Sowing the Seeds: Part 2

      In March 2008, EMS Magazine published a study conducted by the EMS office at Loyola University Medical Center in Maywood, IL. That study surveyed a large number of EMT-Basic students in its area to investigate their backgrounds and expectations of careers in EMS.¹

   Our first study, entitled "Sowing the SEEDS" (SEEDS stood for the Study of Employment Expectations and Demographics of EMT Students), produced results both expected and surprising. Well over half (63%) of EMT-B students had plans to go on to receive EMT-Paramedic licenses, but a large number were pursuing their licenses as a requirement to work in the fire service, not as EMS professionals. Many of these students were young, with some college education but little to no insight into the EMS field or the differences between becoming an EMT-B or EMT-P. With recruitment and retention issues still among the biggest challenges for the EMS profession, we wanted to expand our research to examine EMT-P students--a project that has not been undertaken and published before.

   We distributed a survey instrument consisting of 25 questions to instructors of EMT-P classes throughout the Midwest and selected other states. Additional programs were recruited during a national EMS conference, with several programs volunteering to participate. The majority of programs and students were located in Illinois (73% of participants), with the rest from Missouri (15%), Arkansas (7%) and Indiana (4%). A total of 23 programs agreed to participate, with 18 (78%) sending back completed survey instruments. Survey responses were collected from August 2007-November 2008. We obtained approval with waiver of consent from the Loyola University Medical Center's Institutional Review Board and consent from the lead instructors at each surveyed location. We included a cover letter with the survey explaining the goals of the project, informing students that participation was voluntary, and assuring that responses would remain anonymous. The survey was administered to students within the first two weeks of class and mailed back to the researchers.

RESULTS/DISCUSSION

   Subjects returned a total of 246 out of a possible 275 surveys (89%) from the 18 different locations. The demographics of EMT-P students are shown in Table 1. Students taking EMT-P classes were mainly young adults. More than half (54%) were 24 and younger, and more than three-quarters (78%) were 30 and younger. The majority of students (79%) were male, and 70% reported their marital status as single. This is in line with multiple prior studies showing that EMT-Bs and paramedics are among the youngest allied health professionals.²

   Interestingly, about half of participants recently obtained their EMT-B licenses, and the majority had at least one year of work experience. Although paramedic program entrance requirements vary by state and program, the most basic and universal requirement is an EMT-B license. Of the respondents, while 52% had received their EMT-Bs within the last year (2007-08), 35% reported having no experience as an EMT-B. Why are these students pursuing EMS careers? What are their expectations? Our students are coming to programs with some higher-education experience, which is good, but a large number have had no true medical experience or exposure prior to receiving their EMT-B licenses. Instructors need to be aware of this. For students who had worked as EMT-Bs, work experience was very diverse, and was often obtained with fire or private ambulance companies.

   Similarly, when asked about their level of familiarity with EMS, 5% of respondents indicated they were "somewhat or very unfamiliar," whereas 95% said they had "average" or "greater than average" familiarity with EMS. This is an improvement in comparison with the EMT-B students surveyed a year ago, of whom 22% indicated they felt either "somewhat unfamiliar" or "very unfamiliar" with the profession. In this study, we also found that 42% of respondents have or had family members in the EMS field. We had hypothesized that having family members in EMS would be associated with individual respondents' choices to enter the field, but results were inconclusive on this point.

   Again in this study, similar to the original "Sowing the SEEDS," the percentage of students with college education was a notable finding. Almost 9 of every 10 EMT-P students had at least some higher education. This raises several questions and has immediate implications for EMS educators. Are students leaving college to pursue careers in EMS because they were not previously aware of it as an option, or are students leaving college because it is not a good match for them and their career aspirations? Programs may need to consider recruitment strategies in the high school population in order to give the students career information early on. Also, if the college setting is not working, what should EMS programs be changing to better meet the academic needs of their students?

STUDENTS AND THEIR CLASSES

   Although it was not a strong focus of our study, we wanted to ask a couple of questions to try to determine why students were signing up for paramedic classes (Table 2). The vast majority (92%) responding said they had voluntarily enrolled in paramedic school; the other 8% were required by their employers. In our previous study, we addressed a trend in the Loyola system of many students enrolling in EMT-B programs as a requirement for fire department jobs. Our current study is in contrast with our previous findings, as most EMT-P students identified with being a paramedic as opposed to a firefighter.

   When assessing current students, it is imperative to realize that 88% of respondents plan on working while in paramedic school. Often paramedic school is a full-time commitment, averaging about a year to complete. Combining the commitments of a paramedic program and a job can be challenging for students. Are coordinators designing their curricula to accommodate students' already overloaded schedules? Should more part-time program options be explored? The goal should be to set up programs to help students succeed, and not set them up for failure with unrealistic expectations. In our current survey results, 10% of students were returning after leaving programs, and 52% of those who left paramedic programs withdrew for personal reasons or time issues, not for academics. Also adding to time-management challenges is that almost one-third of the students were traveling significant distances every day to class (greater than 20 miles). One positive component is that 65% of the students working during paramedic school planned on working in the medical/fire setting, which can enhance their learning and promote better job performance.

