june 2007 ucsf center for health profession 1 the national emt/paramedic workforce: an assessment of...

June 2007June 2007 UCSF Center for Health ProfessionUCSF Center for Health Profession 11

The National EMT/Paramedic The National EMT/Paramedic Workforce: An Assessment of Workforce: An Assessment of

What We Know and Don’t What We Know and Don’t Know Related to Supply and Know Related to Supply and

Future DemandFuture DemandIAFFIAFF

June 25, 2007June 25, 2007

Susan A. Chapman, PhD, RNSusan A. Chapman, PhD, RNUCSF Center for Health ProfessionsUCSF Center for Health Professions


Description of ResearchDescription of Research

Research GoalsResearch Goals To conduct a systematic assessment of the To conduct a systematic assessment of the

national EMS prehospital workforce including national EMS prehospital workforce including interviews, surveys, key stakeholder interviews, surveys, key stakeholder meetings, and an assessment of existing data meetings, and an assessment of existing data and research and research

Address size and demographics of workforce, Address size and demographics of workforce, training and education pathways, supply and training and education pathways, supply and demand trends, volunteering, and demand trends, volunteering, and compensation compensation


Research QuestionsResearch Questions

What are the major challenges facing the EMS What are the major challenges facing the EMS workforce?workforce?

What does the existing research and data What does the existing research and data suggest are the major factors impacting suggest are the major factors impacting workforce supply and demand?workforce supply and demand?

What models predict workforce needs for the What models predict workforce needs for the EMS system?EMS system?

How can the data and research contribute to How can the data and research contribute to developing a workforce agenda and strategy for developing a workforce agenda and strategy for the future?the future?


Assessment MethodsAssessment MethodsLiterature review and analysisLiterature review and analysisKey informant interviewsKey informant interviews

focus on rural and volunteer workforcefocus on rural and volunteer workforceAnalysis of secondary data from Analysis of secondary data from

national data setsnational data setsSurvey of training directorsSurvey of training directorsAnalysis of LEADS data and NREMT Analysis of LEADS data and NREMT

re-registration surveyre-registration surveyModerated blog discussionModerated blog discussion


Consensus ProcessConsensus Process Steering CommitteeSteering Committee

Formulated research questionsFormulated research questions Identified stakeholders and key informantsIdentified stakeholders and key informants Reviewed draftsReviewed drafts

Stakeholder MeetingsStakeholder Meetings 14-16 organizations represented14-16 organizations represented Met twice, one more meeting plannedMet twice, one more meeting planned Formulated research questionsFormulated research questions Identified key informantsIdentified key informants Responded to draftsResponded to drafts Developed list of policy issues and prioritizedDeveloped list of policy issues and prioritized

Next stepsNext steps Agenda for the future documentAgenda for the future document Stakeholder reviewStakeholder review Implementation stepsImplementation steps


Workforce ModelingWorkforce Modeling Workforce can be viewed from the Workforce can be viewed from the

perspective of:perspective of: Supply-what impacts the number of credentialed Supply-what impacts the number of credentialed

providers availableproviders available Demand-what impacts the number of jobsDemand-what impacts the number of jobs Need- how many workers to meet needs of the Need- how many workers to meet needs of the

poppop Conceptual models developed to understand Conceptual models developed to understand

inflow and outflow of workersinflow and outflow of workers Theory comes from economics, organization Theory comes from economics, organization

behavior, public health, other disciplinesbehavior, public health, other disciplines


National EMT & Paramedic Workforce SupplyNational EMT & Paramedic Workforce Supply

Immigration/ Population

growth

_ _ _

U.S. POPULATION

Out-

migration/ Population

decline

AFFILIATION

Capacity; Marketing;

Recruitment; Prerequisites/ Requirements;

Interest

I I

_ _ _

ENROLLED IN EDUCATION PROGRAM

Non-completers

AFFILIATION

Cost, Prerequisites/ Requirements

I I _ _ _

CERTIFICATION

Expiration/ Revocation

AFFILIATION

Cost; Prerequisites/ Requirements

I I

STATE LICENSURE

Revocation/ Expiration

Demand

AFFILIATION

Retirement/ Retention

Active practice; Skills;

Procedures; System design

WORKFORCE

CONTRIBUTION


What Do We Know About the What Do We Know About the Current EMS Workforce?Current EMS Workforce?

