Tuesday, October 8, 2013
Michael Greene, MBA/MSHA
The editors of JEMS welcome you to the 2013 JEMS Salary & Workplace Survey, again in collaboration with Fitch & Associates, LLC—an EMS/public safety-consulting firm with nearly 30 years of experience in the industry. We present this EMS industry benchmark about salary with benefits and workplace factors for the EMS industry. For extended data not in the magazine, click the attachments to the right of the About the Data section below.
A television plays an afternoon talk show as 30-year-old Isabel “Bella” and 31-year-old Mateo “Matt” Garza sit in the obstetrics center waiting room. Excitement and a slight tinge of nervousness pulse between the couple while waiting to be seen by the doctor. Married for four years and with a 2-year-old at home, they wait for confirmation that a second child is on the way. As their obstetrician holds open the door to the exam room, both stand and walk toward the physician. She smiles and says, “I have good news for both of you.” Mateo, anticipating the results of Isabella’s pregnancy test, hopes his wife doesn’t sense his anxiety as he wonders if they can continue to make financial ends meet as a family of four.
The Garza family isn’t the only working family concerned about finances. Much attention has been focused on the 15 million people unemployed in the aftermath of the worst economic downturn since the Great Depression, yet even among those who have jobs, livelihoods and living standards have dropped substantially. Growing numbers of employed live in near poverty, struggling to make ends meet. According to a 2013 policy brief from the Working Poor Families Project, “New data from the U.S. Census Bureau show that the number of low-income working families in the United States increased to 10.4 million in 2011, up from 10.2 million a year earlier. This means that nearly one third of all working families—32%—may not have enough money to meet basic needs.”2
Bella is a swing shift supervisor at the Lowe County Regional Communications Center. She met her husband while working as a field medic for Lowe County EMS, when she responded to a call for an elderly woman. Matt had discovered his neighbor had fallen in her backyard and had placed a call to 9-1-1, fearing she had sustained a serious injury. Bella was impressed by the young man who stayed by the woman’s side, promising to care for the patient’s pet cat and finish watering the roses.
Sparks flew months later when, after teaching an EMT class Matt was taking, he approached her.
“Remember me?” he asked, approaching the lectern. “You came and took care of my neighbor when she fell.”
“Sure,” replied Bella. “You’re the kind guy who fed the cat and watered the roses.”
“That’s me. I want to thank you for the great care you gave Mrs. Montgomery, and, well, for the gift.”
“Gift? Wait, I’m confused,” Bella responded.
“Yeah, gift,” Matt offered with passion. “Watching you take care of Maxine really connected with me. I thought, ‘Wow, what a great job, I could do that.’ So I signed up for this class, and seriously I love it!”
A serendipitous beginning, Matt and Bella began dating after he finished the course, and he eventually went to work for a nearby private ambulance service.
Mateo, like many EMS professionals, was captivated by the job because it fulfilled a passion for helping others and provided a daily adrenaline dose of “super action hero.” Be it responding to a multivehicle accident scene or to an “I’ve-fallen-and-can’t-get-up” call, he loved it all. When he was selected for paramedic school, his tuition was “paid in full by his employer,” similar to nearly 45% of this year’s survey respondents. Similarly, Bella was able to pursue college courses because Lowe County offers tuition support like many of the organizations responding to this year’s survey (33% offer partial and 18% offer full college tuition reimbursement).
Looking for more regularity in her schedule and shorter shifts, while still needing to make ends meet, Bella accepted a position in the county dispatch center so she could attend business and leadership classes at the local community college. Bella also elected to work 12-hour shifts as it provided more time with her family.
This year’s data supports the premise that guided Bella’s decision to leave the field for the communications center. Paramedics and EMTs work an average of 47–50 hours per week according to the survey, whereas emergency medical dispatchers (EMDs) average only 43 hours in a workweek. Twenty-four-hour shifts are the most common staffing for paramedics and EMTs (58%) followed by 12-hour shifts (36%). Least common is a 48-hour shift (7%). In comparison, 25% of EMD’s reportedly work 8-hour shifts, 10% work 10-hour shifts and the majority (65%) work 12-hour shifts.
