Administration and Leadership, Airway & Respiratory, Patient Care

It’s What You Know?: EMS pay may differ by organization type

Issue 8 and Volume 34.

Recent news reports have provided us with our next myth to bust. There have been reports that Congress was “stunned” by the salaries of the commuter airline pilots involved in the fatal crash in upstate New York that killed 50 people in February 2009. Congress was concerned that the low salaries and subpar working conditions of commuter pilots may discourage more qualified professionals, posing a safety risk. These reports also stated that, comparatively, major airline captains make sizeable salaries.„

This reminded us of our own reportedly less-than-ideal salaries and made us wonder if there are similar disparities in our profession. Before you go writing your Congress members, let_s take a closer look at EMS compensation.„


What We Know
We_ve heard rumblings that those in rural areas may not receive the same compensation as EMS professionals in urban areas. There has also been chatter by the proverbial water cooler that those who work for “government” departments (fire departments, third service, etc.) make more than those who work for non-governmental organizations (NGO) (privates, hospital-based). To bust this myth, we turned to “old faithful”: the LEADS project.„

For those who haven_t been keeping up with Mythbusters over the years, shame on you! LEADS is a longitudinal study distributed by the National Registry of EMTs and the National Highway Traffic Safety Administration. It_s sent annually to nationally certified EMS professionals throughout the country, and it has been useful in describing the workforce as well as helping us bust a myth or two. It just so happens that LEADS asks about compensation, community size and service type. Everything we need to tackle this myth!

We had to work with the data a bit. The LEADS question regarding compensation asks about yearly income earned from EMS-related jobs but doesn_t tell us if this income was a base salary, wages from part-time work, or if it included all that overtime we love so much. We combined this question with an additional LEADS question, which inquires about hours available for an EMS response in a typical week. We understand that when we work overtime, our hourly wages are increased, but this allows us to get a better idea of true compensation.„

To keep it simple, we excluded anyone who reported they were a volunteer, because there_s still no good understanding of volunteerism as it relates to paid compensation in EMS. For example, “traditional” volunteers report earning no EMS-related income, other people work full-time jobsandvolunteer, some volunteers get stipends, and others report earning quite a bit of EMS-related income. Similarly, we excluded individuals who reported working any number of hours without earning EMS-related income.„

This filtering process allowed us to avoid underestimating hourly wages. Then we had an acceptable estimation of hourly wages. We found out that nationally the median hourly wage was $10 for EMT-Bs and about $17 for EMT-Ps. Not too surprising.„

Next, we considered responses about community size. After crunching a few numbers, we were able to determine if there was a difference in pay based on the community in which respondents worked. It looks like city dwellers make more than country folkƒurban EMTs make $10 an hour versus $8 for rural providers, and urban EMT-Ps make $17 an hour versus $14 for rural.

LEADS also has a question about service type. Unfortunately, it wasn_t as easy as community size because LEADS doesn_t directly ask who works for government services versus NGOs. The LEADS service-type question has nine categories: fire-based, county or municipal third service, for-profit and not-for-profit private services, hospital-based, U.S. Federal Government (non-military), military, not affiliated, and other.„

We combined fire-based, county or municipal, U.S. federal government and military to form our government category. Our non-governmental category included everyone else, except those who responded as “not affiliated” with an organization; we omitted them from our analysis. And what do you know? Government EMT-Bs make $13 an hour versus $6 for non-government, and government EMT-Ps make $17 an hour versus $16 for non-government. It looks like there_s also a difference based on who you work for.„

Now, hold on tight, here comes the grand finale. We_ve determined differences in hourly wage for EMT-Bs and EMT-Ps based on community size and then based on service type (see Figure 1).„

What We Don_t Know
As always, let_s remember we_re only looking at nationally certified EMS professionals, and these individuals may be different from those not nationally certified. Also, we_re working with data obtained from a survey, the responses to which are all self-reported. These types of data have been shown to be not as reliable as information obtained from such direct measures of income as W-2s, paystubs, etc.„

Finally, take another look at the figure. It looks like rural EMT-Bs who work for NGOs make $5 an hour. Yeah, you read that right. If this is true, not only would that make a lot of people very mad, but it would literally be a crime! From July 2007 to July 2008, the federal minimum wage was $5.85, and for the rest of 2008, it was $6.55.„

We believe this discrepancy is again due to the volunteer conundrum. After further review, a substantial number of rural non-governmental EMT-Bs reported being available for an EMS response for more than 50 hours a week but only pulled in $5,000 or less a year. Keep in mind, these are individuals who said they weren_t volunteers, and if that_s true, we don_t have a good answer for why they_re making such a pittance. But again, research breeds more questions than answers.„

The other median hourly wages seem to pass the sniff test. We indeed found differences based on where providers work and who they work for. It may be the case that those who work for government services have more experience that those who work for NGOs, but that still doesn_t explain the differences among community sizes. Finally, we reported only crude estimates of hourly wages; we did not perform analyses to determine if differences were statistically significant.„

Verdict: Confirmed!
It appears salary in EMS depends on where you work and who you work for. We believe safety is one of the top priorities of EMS professionals, and we_re not making a claim that there_s a risk associated with less-than-ideal EMS income. We_ll leave that up to Congress.JEMS

Melissa Bentley,BS, EMT-P, is a research fellow at the National Registry of EMTs and is pursuing her master_s in public health. She_s been involved in EMS for three years.

Antonio R. Fernandez,MS, EMT-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.

Acknowledgement:We would like to offer our sincere condolences to the families of those involved in the fatal crash in New York that we refer to. This Mythbusters is not meant to exploit this tragedy but to instead highlight issues shared by both professions.

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