National data has limitations:National data has limitations: EMT and paramedics combined in most EMT and paramedics combined in most

national databasesnational databases Cross-trained firefighters; how to count, who Cross-trained firefighters; how to count, who

to countto count Data from other sources very limitedData from other sources very limited Uneven data collection at the state levelUneven data collection at the state level

2005 EMT/Paramedic Employment per 100,000 Population, by StateSource: US Census Bureau; BLS Occupational Employment Statistics survey

0 20 40 60 80 100 120 140 160 180

District of ColumbiaWisconsinOklahomaMissouri

MaineSouth Dakota

KentuckyOhio

IllinoisTennessee

PennsylvaniaNorth Dakota

South CarolinaKansas

West VirginiaRhode Island

GeorgiaMassachusetts

ArkansasNorth Carolina

IndianaMinnesota

MarylandIowa

DelawareWyoming

ConnecticutNew Hampshire

MichiganColorado

UtahAlabamaMontana

LouisianaVermont

TexasNew York

New JerseyNew MexicoMississippi

HawaiiArizona

WashingtonFlorida

VirginiaIdaho

NevadaAlaska

CaliforniaOregon

Nebraska

Comparing 2005 Levels of Total Employment: EMTs & Paramedics vs. Select Allied Health Occupations

Source: BLS Occupational Employment Statistics

95,320196,880

710,020

382,720

1,391,430

2,368,070

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

2005

To

tal E

mp

loym

ent

Respiratory Therapists EMTs & Paramedics

Medical Assistants Licensed Practical/Licensed Vocational Nurses

Nursing Aides/Orderlies/Attendants Registered Nurses

Comparing 2005 Level of Employment: EMTs/Paramedics, Fire Fighters & Police/Patrol Officers

Source: BLS Occupational Employment Statistics survey

196,880

282,180

624,130

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

EMTs/Paramedics Fire Fighters Police & Sheriff's Patrol Officers

20

05

To

tal E

mp

loy

me

nt

Comparing % Growth in Employment 2000 - 2005: EMTs/Paramedics vs. Select Allied Health Occupations


5%

8%

15% 16%

19%

9%

0%

5%

10%

15%

20%

25%

Licensed Practical/Licensed Vocational

Nurses

Registered Nurses Nursing Aides/Orderlies/Attendants

RespiratoryTherapists

Medical Assistants EMTs/Paramedics

% G

row

th in

Em

plo

ym

en

t 2

00

0 -

20

05

Comparing % Growth in Employment 2000 - 2005: EMTs/Paramedics, Fire Fighters & Police/Patrol Officers


12%

19%

9%

0%

5%

10%

15%

20%

25%

Police & Sheriff's Patrol Officers Fire Fighters EMTs/Paramedics

% G

row

th in

Em

plo

ymen

t 20

00 -

200

5

2005 Mean Age, by Occupation Source: Current Population Survey Outgoing Rotation (series)

44

43

42

39

39

38

37

35

0 5 10 15 20 25 30 35 40 45 50

Mean Age

Registered Nurses Licensed Practical/Vocational Nurses

Respiratory Therapy Nursing/Psychiatric/Home Health Aides

Police & Sheriff's Patrol Officers Fire Fighters

Medical Assistants EMTs & Paramedics

2005 Percent White, not Hispanic by OccupationSource: Current Population Survey, Outgoing Rotations (series)

80%

78%

76%

72%

69%

66%

47%

81%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

% White, not Hispanic

Respiratory Therapy Registered Nurses

Fire Fighters Police & Sheriff's Patrol Officers

Licensed Practical/Vocational Nurses Medical Assistants

Nursing/Psychiatric/Home Health Aides EMTs & Paramedics

2005 Percent Female by OccupationSource: Current Population Survey Outgoing Rotation (series)

93%

93%

89%

89%

58%

14%

4%

29%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Percent that are Female

Licensed Practical/Vocational Nurses Registered Nurses

Nursing/Psychiatric/Home Health Aides Medical Assistants

Respiratory Therapy Police & Sheriff's Patrol Officers

Fire Fighters EMTs & Paramedics

2005 EMT/Paramedic Median Hourly Wage, by State Source: BLS Occupational Employment Statistics survey

$0 $5 $10 $15 $20 $25

AlaskaDistrict ofMaryland

HawaiiOregon

New YorkWashington

Rhode IslandMassachusetts

ConnecticutColoradoDelaware

NevadaVirgin Islands

IdahoNew Jersey

New HampshireMinnesota

New MexicoMichigan

North CarolinaFlorida

South CarolinaGeorgia

IllinoisOhio

VirginiaIndiana

NebraskaVermont

North DakotaWyoming

TexasCaliforniaMissouri

IowaLouisiana

WisconsinUtah

PennsylvaniaMaine

TennesseeArizona

MississippiKentuckyArkansas

South DakotaAlabama

KansasMontana

OklahomaWest Virginia

Puerto Rico

Comparing 2005 Median Hourly Wages: EMTs/Paramedics vs. Select Allied Health Occupations


