added six positions to the year’s survey: field training officer, fleet manager, billing clerk, billing manager, information technology manager and supply/logistics manager. Salary data for major positions surveyed is reflected in Figures 10 and 11 (below and p. 62).

Frontline personnel: Salaries for frontline posi­tions in the field and communications continue to have wide market ranges of as much as $10,000. Pay levels are similar to the means reported in 2007 with no significant growth or decline noted for any position.

Communications: Often the first true help to be offered to a person in need comes from a certified emergency medical dispatcher (EMD) who assures them help is on the way, confirms important details to enable reliable response, and provides life-saving instructions as ambulances respond. As communications continues to evolve as a career path and dedicated skill, we continue to watch for a trend in the growth of the compensation for the position. The median annual wage for an EMD is $36,286; the market range is $32,632.27 to $39,119.28.

As communications take on larger call volumes and employ more people, there’s a greater need for dedicated supervision and management to include communications supervisors on the floor and managers that lead the overall communications component of an EMS operation. The median income for a communication supervisor is $52,963.83; the market range is $46,866.46 to $59,099.10. Communications managers have a reported mean income of $75,798.34; the market range is $70,224.37 to $81,258.78.

Field operations: When an ambulance is dispatched to the scene, it’s traditionally staffed with a combination of emergency medical technicians (EMTs), EMT-Intermediates, orparamedics based on the level of service or crew configuration preferred by the jurisdiction. The median annual wage for an EMT is $28,196.99; the market range is from $25,066.80 to $33,229.80. EMT-Intermediates have a median wage of $27,588 (below an EMT-Basic); the market range is from $25,587.37 to $30,863.54. Paramedic annual earnings are usually about $10,000 greater than that of EMTs and EMT-Intermediates and that’s reasonably true this year with a median annual wage of $37,699.78; the market range is from $32,909.29 to $41,809.34.

If one works hard in the field, is a sound clinician and shows competencies for teaching and mentoring, they’re often considered for the first rung of the EMS career ladder—the field training officer (FTO). The position and its roles and responsibilities can vary greatly from service to service, but in general, it’s often only a small percentage increase above what an experienced provider makes. The median annual wage for an FTO is $45,538.47; the market range is wide from $40,783.54 to $51,085.13.

Although EMS management rarely comes with the proper training and preparation, it’s clear that good EMS field supervision and leadership from a dedicated operations manager are important to service delivery and field crew work satisfaction. The median annual wage for a field supervisor is $51,129.28; the market range is from $43,525.94 to $58,801.03. The operations manager, in charge of day-to-day operations and guiding field supervision, has a median annual income of $74,588.43; the market range is from $63,372.02 to $86,344.92.

The support team: The people on the ambulance represent the faces of an organization, but behind every great EMS operation is a whole host of dedicated and talented staffers and managers running components of the system to enable quality service around the clock to whoever calls. This includes billing, information technology, fleet, supply and logistics, and the senior managers of the organization.

Road readiness: Critical to running an EMS operation is the ability to maintain safe and stocked ambulances that are ready to roll. This requires a well-maintained and serviced fleet equipped with the needed supplies and equipment to accomplish the mission and minimize lost unit hours. Achieving that aim is the responsibility of the fleet manager and the supply/logistics manager. The median annual wage for a fleet manager is $61,285.71; the market range is wide from $55,515.47 to $68,582.88. The median annual wage for a supply/logistics manager is $59,669.23; the market range is wide from $48,655.15 to $69,170.91.

Enhancing the practice of medicine: In many organizations, attention is focused so heavily on unit hour utilization, response time compliance and reimbursement that the primary service can be overlooked. Whether public or private, EMS is a service business, and that service includes customer interaction, clinical care and responsible transportation. Two positions central to enabling EMTs and paramedics to be prepared to provide service are the education coordinators or managers who ensure providers know what to do and the quality coordinators or managers who frequently look at care that has already occurred to ensure the care provided matched the protocols. The median annual wage for an education coordinator is $62,830.78; the market range is from $54,354.62 to $69,913.35. The median annual wage for a quality coordinator is $63,240.44; the market range is from $57.857.07 to $68,708.92.

The information backbone: Even the smallest organization is now faced with a technology infrastructure to maintain. Web sites are the new front door of many organizations for reaching the public and recruiting, organizational communication now relies on e-mail, and not too far in the future every patient record will be captured electronically. The result is many mid-size to large organizations are hiring information technology expertise to manage their growing tech support needs. The median annual wage for an IT manager is $68,364.38; the market range is from $58,819.25 to $77,134.73.