The Living Wage Standard
As a single household with single-income adults living on their own, Bella and Matt found that the EMS profession provided a comfortable income. Individually they were able to afford the basics for quality of life, shelter, food, clothing, utilities, transport, health care, recreation and occasional classes to upgrade their education. In public policy, a living wage or subsistence wage is the minimum income necessary for a worker to meet basic needs such as these.3 This standard generally holds that a person works 40 hours each week, with no additional income. In many cases, saving for retirement and, less commonly, legal fees and insurance, or taking care of a sick or elderly family member, are not included. It also doesn’t allow for debt repayment of any kind.
Now that Bella and Matt are a family of almost four, the concept of a living wage becomes prominent, especially if either loses a job. What they don’t realize is that the living wage movement began almost a century ago with the Catholic Church. According to a 2006 article in the National Catholic Review titled “The living wage and catholic social teaching,” author William Quigley’s chronology of the idea dates back to 1891 when Pope Leo XIII wrote “On the Condition of Workers.”4 Quigley details the commitment of the institution and its advocacy for a living wage to current day philosophy and practice.
The 2013 JEMS Workplace & Salary Survey queried respondents with the question, “Does your lowest-paid worker make a ‘living wage’?” Sixty-six percent of respondents representing EMS leadership indicated that their agencies did achieve a living wage for those lowest-paid workers. Quantitatively we compared a state from each of the 10 Federal regions against the 2013 regional results using The Living Wage Calculator developed by Dr. Amy Glasmeier and the Massachusetts Institute of Technology.5 (Author’s Note: States selected for the living wage comparison demonstrate the highest number of responses to the survey for that representative region.)
Tables 3 through 5 illustrate, according to our data, that the lowest-paid workers in EMS actually exceed the living wage in all ten regions for a single adult living on their own. An optimistic result indeed, but tempered with the statement that the calculator “is designed to provide a minimum estimate of the cost of living for low-wage families. The estimates do not reflect a middle-class standard of living.”5 Regrettably, we acknowledge that a family consisting of two adults and two children (assuming a single-wage earner) doesn’t achieve a living wage, according to this analysis.
Second Jobs & Fatigue Management
During a previous shift, Matt was cornered in the station kitchen by a well-meaning but often-pessimistic coworker who overheard his conversation with Bella about the potential pregnancy. Matt found himself peppered with words of wisdom from this coworker about “finding a second job to support the family” and “coming to work to get rest with a newborn at home.” Humoring his peer and maneuvering himself to the kitchen door, Matt made a hasty exit. Still, the conversation was not easily erased from his memory.
“At least half the guys I work with have second jobs,” he reflected. “What if Bella has to quit working?” Despite a quiet night at the station, Matt found himself sleepless and bleary eyed as he watched the sunrise announce the end of his shift.
True, survey participants estimate that more than 50% of their line EMS staff have second jobs. A second job seems to be common in EMS throughout the past four or five years according to our data, varying just a few percentage points around the 50% mark year-to-year. On-the-job fatigue remains a probable issue in the industry. Respondents reported that, “By policy the maximum number of consecutive hours an agency allows an employee to work before they are considered no longer eligible to continue working” is, on average, 37 hours. The minimum number of hours to “time-out” due to fatigue in 2013 was 15 hours, and the maximum number of continuous hours worked was 96 hours. Thus, given the industry-reported data, our fictional EMS professional would likely have a second job and suffer chronic fatigue. Following a “time-out” for fatigue, the industry reports an average mandatory rest period of 11 hours before returning to work.
EMS is not the easiest profession to balance work and family life. At a minimum, it requires an EMS professional to actively plan and execute a strategy that achieves a healthy and happy lifestyle. Work hours, job-related stress, and professional growth and development often come with a price to those closest to us—this is a personal and professional observation. We, as a profession, owe our appreciation to the unsung “heroes behind the heroes” in EMS: the families, friends and loved ones who support us in this noble profession.
Leaving the clinic, Bella and Matt join hands and simultaneously begin smiling ear to ear. At ten weeks, they still have a little time to adjust to a fourth member of the Garza family, yet at this joyous moment, they feel blessed with each other and fortunate to have good jobs in a profession they love. jems
1. Federal Trade Commision & Department of Justice. (August 1996.) Department of Justice and Federal Trade Commission statements of antitrust enforcement policy in health care statement 6: Enforcement policy on provider participation in exchanges of price and Cost Information. Federal Trade Commission. Retrieved July 13, 2013, at www.ftc.gov/bc/healthcare/industryguide/policy/statement6.pdf.
