The “JEMS Salary & Workplace Survey” is a joint research project in collaboration with Fitch & Associates, LLC (www.fitchassoc.com). For 28 years, Fitch & Associates is the leading international emergency services consulting firm and serves a diverse range of clients.
About the Data
The Web-based survey consisted of approximately 150 questions. It allowed participants to voluntarily “skip” sections they considered “not applicable.” Two hundred twenty-one organizations (N=221) initiated the survey - a return rate of 10% from a distribution of 2,411 invitations. Survey participation was open for a five-week period during May and June 2012. Figure 1, p. 32, shows the breakdown of provider types and their call volumes.
The median of respondents serves populations of 50,000 and responds to 5,000 calls annually. Total respondents are noted as “n =” for each dataset where possible. In some instances, data was limited, not available or not applicable for all respondents. For example, respondents may answer call volume but not provider type, which means that “n” can change from dataset to dataset.
A representative sample of participation from provider organizations in each region of the U.S. and across all system model designs (see Figure 2, p. 34) was achieved. All 10 federal regions are represented in this year’s data national salary rollup, however several job classes and regions did not reach required participation for reporting.
Salary reporting follows Department of Justice and Federal Trade Commission issued Statements of Antitrust Enforcement Policy in Health Care.1 The text of the guidelines as they relate to salary surveys can be accessed online; the following are the most relevant extracts:
The agencies will not challenge, absent extraordinary circumstances, provider participation in written surveys of a) prices for health care services, or b) wages, salaries or benefits of health care personnel, if the following conditions are satisfied:
The survey represents all federal regions. But the individual states not responding were Massachusetts, New Hampshire, Vermont, Delaware, District of Columbia, Nevada and Wyoming.
This year, participating EMS organizations were given the option to complete the survey anonymously. Thirty-six respondents selected this option. With this selection the author and research staff are “blinded” to the e-mail or IP address of the respondents. Regardless of how information is submitted, raw data is only available to the research staff and author, and only aggregate data is published.
Data accuracy is a primary objective. Survey results may be limited by the accuracy of respondent submitted data, organizational selective participation and an inconsistent pool of respondents year-to-year. Ambiguous, unclear or incomplete answers were unilaterally excluded from the dataset, rather than interpreted by the author, thus creating a potential additional bias.
JEMS 2012 Salary & Workplace Survey
In the JEMS 2011 Salary & Workplace Survey, we followed a long day in the life of fictional character Duke Gracie, a field training officer and veteran paramedic at Flowing Springs EMS (FSEMS). For 28 years, running the JEMS Salary and Workplace Survey, conducted in cooperation with EMS consulting firm Fitch & Associates, provides insight and understanding on key human resource topics. Continuing on the narrative from a year ago, we’ll check in not only on the fictional Duke Gracie, but also his boss Margaret Taylor and FSEMS.
This year, we find Duke as a newly minted community paramedic, looking like a new man who is refreshed and self-assured. In a freshly pressed uniform, Duke steps out of a Flowing Springs EMS Community Paramedic rig and pulls his sunglasses down over eyes in the bright early morning sunlight. “Another day in paradise, saving lives and stomping out disease,” he thinks as he smiles to himself.
In EMS, the human element—be it patient or provider—is the driving force in the system. As Michael F. Staley wrote in Igniting the Leader Within, “Knowing how to motivate a person in emergency medical services requires that you understand the person, the passion and the paycheck—in that order.”(2)
After his internal struggle in this past year’s survey, Duke is now passionate about his work. “It’s not like building widgets in some factory,” he tells family and friends. “I save lives, and get paid for doing it. I can’t imagine doing anything else!” (Doing something else was exactly what Duke was pondering a year ago, but more on that later.)
Recruitment, Hiring & Retention
“I haven’t been ‘texted’ about open shifts in months now,” Duke comments as he walks into the FSEMS Communications Center. “Maggie must have gotten my replacement hired.”
“Yup, you’ve been replaced,” replies Lyndy Grayson, the communications supervisor. “We got hundreds of hits on Monster and our Facebook page, tens of qualified candidates from Maggie’s Tweet and a huge response from the buzz on the streets. Your job was as hot as a software IPO [initial public offering].”
“Tweet, Monster, Facebook, IPO … this sounds like ‘Maggie speak’ to me,” Duke responds with a snort. “Kids these days don’t use the same language as they used to.”
