Careers in Emergency Medical Services can be deeply fulfilling. But staffing and retention continue to be huge problems for the industry. Why?
EMS providers are underpaid.
There are a variety of complex forces that push salaries for EMS to the bottom of the healthcare industry’s pay scales. A primary factor is the funding structure of EMS agencies. The way EMS is currently billed and funded makes the service free to community members… until they actually need the service. As healthcare has become more expensive overall, both public and private payers have reduced what they are willing to pay for these services. This squeeze on revenues leads to an inevitable need to reduce personnel expenses, which are the largest component of EMS budgets[1].
Another contributor to the low pay of EMS providers is the resistance to formal education within the profession. This resistance can negatively affect prevailing wages[1]. The certification required to become an EMT or paramedic is relatively minimal, which can also contribute to lower wages. It only takes 120 to 150 hours of training to become an EMT, and ambulances in rural communities are often staffed by volunteers, which depresses wages for those who do pursue the role as a career[2].
Discrimination also plays a role in keeping wages low. For instance, in New York City, EMS workers have claimed that gender and racial discrimination keep their wages low and their prospects for advancement limited, making them “third-class citizens.”[3] The workforce of EMS in New York City is predominantly women and minorities. On the other hand, the FDNY (of which EMS is a division) has a predominantly white leadership. According to City data, FDNY EMS is 59% non-white, 89% male, and 12% female but women and minorities make up only 11% of the FDNY EMS workforce at the rank of Deputy Chief and above (2019 data).”[4] While these trends may not directly dictate low wages across the entire industry, the effect of discrimination reverberates throughout staffing and retention. If you may get stuck in a low-paying role, why start in the first place?
The pay structure for EMS workers is also influenced by the perceived nature of the work, which is often viewed as less high-risk and stressful than other public safety jobs. The rising number of attacks on EMS personnel indicates otherwise. According to the U.S. Centers for Disease Control and Prevention, 2,000 EMS professionals are injured every year in violence-related incidents. Despite the dangers, EMS workers are often paid less than other first responders like firefighters and police officers[5]. Again, using NYC as an example, the starting pay for a FDNY EMS EMT is just $35,000, a wage difficult to live on anywhere but nearly impossible as a living wage in NYC. Starting pay for cops is $42,500 and $45,000 for firefighters. Pay for EMS is tops out at $50,000 while fire and police can earn $100,000 or more as they advance.[6] Why aren’t EMS first responders compensated for what they do on the same scale as these other lauded first responders?
Lastly, the depth and difficulty of EMS roles is largely misunderstood, which can lead to underappreciation and underpayment. Despite efforts to raise the profile of EMS practitioners, EMTs and paramedics are still rarely viewed as integral contributors and providers within the overall healthcare system. EMS workers are often the first line of defense in keeping populations alive, especially in the face of crises like the opioid epidemic. Or take for example the Eagle Pass Fire Department in Texas, which is spending tens of thousands of dollars per day taking care of migrants who’ve crossed the southern border – without any federal assistance.[7]
The underpayment of EMS providers is a complex issue that is influenced by an equally complex ecosystem of factors, including the funding structure of EMS agencies, resistance to formal education, discrimination, widespread ignorance of the high-risk nature of the work, minimal certification requirements, and a lack of understanding and appreciation for the role of EMS workers as a vital component of public safety. It’s going to take a massive effort on the part of EMS agencies, their allies, and their constituents to change these misconceptions.
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