2. Roberts B, Povich D, Mather M. (2012.) Low-income working families: The growing economic gap. The Working Poor Families Project. Retrieved July 13, 2013, at www.workingpoorfamilies.org/wp-content/uploads/2013/01/
3. Gertner J. (Jan. 15, 2006.) What is a living wage? The New York Times. Retrieved June 19, 2013, from www.nytimes.com/2006/01/15/magazine/15wage.html?pagewanted=all.
4. Quigley W. (Aug. 28, 2006). The living wage and Catholic social teaching. America Magazine. Retrieved June 15, 2013, from www.americamagazine.org/issue/581/article/living-wage-and-catholic-social-teaching.
5. Massachusetts Institute of Technology. Poverty in America. (n.d.). The Living Wage Calculator. Retrieved June 15, 2013, from
http://livingwage.mit.edu, accessed 18 July 2013.
About the Data
The Web-based survey consisted of approximately 150 questions and allowed participants to voluntarily “skip” sections considered “not applicable.” Two hundred forty-four organizations (N=244) initiated the survey, which was more than last year—a return rate of 10% from a distribution of 2,454 invitations. Survey participation was open for a six-week period during May and June 2013.
Table 1: Participant Distribution shows the breakdown of provider types and their call volumes. The median of respondents serves populations of 50,001—100,000 and responds to 5,000 calls annually. This year nearly 50% of respondents represent public service providers (city, county or fire). 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 was achieved. (See Table 2: Federal Region Map.) All 10 federal regions are represented in this year’s data national salary rollup, but several job classes and regions didn’t 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 complete text of the guidelines as they relate to salary surveys can be accessed online. For the most relevant extracts, see Antitrust Safe Harbor on p. 38.
Participating EMS organizations were given the option to complete the survey anonymously. With this selection, the author and research staff are “blinded” to the email 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.
The “JEMS Salary & Workplace Survey” is a joint research project in collaboration with Fitch & Associates, LLC (www.fitchassoc.com). For 29 years, Fitch & Associates is the leading international emergency services consulting firm and serves a diverse range of clients.
Balancing work and family life can be difficult for someone with a career in EMS. It’s important to have a strategy to help achieve a healthy and happy lifestyle. Photo Matthew Strauss
The survey represents all federal regions, but no one responded from the individual states of Delaware, Maine, Mississippi, Hawaii, New Mexico, Montana and Wyoming.
244 participants in the survey resulted in a 10% response rate.
The median population served by respondents is 50,001
Median annual call volume is 5,000.
Nearly one-third (25%) of responses were from multi-role fire services.
Respondents reported, “In the past 12 months, has your agency experienced an increase (28%) or decrease (10%) or no change (62%) in employee separations?
Salaries grew an average of 6% across all job categories, exceeding the 1.8% rolling inflation rate (June 2012 through May 2013).
A single working adult in four of the EMS entry-level/line staff jobs (e.g., EMT, EMT-P, EM dispatch, communications supervisor) can achieve a “living wage” in all regions according to this survey. A single-income, two-adult household also meets the living wage calculation in many regions, but single-income households with dependent children may not achieve the living wage threshold in any region.
Single-digit reduction or elimination of employee benefits was reported in this year’s survey with healthcare and education leading the benefits loss.
Respondents estimate that more than half of full-time staff members have a second job.
EMTs/paramedics reportedly receive adequate live patient encounters and actual skill exposures to remain proficient at performing their clinical skills (65%), yet 15% of respondents have not implemented skill proficiency practice
and competency confirmation at regular intervals to assure high performance.
28% of agencies have altered continuing-education programs and funding due to the “current economic environment” through reduced offerings (10%), more in-house continuing education units (6%) and increased use of online education (11%).
71% reported “no” for the question, “Does your organization use incentives or penalties as part of your health coverage to address employee health issues that may be tied to
lifestyle (e.g., smoking and obesity)?”
65% of all organizations report an “in-house” or “third-party” stress management program.