Although these terms might sound unfamiliar to Duke, Flowing Springs EMS Executive Director Maggie Taylor leverages the same technology in her recruitment strategy as her industry colleagues. Recruitment via an “agency website” (31%) takes a narrow second to “employee referral” (32%) in this year’s survey results. Other job websites, such as Monster.com and CareerBuilder.com (10%), as well as electronic mailing/list-servs (7%), round out the technological approach to recruiting. Trade journal ads (4%) and conference booth recruiting (6%) are the least-used tools to find new employees, while local EMS training programs (23%) continue to be fertile ground to fill job openings.
Seventy-six of 221 agencies reported vacancies within their organizations. They reported an average of three vacancies in 2012, down from five in 2011.(3) Additionally, agencies continue to use part-time EMS personnel (67%) with nearly 30% reporting an increased interest from applicants in part-time employment.
Of key frontline EMS positions, organizations continue to report a shortage of paramedic staff (39% vs. 40% in 2011) with an increase in a shortage of emergency medical dispatchers (28%), which is up 10% from 2011. The EMT-Basic category continues to exhibit a low percentage of reported shortages (18%).
When positions are available, Flowing Springs EMS is able to hire qualified candidates that they recruit. Similarly, 83% of survey respondents report “hiring as usual” with a single-digit minority saying “hiring is on hold or frozen” (greater than 6%).
Training, Education & Medical Control
“Turn and burn,” quips Duke. “Those newbies are in and out of orientation quickly; they’re in the field at breakneck speed.”
“It’s like a well-oiled machine,” Lyndy comments. “We’ve got the orientation process dialed in.”
Little has changed this year over last in the subject matter covered in new employee orientation (e.g., policies, patient care guidelines and customer service). What has changed are the average hours the employee spends in orientation. In 2011, respondents indicated that 240 was the average number of hours of orientation training required for new EMS employees. The average number of hours in orientation has dropped to 160 hours for 2012. A concurrent drop in the “average length of time (weeks) an employee new to your organization spends in the clearance/probation process before they are considered a fully functional and independent member of field staff” is noted in 2012 data. This is down from 10 weeks in 2011 to seven in 2012.
“What’s Dr. Mark’s stance on this ‘speed training’ process?” Duke asks Lyndy.
“I guess I don’t know,” she responds. “He’s been a bit overcommitted to the new community paramedic (CP) training.
“Between that and trips to the rural health clinic, he hasn’t been as hands-on as in the past,” she adds, looking at a closed office door marked with “Mark Mangus, MD—Medical Director.”
Duke thinks about how unusual that is, remembering the days when he and Mangus ran calls together.
“Maggie needs to talk to him,” Duke tells Lyndy. “Now that the CP program is up and running, he needs to get back in here.”
Only 30% of “new employees who have completed their probationary credentialing process must complete an interview with a medical control physician as the final step to clearance.”
Worse yet, following the probationary credentialing process, some field employees (22%) “never” meet one-on-one with the medical control physician. Furthermore, in 2012 organizations reported field staff only met with the medical director “when needed” (67%).
Although the American College of Emergency Physicians (ACEP) doesn’t specify how much face-to-face time a medical director needs to spend with EMS caregivers, ACEP has stated that it “believes that all aspects of the organization and provision of basic (including first responder) and advanced life support emergency medical services (EMS) require the active involvement and participation of physicians.”(4)
How much time does your medical director spend one-on-one with field staff?
Few organizations report that continuing education (CE) content is developed and delivered solely “in-house” (9%) or entirely “outsourced” (15%); in fact, most use “both” (76%). CE occurs in a “traditional classroom” at 40% of the agencies responding. Less than 2% use “distributive methods” (e.g., video and the Internet) exclusively; most, or 58%, use both methods. Monthly CE occurs at 49% of organizations, more frequently than monthly at 27%, quarterly at 16% and on-demand at 13%.
Duke’s former partner and field trainee Dave stops as he’s walking by. He leans in the door, “Hey old man, how’s it going with the new job?” Duke stands and they shake hands and exchange backslaps.
“Good,” Duke responds. “We’re always doing more; it’s job security, you know.”
“It’s not enough to be a paramedic and field training officer. No, Duke’s got to be a community paramedic too,” mocks Dave. “Looking to the future’s not a bad thing,” responds Duke, “Do more, or someone else gives you more to do. Besides, if I can make the system work even better, then I’ve made a difference.”
“It’s all about productivity,” Lyndy chimes in. “I’d rather be in Duke’s shoes than handing out parking tickets.”
City managers in a Tennessee community may have found a win/win on productivity and budget. Firefighters in Oak Ridge will be issuing parking tickets according to one online publication.(5) Whether it’s to generate revenue or boost productivity, doing more with less is the new norm.
