Wanted: Paramedics
In January of this year, a newspaper headline in Gulfport, MS, warned, “Medic shortage nearing critical.” According to the article, there were not enough paramedics in southern Mississippi over the New Year’s holiday to staff all emergency calls. Authorities further warned that the situation was expected to become worse as paramedics were being recruited from as far away as Alaska. To illustrate the problem, in 2003, only six paramedics in Mississippi took the National Registry examination.
Some other recent headlines from across the country proclaim, “Paramedic shortage slows response – Sunstar has missed its goal for month,” “Paramedic shortage in Louisville” and “Paramedic shortage means bigger paychecks.”
Some areas of Connecticut are experiencing the same paramedic shortage and studies have indicated that sometimes there are only one or two paramedics on duty to cover vast areas. If the paramedic is on one ALS call, and another comes in, the call is handled by EMTs.
Fairfax County, VA, lost at least 38 paramedics in a recent three-month period, and the fire department is approaching the limits of its daily staffing requirements. According to an article in the Washington Times, most of the Fairfax County paramedics retired or dropped their advanced life support (ALS) certifications amid newly increased national requirements for paramedic education and on-going certification. In some situations in Fairfax County, paramedics are working 36-hour shifts in order to fill gaps.
A recent e-mail from a county fire department in Georgia to the International Association of Fire Chiefs (IAFC) looked for information related to “real or perceived” paramedic shortages. The department indicated it needs paramedics on all of its 23 engines and 16 ambulances to even come close to meeting the ALS response time standard of eight minutes, 90% of the time. According to the e-mail, the department’s problem is that it continues to promote paramedics cross-trained as firefighters to the upper ranks and does not have enough applications to fill the vacant positions.
A random visit to various state fire organization websites shows a clear need for paramedics as job postings are numerous. If you are a licensed paramedic and certified firefighter in California, you can almost write your ticket to whatever department you wish to apply to as numerous California fire departments are looking for qualified people.
Some departments have resorted to national advertising to recruit paramedics. Las Vegas Fire and Rescue ran one such national advertisement about five years ago and only 158 applications were received. Interestingly, there was no diversity in the applicants, since only one application was from a black person, and no women applied. Of the 158 applications, only 25 people passed the test, and after background and psychological evaluations, only 12 people were hired.
In 2001, Las Vegas Fire and Rescue again advertised for paramedics. That time, only about 100 applications were received and only 12 applicants met all the qualifications. A review of the professional trade journals shows that a number of other fire agencies have also resorted to advertisement to attract paramedics to their departments.
One of the most frequent questions I receive is, “Why is there a paramedic shortage?” I actually have several theories on this.
First, the new national curriculum for paramedics has reduced the number of paramedics who are graduating each year. Prior to the implementation of the new curriculum, most paramedic training programs lasted about one year. Now, the paramedic curriculum lasts two years.
Picture a funnel that represents the job market for paramedics. The bottom of the funnel represents those paramedics leaving the profession because of retirement, career change, promotion, etc. The top of the funnel represents those paramedics entering the profession from training programs. With the introduction of the two-year curriculum, the flow of paramedics into the top of the funnel has slowed and has not kept pace with those exiting the bottom of the funnel.
What is most interesting about the new paramedic curriculum is the group of educators from the University of Pittsburgh who were under contract from the National Highway Traffic Safety Administration to develop a new curriculum originally wanted to make paramedic training a four-year program. National fire service organizations strongly objected and the program was scaled down to two years. One can only imagine the impact on EMS systems today if the four-year program had been implemented.
Another reason I believe there is a paramedic shortage is because of the “me” generation. The “youngsters of the fire service” today are part of the “me” generation. Another term for “me” generation is the “X” generation. Generation Xers were born after the baby boom generation, typically between 1965 and 1985. Today, their ages range from 19 to 39. Generation Xers were brought up on television, Atari 2600s and personal computers. They are the generation that was raised in the 1970s and 1980s, and saw this country undergo a selfish phase. This has translated into self-indulgence and self-gratification first.
As a result of the “me” generation mentality, unless there is sufficient compensation or other benefits for becoming a paramedic, there is no incentive to get the training or if they do have the training, they may let their certifications lapse.
I believe another reason for the paramedic shortage is that a number of paramedics have moved into nursing, where pay is much greater and working conditions are more suitable and abuse much less.
Another factor I feel has contributed to the paramedic shortage is the proliferation of ALS or paramedic engines. With the arrival of “front-loading” EMS runs with ALS or paramedic engines, there is more of a need for paramedics. In some communities, only the ambulance had paramedics on them. Those same communities now have to also staff ALS or paramedic engines. One engine requires a minimum of three paramedics to staff three different shifts.
Unfortunately, I do not see any relief in the near future and I think the situation is going to get worse before it gets better. Those paramedics who are in the workforce are being subjected to overtime hours to fill empty shifts and are subject to being burned out.
On the positive side, licensed paramedics have their pick of who they want to work for. Many are shifting to employers that pay better, offer better benefits or have better organizations. Fire departments that have poor morale among their workforces typically will see paramedics leave and will have trouble recruiting replacements.
There are no immediate answers or quick fixes to this quandary. Fire administrators in the short term need to create tiered systems, offer better pay and other incentives, and look for other opportunities to retain and recruit paramedics.
Gary Ludwig, MS, EMT-P, a Firehouse® contributing editor, is the chief of Special Operations for Jefferson County, MO. He retired in 2001 as the chief paramedic for the St. Louis Fire Department after serving the City of St. Louis for 25 years. He is also vice chairman of the EMS Section of the International Association of Fire Chiefs (IAFC). He is a frequent speaker at EMS and fire conferences nationally and internationally, and is on the faculty of three colleges. Ludwig has a master’s degree in management and business and a bachelor’s degree in business administration, and is a licensed paramedic. He also operates The Ludwig Group, a professional consulting firm. He can be reached at 636 789-5660 or via www.garyludwig.com.