$12.54

$10.31$12.19

$16.94

$21.70

$26.28

$0

$5

$10

$15

$20

$25

$30

$35

EMTs/Paramedics Nursing Aides/Orderlies/Attendants

Medical Assistants Licensed Practical/Licensed Vocational

Nurses

RespiratoryTherapists

Registered Nurses

20

05

Me

dia

n H

ou

rly

Wa

ge

Comparing 2005 Median Hourly Wages: EMTs/Paramedics, Fire Fighters & Police/Patrol Officers


$12.54

$22.25

$26.82

$0

$5

$10

$15

$20

$25

$30

$35

EMTs/Paramedics Police & Sheriff's Patrol Officers Fire Fighters

20

05

Me

dia

n H

ou

rly

Wa

ge


Is There Evidence of a Is There Evidence of a Shortage?Shortage?

Key informants: shortages vary by sector Key informants: shortages vary by sector and geographyand geography

No data on sectors: govt, privateNo data on sectors: govt, privateData does not suggest that wages are Data does not suggest that wages are

outpacing inflationoutpacing inflationNo national data on vacancies No national data on vacancies No national data on overtime workedNo national data on overtime workedSome use of incentives, recruitment bonusSome use of incentives, recruitment bonus


Workforce ProjectionsWorkforce Projections

Changing population demographicsChanging population demographicsExits and entrants into the occupationExits and entrants into the occupationEconomic projectionsEconomic projectionsHistoric employment ratesHistoric employment rates


EMT/Paramedic Employment ProjectionsEMT/Paramedic Employment Projections

27.3% growth over next decade27.3% growth over next decadeBLS classifies as “much faster than BLS classifies as “much faster than

average”average”Net replacement is Net replacement is

“positive”—”separations exceed “positive”—”separations exceed entrants” into the professionentrants” into the profession

BLS projections are likely low due to BLS projections are likely low due to data limitations; no volunteers or cross-data limitations; no volunteers or cross-trained firefighters includedtrained firefighters included


Comparing Estimates of Projected Employment: EMTs & ParamedicsSource: BLS Occupational Employment Statistics survey; BLS Employment Projections Program;

Census Bureau Population Estimates

196,880

255,000

266,000

150,000

175,000

200,000

225,000

250,000

275,000

Estimated Total Employment in 2005 Projected Number of Job Openings in 2014

To

tal E

mp

loy

me

nt

Forecast using known Employment per Population Ratios

BLS-published Forecast


What Do We Know about EMT What Do We Know about EMT and Paramedic Education?and Paramedic Education?


AMA: Accredited Paramedic Programs AMA: Accredited Paramedic Programs in the U.S.in the U.S.1985 - 20041985 - 2004

178

132

96

72

20

0

20

40

60

80

100

120

140

160

180

200

1985 1990 1995 2000 2004Source: AMA Health Professions Education Databook (series)

IPEDS: EMT/Paramedic Graduates IPEDS: EMT/Paramedic Graduates by Type of Awardby Type of Award

N = 19,833N = 19,833

Masters 0%

Certificate 2-4 years

0%Bachelors

0%

Associates 9%

Certificate 1-2 years

15%

Certificate < 1 year

75%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Type of AwardSource: 2005 IPEDS Completion Survey

Reported Counts of Reported Counts of Paramedic GraduatesParamedic GraduatesAccredited Programs: Accredited Programs:

1997-20041997-2004

0500

10001500200025003000350040004500

1997-1998

1998-1999

1999-2000

2000-2001

2001-2002

2002-2003

2003-2004

Year

Nu

mb

er

of

Gra

du

ate

s

Source: AMA Health Professions Education Data Book (series)


Key Informant Data: Key Informant Data: Supply/Demand Issues Supply/Demand Issues

DominatedDominatedWorkforce ShortageWorkforce ShortageRetentionRetentionRecruitingRecruitingGetting higher or more fair Getting higher or more fair

pay/benefitspay/benefitsProfessionalizing/career laddersProfessionalizing/career ladders


What is your major What is your major concern about the EMT and concern about the EMT and

paramedic workforce?paramedic workforce? ““There ain't enough of 'em. It's a chronic There ain't enough of 'em. It's a chronic

undersupply.”undersupply.” ““We don't have enough of them and we don't We don't have enough of them and we don't

know where to find them.”know where to find them.” ““Our challenge is to slow down exit from the Our challenge is to slow down exit from the

industry and retain workers longer.” industry and retain workers longer.” "Keeping up with attrition isn't good enough "Keeping up with attrition isn't good enough

but I'd be happy just to do that. It will get but I'd be happy just to do that. It will get worse as the baby boomers retire."worse as the baby boomers retire."