As director of Flowing Springs EMS, Maggie knows it’s imperative that the service operates in an economically sustainable and accountable model. Mention productivity to staff, and you can see a visible shudder. If she mentions unit hour utilization (UHU), she can almost hear the chorus of moans. As a visionary leader, she sees great potential for a win/win in her new community paramedicine program.
As uncertainty over the financial impact of the Patient Protection and Affordable Care Act (PPACA) leads the media headlines and political campaigns, some EMS systems are looking to expand their role in healthcare. PPACA places increased priority on prevention, wellness and improved outcomes within a healthcare system. According to Wikipedia.com, “An accountable care organization [ACO] is a healthcare organization characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients.”
Can EMS do more? For a UHU calculator, see Figure 3, p 34. Using this year’s respondent data, participant UHU is presented in Figure 4, p. 34. Reported annual response volume and average unit hours were distributed by 52 weeks per year to determine an average UHU. Comparing that UHU to several published benchmarks the conclusion is clear.(6–8) There’s capacity to do more within many EMS organizations, whether it be writing parking tickets or becoming more accountable for the health of your community. If you had to choose between the two, it doesn’t seem to be a difficult decision; EMS is at its best when it’s caring for patients.
Can CP programs make a difference? According to the Agency for Healthcare Research and Quality (AHRQ), they do.(9) MedStar Health’s Community Health Program in Fort Worth, Texas, has saved millions in emergency room charges and reduced 9-1-1 use.(10) The Centers for Medicare and Medicaid Services (CMS) must think so as well. In July, the CMS Health Care Innovations Grant program awarded Prosser Memorial Hospital in Washington almost $1.5 million to develop and provide a community paramedic program.(11)
Which model for community paramedicine should you choose? It could be a “new niche for EMS,” according to the August JEMS article “It Takes a Village.”(12) The article identifies the key component of the multiple CP models as the needs of and resources in the community. “They all feature aspects of home assessment, home care and patient follow-up. They all focus resources on target population, follow-up care and prevention,” the article states. The take-home message: “Community need” should drive model development and implementation, creating a partnership in the healthcare of the community.
In May 2012, the U.S. Bureau of Labor Statistics (BLS) reported that the unemployment rate ticked up a tenth of percent to 8.2.(13) Yet a February 2012 BLS report on employment projections opened with, “Industries and occupations related to healthcare, personal care and social assistance … are projected to have the fastest job growth between 2010 and 2020.”(14)
Listed as one of the “top five industries for salary growth,” healthcare workers have gained the biggest changes in wages, 9.4%, since 2006.(15)
What does that mean to EMS workers? There’s reason for some optimism in EMS wages. Twelve job categories from the 2006 JEMS Salary and Workplace Survey were compared to 2012 data (See Figure 5, at left).(16) Despite losses in two individual categories, EMS salaries increased 8% over that timeframe. This increase places EMS with general healthcare as one of the best jobs for wage growth.
Not all the news is good. Organizational “belt tightening” is reflected in the 2012 Employee Benefits data (See Figure 6, below left.). Twenty of 25 benefits categories were reduced or eliminated this year. Taking the biggest hits, the categories of EMS reimbursement (5%) and college tuition reimbursement (6%) and new employee relocation expenses (4%) were eliminated by organizations reporting.
Show Me the Money
“Daylight is burning,” declares Duke as he ends the conversation and heads toward the Communications Center for a schedule of today’s community visits. During his workday Duke will visit a number of “frequent flyers” that have been identified within the healthcare community as needing screening and help with chronic care.
One of Duke’s congestive heart failure patients wrote in recent thank-you card to FSEMS that Duke saved him from an ambulance trip to the hospital. “He listened to me breathe, took a blood pressure and made a complete assessment. Then he called my doctor, who adjusted my pills. He did all of this before I was really sick,” Mr. Write wrote, adding that Duke even stopped by later to check on him again that day, concluding with a thank you to both Duke and FSEMS for good community service.
National salaries for 2012 are broken down into several categories and stratified by region (see Figure 7, at right) and call volume (see Figure 8, p. 40). The job descriptions used in the survey are also presented in “Job Descriptions for Salary Data,” p. 36–37. Regional data is reported where antitrust guidelines were achieved. All wages are adjusted to reflect a 40-hour workweek for comparison. See Figure 9, p. 40, for instructions on calculating wages for comparison to different shift lengths.