Getting the word out: One would think the nature and value of emergency service work would be self-evident. As local tax dollars shrink and available funds are less abundant, ensuring a positive public presence is vital. Because keeping EMS in the news is strategically essential, many organizations are turning to dedicated public information officers (PIOs) to manage and feed local media. The median annual wage for a PIO is $65,518.14; the market range is from $61,696.51 to $75,095.14.

Every dollar counts: Although some organi­zations don’t rely on fee-for-service dollars for funding, the majority is heavily dependent on it to supplement local tax subsidy or as its sole funding source. Billing and collection services can either be outsourced to a third-party organization or managed by in-house staff, including billing clerks and a manager. The median annual wage for a billing clerk is $31,408.24; the market range is from $28,895.66 to $34,164.33. The median annual wage for a billing manager is $48,448.98; the market range is from $45,233.92 to $56,646.37.

Setting the course: The senior rung of an organization is often not clearly defined when you’re looking up from running calls in the streets, but the senior leadership team is critical to the organization’s overall success. Positions include the chief financial officer, administrative director and the executive director. The positions are a significant step above the more tactical processes or middle management positions and are focused on seeing the big picture and steering the organization in the right direction.

The median annual wage for a financial officer is $71,597.81; the market range is from $57,437.19 to $84,070.58. The median annual wage for an administrative director is $86,268.32; the market range is from $74,507.48 to $96,586.57. The median annual wage for an executive director is $97,353.31; the market range is from $81,567.28 to $115,573.40.

Overall: This year’s salary data provides an even clearer picture of current wage levels than last year and gives agency leaders a solid framework from which to benchmark local wages with traditional market ranges. Local variation will exist in some cases. Remember, wages are only one part of the total compensation employees receive, and it’s important to think about the total compensation package as well.

Conclusion
When it was created, the “JEMS Salary & Workplace Survey” aimed to take a snapshot of the industry to provide benchmark data and encourage improvement. A quarter-century later, the survey has fully achieved only one of those objectives. The survey continues to provide a snapshot of the industry and strives to evolve to make it as valuable as possible and push the industry forward. However, the industry has yet to respond en masse to strive to improve the EMS workplace, leaving the survey to report the status quo.

The EMS Workforce for the 21st Century report complements the efforts of the “JEMS Salary & Workplace Survey” in an attempt to hold a mirror to EMS to help stakeholders better understand their work environment and the industry. The missing link is that EMS organizations and communities need to stop looking outside for answers and must begin to look inward.

The data all point to opportunities for change. The key is EMS leaders breaking from tradition, culture, self-restriction and one-foot obstacles to making customer-focused improvements and, at the same time, improving the satisfaction and safety of the EMS workforce. You get to decide whether the future remains the same. What will you do to change course?

The author acknowledges the great support of the Fitch project team members and their contribution to the article: Sharon Conroy, Melissa Addison and Cindy Jackson.

References
1. National HighwayTraffic Safety Administration: EMS Workforce for the 21st Century: A National Assessment. May 2008. www.nhtsa.gov/staticfiles/DOT/NHTSA/Traffic%20Injury%20Control/Articles/Associated%20Files/EMSWorkforceReport_June2008.pdf

2. Acadian Ambulance Service Inc.: www.acadian.com

3. Gomez HJ, Baird G: “EMS workers in Cleveland are bolting to Memphis.” The Plain Dealer. www.cleveland.com/community/plaindealer/index.ssf?/base/cuyahoga/1206779.... xml&coll=2&thispage=1

4. Williams DM: “2007 JEMS Salary & Workplace Survey.” JEMS. 33(10):42–57, 2007.

5. U.S. Bureau of Labor and Statistics: www.bls.gov/opub/ted/2008/mar/wk2/art04.htm

6. Maguire BJ, Hunting KL, Guidotti TL, et al: “Occupational injuries among emergency medical services personnel.” Prehospital Emergency Care. 9(4):405–411, 2005.



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Related Topics: Training, Surveys Special Topics, EMS salaries,, JEMS salary survey, Jems Features

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David M. Williams, PhD

David M. Williams, PhD, is an improvement advisor at TrueSimple (www.truesimple.com), a quality improvement practice. He’s an improvement advisor for and on the faculty of the Institute for Healthcare Improvement. Contact Dr. Williams at 512/850-4119 or dave@truesimple.com.

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