What Is Your Major What Is Your Major Concern About the EMT and Concern About the EMT and

Paramedic Workforce?Paramedic Workforce? ““Professionalism and pay. Adapting to a Professionalism and pay. Adapting to a

changing patient population. The geriatric changing patient population. The geriatric population will triple. It will require population will triple. It will require paramedics to be smarter and to have more paramedics to be smarter and to have more pay.” pay.”

““The need to professionalize and have more The need to professionalize and have more career EMS. The need for appropriate career EMS. The need for appropriate training and job pathways; advanced training and job pathways; advanced opportunities. We need more uniform policies opportunities. We need more uniform policies state-to-state and more appropriate pay.”state-to-state and more appropriate pay.”


Key Informant Educators had Key Informant Educators had a Range of Concernsa Range of Concerns

What skills should be taught at the basic What skills should be taught at the basic and paramedic levels? What really makes and paramedic levels? What really makes a difference in patient outcomes?a difference in patient outcomes?

One educator said enrollments had One educator said enrollments had increased, but others said enrollments and increased, but others said enrollments and interest in the field are downinterest in the field are down

Educators said clinical internships and Educators said clinical internships and field preceptors are in short supply, can field preceptors are in short supply, can prevent programs from growingprevent programs from growing


Educators on Recruitment Educators on Recruitment and Retentionand Retention

““Salary is somewhat of an impediment.”Salary is somewhat of an impediment.” Some programs mislead by romanticizing the Some programs mislead by romanticizing the

work; creates mismatch between work; creates mismatch between expectations and reality – must recruit right expectations and reality – must recruit right people for the jobpeople for the job

Easier where services fire-based; better Easier where services fire-based; better pay/benefits, a career ladder, 24-hour shifts pay/benefits, a career ladder, 24-hour shifts lead to flexible scheduling and they can work lead to flexible scheduling and they can work on the sideon the side


Demographics of the Rural and Demographics of the Rural and Volunteer EMS WorkforceVolunteer EMS Workforce

58% volunteer are male (LEADS survey)58% volunteer are male (LEADS survey)39 average age for volunteers (LEADS 39 average age for volunteers (LEADS

survey)survey)Most volunteers are EMT levelMost volunteers are EMT levelRural areas rely heavily on volunteersRural areas rely heavily on volunteers


VolunteerVolunteer EMTs and EMTs and Paramedics Paramedics

Larger proportion of volunteers in rural Larger proportion of volunteers in rural EMS than urban EMSEMS than urban EMS lack of standard definition of rurallack of standard definition of rural

Difficult to assess total workforce Difficult to assess total workforce contribution of volunteers because:contribution of volunteers because: Not in most national data setsNot in most national data sets Are variable, part-time, and/or on-call Are variable, part-time, and/or on-call

workersworkers


Quote from IOMQuote from IOM

40 years have gone by since the 1966 40 years have gone by since the 1966 report- Accidental and Disability:the report- Accidental and Disability:the Neglected Disease of Modern Society Neglected Disease of Modern Society marking the birth of EMS.marking the birth of EMS.

IOM- ”…today the system is more IOM- ”…today the system is more fragmented than ever, and the lack of fragmented than ever, and the lack of effective coordination and accountability effective coordination and accountability stand in the way of further progress and stand in the way of further progress and improved quality of care.”improved quality of care.”


Thank youThank you

Thank you to funders:Thank you to funders:

National Highway Traffic Safety National Highway Traffic Safety AdministrationAdministration

Health Resources and Services Health Resources and Services Administration, Emergency Medical Administration, Emergency Medical Services for Children ProgramServices for Children Program

june 2007 ucsf center for health profession 1 the national emt/paramedic workforce: an assessment of...

Documents

workforce supply

ems workforce

workforce agenda

demographics of workforce

existing research

formulated research

assessment of existing

key informants