Author’s note: Comparing 2012 salary data to 2011 appears unreliable due to a qualitative participation bias. Data reported for 2011 national average salaries was significantly higher than data reported in 2010 and 2012. As previously noted, selective participation and a different pool of respondents year-to-year creates this situation outside of survey and researcher control. Visit jems.com/journal and click on the salary survey for an extended figure with additional job categories not shown here as well as a complete comparison of 2011–2012 data.
Out of 19 job categories, 14 reported salary growth in comparison to 2010 wages. The billing manager position showed no growth in wages between 2010 and 2012 (see bonus salary figure online at jems.com/journal).
EMTs and education coordinators demonstrated a moderate loss in wages, minus two and minus four percent respectively. Chief financial officers (CFO) and supply coordinators took the greatest wage losses at -9% and -14%, respectively.
A just-released Pew Research Center survey reports that a $70,000 annual income is needed for a family of four to lead a middle-class lifestyle in the U.S. Using the Pew study definition of middle-class lifestyle, only three of the EMS job categories—operations manager, administrative director and executive director—would allow a single-income family of four to live middle-class lifestyle.(17) In comparison, a registered nurse receives an annual salary of approximately $70,000.18,19 It’s no wonder that EMS often experiences a migration of EMS personnel to nursing professions.
Duke considers the opportunity that the community paramedicine program has provided him to be a good one. “It’s not just a paycheck. I get to help people before they need an ambulance. I get to spend some time helping them stay out of the ambulance and hospital,” he thinks. “And it saves the system money. How great is that?”
Considering the current state of jobs and employment in the U.S. today, EMS is looking pretty good. Although the profession’s future might not quite be bright enough for “dark sunglasses,” wage growth has been a bright spot in an otherwise depressed U.S. job market. EMS innovation, aimed at serving the population and cutting costs, has demonstrated benefit and value to healthcare. Community paramedicine is a key component in future ACO success.
Based on the quantitative reductions in education, training and tuition reimbursement, EMS leaders and providers in all sectors of the industry are cautioned that short-term economic gains may hinder future EMS capacity and capability. Further, a family-oriented EMS employer must consider that many EMS workers households are supported by two working adults in order to maintain a middle-class lifestyle. Flexible staffing, scheduling, childcare and sick childcare may be a key component of workforce recruitment, retention, employee satisfaction and loyalty.
Circling back to Staley’s motivational theory in EMS, it’s the person who brings the passion that gives the “heart” to EMS. A paycheck is meaningless if you lack the understanding of those human components.
Acknowledgment: The author acknowledges the support and contributions of Fitch project team members Sharon Conroy, Melissa Addison and Cindy Jackson.
Disclosure: The author is an external, expert consultant with the consulting firm Fitch & Associates, LLC, which provides emergency service organizational and system audits for communities and individual organizations.
Note: If you’re an EMS service with paid staff that did not participate in this year’s survey but would like to include your agency data next year, please e-mail the author.
1. Department of Justice and Federal Trade Commission. (August 1996). Statements of Antitrust Enforcement Policy in Health Care Statement 6: Enforcement policy on provider participation in exchanges of price and cost information. In Federal Trade Commission. Retrieved July 13, 2012, from www.ftc.gov/bc/healthcare/industryguide/policy/statement6.pdf.
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5. Fowler B. (July 12, 2012). Car parked near hydrant? OR firefighters might write you up. In Knoxville News Sentinel. Retrieved July 16, 2012. from http://www.knoxnews.com/news/2012/jul/12/car-parked-near-hydrant-or-firefighters-might-up/.
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12. Berry J. It Takes a Village. JEMS. 2012;37(8):42–47.
13. U.S. Department of Labor. (n.d.). Databases, Tables & Calculators by Subject. In Bureau of Labor Statistics. Retrieved July 12, 2012 from http://data.bls.gov.
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15. Ritter T. (July 16, 2012). Best and Worst Jobs for Wage Growth [infographic]. In Payscale. Retrieved Aug.2, 2012, from http://blogs.payscale.com/compensation/2012/07/prevailing-wage-rates.html.
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17. Pew Social & Demographic Trends. (Aug. 22, 2012). Fewer, Poorer, Gloomier: The lost decade of the middle class. In Pew Research Center. Retrieved Aug. 22, 2012, from www.pewsocialtrends.org/files/2012/08/pew-social-trends-lost-decade-of-the-middle-class.pdf.
18. Bacon D. Results of the 2011 AORN Salary and Compensation Survey. AORN J. 2011;94(6):536–553.
19. U.S. Department of Labor. (May 2011). Occupational Employment and Wages: 2011;29-1111 registered nurses. In Bureau of Labor Statistics. Retrieved Aug. 5, 2012, from www.bls.gov/oes/current/oes291111.htm.