50% of agencies answered “yes” to the question, “Does your agency have a formal policy or plan for fatigue management?”
The average answer to the question, “What is the maximum number of consecutive hours your agency allows an employee to work before they are considered no longer eligible to continue working?” is 36.9 hours, with a range from 16–96 hours.
The average answer to the question, “What is the minimum number of hours an employee must be off duty to rest/recuperate before being allowed to return to duty?” is 11 hours, with a range of 4–24 hours.
The accident rate among agencies calculates to be 1.97 accidents per 100,000 miles.
Job Descriptions for Salary Data
Emergency Medical Technician (EMT-B): Full-time emergency medical technicians with basic EMS skill levels that may include additional skills such as defibrillation, assisting patients with medications and first-aid, based on the current National Standard Curriculum (NSC).
Emergency Medical Technician-Intermediate (EMT-I): Full-time emergency medical technicians–intermediate based on the current NSC.
Emergency Medical Technician-Paramedic (EMT-P): Full-time emergency medical technician at the paramedic level, based on the current NSC.
Emergency Medical Dispatcher (EMD): Full-time emergency medical dispatcher and other frontline communications positions. Duties include call taking, dispatch or both. May also be certified as an EMT or paramedic.
Communications/Dispatch Supervisor: First-line supervisor of emergency medical dispatcher(s). Duties may include shift supervision, scheduling, performance evaluation, call taking and dispatch. May also be certified as an EMT or paramedic.
Communications Manager: Senior management position of the EMS communication center. May oversee all operations, budgeting, hiring and quality and strategic planning.
Field Training Officer: Full-time field training officer. Duties include field training of new employees or EMT students at all levels. May be a full-time position or performed as part of regular shift work.
Education Coordinator: Entry-level management position. May be charged with providing or coordinating continuing medical education, overseeing field training and supporting recertification of staff. In some organizations, duties may be blended with the quality management functions.
Quality Coordinator/Manager: Traditionally, an entry-level management position. May be charged with coordinating and managing key clinical performance indicators (e.g., cardiac arrest survival) and quality assurance (e.g., run form review and complaint investigation). In some organizations, duties may be blended with the quality management functions.
Financial Officer/Manager: Full-time management position focused on budget and finance. May also have blended duties related to the oversight of billing operations.
Billing/Reimbursement Clerk: Frontline position responsible for processing patient care records, billing payers and collecting reimbursement for services.
Billing/Reimbursement Manager: Traditionally, middle management position responsible for supervising the processing of patient care records, billing payers and collecting reimbursement for services.
Fleet Mechanic: Frontline mechanic in fleet services. Duties may include preventative maintenance, scheduled/unscheduled maintenance, vehicle remounting/replacement and purchase specifications.
Fleet Manager: Middle management position charged with leading fleet services. Duties may include supervising mechanics, coordinating preventative maintenance, vehicle remounting/replacement and purchase specifications.
Information Technology/Systems Manager: May be a management position. Responsible for maintaining technological infrastructure (e.g., email, servers and networks) of the organization.
Logistics/Supply Manager: May be management position. Responsibilities may include supply purchasing, storage, distribution and tracking. May also manage restocking of stations or ambulances.
EMS Operations Manager/EMS Chief: Middle- to upper-management position responsible for managing day-to-day operations. May have field supervisors and other frontline leadership positions reporting directly to them.
Administrative Director/EMS Administrative Chief: Senior-level management position. Traditionally includes oversight of all non-operations functions and may include finance, billing/reimbursement and human resources.
Executive Director/Highest-Ranking EMS Chief: Senior leader of all EMS functions. Duties include strategic planning, constituent relations, and leading senior management team.
Antitrust Safe Harbor
Provider participation in exchanges of price and cost information
The agencies will not challenge, absent extraordinary circumstances or 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 is managed by a third party (e.g., a purchaser, government agency, healthcare consultant, academic institution or trade association).
Information provided by survey participants is based on data more than three months old.
There are at least five providers reporting data upon which each disseminated statistic is based, no individual provider’s data represents more than 25% on a weighted basis of that statistic, and any information disseminated is sufficiently aggregated such that it would not allow recipients to identify the prices charged or compensation paid by any particular provider.