The strength and stability of the EMS workforce in the United States is of significant public health concern following increasing reports of local and state workforce shortages. The challenges faced by frontline EMS clinicians and EMS agencies have not gone unnoticed and prompted the EMS research community to take action through replicable and reputable peer-reviewed research.
What questions are commonly asked by the EMS community, and what research has been done to answer them?
1. Are there less EMS clinicians entering the field each year?
Looking at initial certification data over the past 10 years from the National Registry of Emergency Medical Technicians, representing those entering the workforce, there has been an average growth of 4.3% each year.1 However, there are varying national estimates of the overall EMS workforce.
Survey data from the Bureau of Labor Statistics reports 261,000 EMS clinicians while surveys from the National Association of State EMS Officials (NASEMSO) estimate approximately one million EMS clinicians.2,3 The only population-based analysis of the EMS workforce comes from the National Registry, whose nationally certified population accounts for 474,622 EMTs, AEMTs, and paramedics as of 2022.1
Recently published in JACEP Open, an analysis of the entry, staying, and leaving of EMS clinicians in nine states and territories found a net growth of 7.6% over 2 years (2017-2019 or 2018-2020).4
2. Does initial certification act as a barrier to entering the EMS workforce?
Using EMS program educational data from the Committee on Accreditation for the EMS Professions (CoAEMSP), more potential paramedics were lost to the workforce (i.e., did not obtain certification or licensure) from not completing their educational program (21%) compared to not attaining national certification (11%).5
Using data from the State of Virginia from 2018-2019, similar trends were observed with 26% lost due to not completing their educational program, compared to not obtaining national certification (14%).6
3. Are EMS clinicians still working mostly on the ambulance?
Yes, they are. In a large research study conducted by the National Registry, over 30,000 survey respondents were asked about their primary role in EMS. The proportion of paramedics, AEMTs, and EMTs primarily working in emergency response (9-1-1) was 75%, 84%, and 79%, respectively.
The second and third largest roles for all three certification levels were clinical services (e.g., emergency department, outpatient settings, hospital care) and non-emergent medical transport.6
4. Do we know the rate at which EMS clinicians leave the workforce?
No comprehensive national dataset captures EMS leaving using consistent and replicable estimates that can be compared over time. The American Ambulance Association surveyed a convenience sample of EMS agency leaders and found turnover estimates ranging from 6% to 36%, varying by certification level and role.
To follow workforce dynamics over time and provide more accurate estimates, the National Registry evaluated full state-based populations of EMS clinicians requiring certification for licensure. In these populations, turnover estimates varied from 16% to 26% and were higher among those with patient care roles.
5. What are the drivers for EMS clinicians to leave the workforce?
In surveys conducted by the National Registry, pay is no longer the primary reason for leaving the EMS profession. Instead, this has been replaced by job stress.6 A more detailed analysis of these respondents showed that higher odds of leaving the workforce within one year were associated with low job satisfaction and needing more than one EMS job to make ends meet.
Continuing to assess stress and burnout, an additional study found that burnout estimates nearly doubled from 2015 to 2022 and were associated with intention to leave the profession within one year.6
As the EMS profession and our associated questions continue to grow, researchers should continue to be responsive to the needs of EMS clinicians. This direction is particularly true regarding workforce challenges impacting the daily lives of EMS clinicians.
References
1. Gage CB, Powell JR, Cash RE, Panchal AR. Prehospital Workforce Changes: 10-Year Evaluation of National Registry Certifications. Prehospital Emergency Care 2023:1-2. DOI: 10.1080/10903127.2023.2249566.
2. Bureau of Labor and Statistics. Occupational Outlook Handbook, EMTs and Paramedics. (https://www.bls.gov/ooh/healthcare/emts-and-paramedics.htm).
3. National Association of State EMS Officials. 2020 National Emergency Medical Services Assessment. 2020.
4. Kurth JD, Powell JR, Gage CB, et al. Evaluating changes in the emergency medical services workforce: A preliminary multistate study. J Am Coll Emerg Physicians Open 2023;4(3):e12975. (In eng). DOI: 10.1002/emp2.12975.
5. Ball M, Powell JR, Gage CB, et al. Paramedic educational program attrition accounts for significant loss of potential EMS workforce. J Am Coll Emerg Physicians Open 2023;4(2):e12917. DOI: 10.1002/emp2.12917.
6. The Menegazzi Scientific Sessions: Research Abstracts from the 2023 National Association of EMS Physicians Annual Meeting. Prehospital Emergency Care 2023;27(sup1):S1-S96. DOI: 10.1080/10903127.2022.2138658.
7. Association; AA, 360; N, Consulting; D, Research TCfO. AAA/ Newton 360 2021 Ambulance Industry Employee Turnover Study. (https://ambulance.org/sp_product/2022-ems-employee-turnover-study/).
