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Emergency medical services (EMS) is a relatively new profession with its foundations in the late 1960s.1 Today, almost every area of the United States enjoys EMS services, and the general public expects access to EMS. The U.S. Department of Labor’s Bureau of Labor Statistics (2019) reports that EMS work demands cognitive, physical, and emotional labor in a high-stress and unpredictable work environment. The EMS workforce is distributed among fire departments (48%), private ambulance companies (21%), governmental non-fire agencies (12%), hospitals (11%), air medical (3%), and other (5%) with the vast majority of EMS workers (72%) listing 911 response as their primary job function.2
There is also a significant part of the workforce that is volunteer or pseudo-volunteer. The majority of EMS workers are paid and are employed by municipal fire departments. The median annual salary for this group is $36,450.3 However, there exists a wide variance in the profession with regard to pay depending on geographical location, organization of the employing local government, and tenure. This complex landscape of subcategories within EMS confounds the study of the workforce.
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Traditionally, the public sector of the EMS workforce has been the highest paid and has enjoyed low turnover rates.4 However, the rate of retention for EMS workers in the public sector has declined dramatically in recent years.5 Simultaneously, the demand for EMS services in the U.S. is predicted to continue to increase substantially.3 A thorough understanding of the factors affecting the recruitment and retention of EMS workers is necessary to formulate effective strategies moving forward.
Recruitment
Many U.S. fire departments are finding it increasingly difficult to fill their paramedic positions.6 This phenomenon has created a need for EMS directors to delve into the unfamiliar area of recruiting. Many traditional economists would advise that increases in compensation are necessary to solve the problem. However, public service EMS employers are rarely in a position to change compensation packages to meet the needs of the job market. Additionally, compensation is generally limited to the ability of the organization to raise funds. Transport fees for EMS do generate revenue for both public and private providers. However, rates for these fees are tightly controlled by the Centers for Medicare and Medicaid Services (CMS) and the private healthcare industry. Change in that area is likely to come much too late to solve the current crises in EMS recruitment.4 Recruitment solutions may be linked to factors other than compensation.
The main motivator for workers seeking employment in public sector EMS has long been assumed to be exclusively public service motivation.7 Public service motivation is an intrinsic motivator that exists in some portion of the population which steers people toward public service jobs to suffice a desire to serve their community. Public service motivation has been well-studied and quantified. Public service motivation is required to fill EMS positions with relatively high job demands and low pay in the traditional rational economic view. Availability of education for EMS workers in