EMPLOYMENT GOALS AND EXPECTATIONS

   What students will do after successful graduation must be something EMS educators explore with their students. It should be an interactive process that allows for discussion and feedback. We are not doing the field any service by simply graduating students who are unfamiliar with the EMS field or job opportunities available to them. Table 3 summarizes our findings concerning students' employment expectations. Consistent with the EMT-B survey findings, a large number of students planned on pursuing higher education or additional certifications after receiving their EMT-P licenses. The largest percentage of EMT-P students, 68%, planned on obtaining licensure as critical care paramedics. Interestingly, this license is not recognized by many states or the NREMT. Are these students hoping to gain employment in aeromedical programs or with critical transports on the private side? If so, an issue that arises is that these highly specialized jobs are often location-dependent--they can require relocation and prior clinical experience. Do these students plan on working for a time as paramedics, or are they looking at the license as a stepping stone? Or are they attracted to other healthcare jobs for potentially greater incomes and advancement opportunities? Again this underscores the importance of EMS instructors educating students about their profession and gaining greater understanding of their students' perceptions and expectations.

   Concerning future employment, 38% of paramedic students planned on working at fire departments where they were currently employed, and 44% planned on waiting until completion of their programs to start looking for paramedic jobs. Only 11% were currently looking for paramedic jobs. A large number (82%) of students hoped to work in the fire service. However, research has shown that most employed EMT-Bs/paramedics are found in the private ambulance industry (40%), followed by local government (30%) and hospitals (20%).³ Employment with a fire service can be quite difficult to come by. If it's not obtained prior to the start of EMT-P class, fire departments may not be hiring immediately after its completion, which can lead to a period of unemployment for students. Finding employment is often location-dependent, and it can be a lengthy and time-consuming process to get on a fire department. As stated in "Sowing the SEEDS," it is likely that a higher percentage of paramedic graduates will ultimately work for private companies for some period of time.

   Not surprisingly, almost all the students planned to pursue full-time employment and, in turn, receive benefits. This is a greater percentage than the EMT-B population (82%). We know from a recent survey that having a full-time EMS job does not automatically equate to having benefits.⁴ Students should understand that not all EMS jobs will give them all their expected benefits, including medical, dental and life insurance, retirement and many others.⁵ Given that just about everyone wanted to work full-time, it was surprising that the salaries students expected to make, and the minimum amounts they would accept, were quite variable. Almost no students wanted to volunteer (without pay), while 2% expected between $15,001-$25,000, 9% between $25,001-$35,000, 25% between $35,001-$45,000, 35% between $45,001-$55,000, 16% between $55,001-$65,000, and 12% greater than $65,000. However the majority of EMT-P students were willing to accept under $45,000 for salary. We know from a 2008 survey that the median annual wage for a full-time paramedic is $37,699.78. Again, salary is something that will vary greatly depending on location and job environment.

CONCLUSION

   This study identified many questions and challenges that need to be addressed. Recruitment and retention challenges facing programs remain a top priority. The results from this and our previous survey show a need for programs to prepare for more-challenging students with higher expectations. Continued research should help explore what draws our students to EMS.

   With the aging population and the growing need to address emergency management concerns, there will continue to be a need for all levels of prehospital care professionals. We know from other research that there is likely a shortage of qualified paramedics in the U.S.² In one recent study, more than three-quarters of surveyed EMS personnel believed they experienced paramedic shortages or a greater demand for their skills.⁴ Projections predict a need for about 58,000-69,000 new prehospital providers by 2014.²

   As the need for these providers grows and the economic state remains questionable, salary and benefits will need to be reassessed. Also, educators should continue to teach their students about job opportunities and benefits offered by the varying sectors within EMS. Do students know the difference in pay and opportunities available from private departments and in specialty areas? Benefits and continuing opportunities will also play important roles in recruitment and retention of EMS professionals.

   Paramedics are indispensable in today's medical field, and their scope of care will continue to expand. The results of our current survey equate to those of the first "SEEDS" article in that paramedic students are generally young, with a large majority having some college education, but minimal healthcare experience or military service. Our study also reflects the higher level of education of students entering EMS. It is important for educators to know the caliber of the students they may be educating and their expectations for their programs and professional development. Fulfilling educational desires and providing healthy growth and challenges can help retain paramedics. If we cannot satisfy students' desires for additional education, EMS risks becoming a stagnant field.

   We hope the insights gained from our studies will help EMS managers and educators develop programs and strategies to help not only recruit, educate and retain EMS professionals, but also grow the EMS profession.

References

1. Deluhery M. Sowing the SEEDS. Emerg Med Serv 37(3): 94-7, Mar 2008.

2. National Highway Traffic Safety Administration. EMS Workforce for the 21st Century: A National Assessment, June 2008.

3. Bureau of Labor Statistics. Occupational Outlook Handbook, 2004-06 Edition.

4. Williams DM. 2008 JEMS Salary and Workforce Survey. J Emerg Med Serv 33(10): 48-64, 2008.

5. Brown WE, Jr. Compensation, benefits and satisfaction: The Longitudinal Emergency Medical Technician Demographic Study (LEADS) project. Preh Emerg Care 7(3): 357-62, 2003.

   Lauri L. Beechler, RN, BSN, CEN, PHRN, NREMT-B, is the paramedic program director, an EMS instructor and an ED nurse at Loyola University Medical Center.

   Ginger M. Worlds, CCEMT-P, NREMT-P, has had a long career as an NREMT-P and an EMS instructor at Loyola University Medical Center. Contact her at gworlds@lumc.edu.

   Matthew R. Deluhery, MD, is an emergency medicine resident physician at the Medical College of Wisconsin.

   Christine E. Stake, MA, is research program coordinator for the EMS Department at Loyola University Medical Center.

   Mark E. Cichon, DO, FACEP, FACOEP, is an emergency physician and medical director for Loyola University Medical Center's prehospital system.