The Fight to Recruit and Retain Paramedics

Henry Lewis came to a career as a paramedic by accident, starting as a volunteer firefighter and switching to emergency medical services 15 years ago. It was a fateful decision, he said, that “just happened.”

“I found EMS by accident,” he said. “But I feel like this is my calling. I can’t imagine doing anything else.”

In emergency medical services, people staying in the field for their whole career is increasingly rare. Across the country, local emergency services are struggling to recruit and retain EMTs and paramedics in the face of ongoing shortages, stagnating wages and increasing call volumes.

“There are definitely places that have classified shortages now, and I think those places probably have the same shortages in other health-care fields,” said Lewis, who serves as president of the South Carolina EMS Association. “As a profession, I think EMS is probably going to have to rethink what we do in terms of recruitment and retention, or we’ll all end up feeling the brunt of those shortages in the next decade.”

Staffing shortages “have taxed our response system, increased response times and left patients without adequate levels of care,” according to a 2015 article in the Journal of Emergency Medicine. But assessing the scope of the problem is difficult. There is no national standard that governs optimal staffing levels for emergent care, as needs differ greatly in different areas (in a rural community with residents spread across a wider geographical region versus a tightly packed urban center, for example).

Still, it’s a known problem, and one that’s likely to increase in the future as call volumes grow. Demand for EMTs and paramedics is expected to increase by 15 percent in the next seven years, more than twice the expected level of growth for all jobs, according to the Bureau of Labor Statistics.

There are multiple reasons for the struggle, including long hours, stressful working conditions and relatively low pay (paramedics and EMTs earn an average of $37,760, according to federal data). Stagnant wages and declining benefits have made retention an ongoing battle, Lewis said.

“It used to be folks would come into these types of jobs because of retirement benefits, pension, the longevity and the job security,” he said.

But he finds that pay is more of the focus with newer employees. “EMS is as much a calling as it is a profession," Lewis said. "Nobody really becomes a paramedic for the money—that’s not traditionally why you would do it, but the mindset is changing.”

Officials in South Carolina attempted to quantify the problem last year by surveying EMS agencies across the state about staffing levels, vacant positions and hiring trends. Half of the responding agencies had vacancies for EMTs and paramedics. Filling those jobs can take anywhere from four to six months, with no guarantee that the people hired will stay in the career track long term. Across the state line in North Carolina, for example, there are roughly 40,000 credentialed EMS workers, but many are working in other professions, said Jim Albright, a member of the state’s EMS Advisory Council and director of Emergency Services in Guilford County.

“People become involved in this career field and it opens up other opportunities in health care, so they use it as a transition,” Albright said. “We’ve lost four to (physician assistant) school here in the last three weeks. And that’s not uncommon.”

Low pay is a factor—in Guilford County, EMTs start at $12.18 per hour—but so is a general misperception of what constitutes EMS work. Many job candidates focus on the “Hollywood” side of it, Lewis said, and are surprised to discover that much of their day-to-day work is more routine health calls.

“Most EMS is not blood and guts. A lot of times it’s simply people who have barriers to traditional health access and are using the ambulance and the emergency department as primary care,” he said. “Folks can become frustrated with that. But in that moment, you are the person who is there to care for them, not to determine whether it’s right or wrong for them to be using the ambulance.”

Wholesale solutions are largely evasive, especially as interest in service professions overall seems to wane. In the past, Albright said, EMS recruited staff members from volunteer squads, but participation in those programs has declined over time. To address the issue, agencies have begun examining recruitment practices, including trying to reach high school students who are still considering their career options. Those efforts include establishing high school preparatory programs, including public safety academies, to introduce teenagers to the field.

“I don’t think we do a particularly good job of reaching kids in their early formative years of career choice,” Albright said. “We ultimately have not been able to make an impact in early career development, and that’s something that has to change as we examine solutions for the training pipeline.”

In South Carolina, the state association is working with tech schools to offer college-level credit to juniors and seniors who take EMT classes as part of vocational school, allowing them to begin working in EMS directly out of high school. Officials there are also preparing a second survey of EMS agencies, this one focused on education. If agencies mounted a big recruiting push in high schools, Lewis said, would the educational system be able to handle the additional load?

“We’re trying to understand and address the challenges,” Lewis said. “We are actively engaged in our role in public health and trying to come up with innovative solutions to serve the public, while also creating a better environment for our staff which can only help to bring more people into the field.”