Guest Editorial: Medics Needed

Wanted: Paramedics and EMTs. Applicants must have state and national certification. Expect long hours away from family. Pay is probably less than what McDonald's pays, and the benefits are average at best. Your safety is of utmost importance, but as in life, the environment can't always be controlled. You will be subjected to the worst society has to offer and exposed to diseases that can end your career and bring your life to a slow and painful death. Alternatively, your life may be taken because someone wants to shave two minutes off their travel time and speeds through your accident scene. You will not receive hazard pay. But wait: You will make the difference between life and death! You will be the one to administer that lifesaving breath into a dying person's lungs, pump oxygen-carrying blood to vital organs, and administer medications that will continue the circle of life! The job is also challenging and ever-changing, so apply now!

I wish I had read the above ad before signing up! Like most medics, I don't mind getting up at 3 a.m. after 20 minutes of sleep to drive through the worst weather imaginable to rescue a trapped family from a wreck; however, I might feel differently about the routine response to a frequent flyer for another "emergency" at 3 a.m. Most medics get into EMS expecting lights and sirens, trauma and blood! Reality check! Your training is good for less than 10% of calls, and the times you actually make a difference between life and death is closer to 1%. At this point, some of you are saying, "If you don't like your job in EMS, do something else."

To be honest, I do love my job. That's why I trained to become a paramedic. That's why I commit to countless hours of continuing education every year, not only to keep my license up, but to enhance my knowledge base and skills. And I don't even mind getting up at 3 a.m. for the less-than-glamorous calls. I do this job because I love it, as do most medics. But how long are medics going to keep working just because they love their job?

The Burnout Business

Several of my fellow medics who came into EMS when I did have hit "burnout" in just four short years, and many have moved completely out of the industry. Most of the "burnouts" were attributed to low pay and long hours away from their family, not because of what they saw and did. Some simply grew tired of the misuse and abuse of ambulance services.

Clearly, EMS providers are a critical link in the chain of medical professionals. In the last few years, however, there has been a growing shortage of medics across the nation. Recently, this shortage has been called a crisis affecting rural and urban systems alike. In an article in the Huntsville Times, staff writer Wendy Reeves pointed out that the paramedic shortage may continue unless pay rises along with the new education requirements.1 The article quotes Mike Coakley, director of the Alabama Fire College EMS program, saying, "Things are about to get tight." His contract recently expired due to a "great reduction in enrollment" for the program he had worked with for 10 years. As reported, the remainder of the permanent staff were dismissed, and part-time instructors are now teaching courses. According to the Alabama State Department of Public Health, Alabama had 312 paramedic graduates during the 2001-02 school year. Coakley said the Fire College alone had 1,000 EMS students five years ago.

Got Medics?

Why are we seeing a shortage of medics? It could be due in part to low pay, coupled with poor benefits and long hours. It may be that people are finally asking, "Why am I doing this when the demands are increasing and the rewards are not improving?" Due to the nursing shortage, many medics are moving into the emergency department for higher pay. Bre Jones of the Bradenton Herald quotes John Gosford, a medical healthcare program analyst for the Florida Department of Health, saying, "In Florida, we have about 39,000 certified EMTs and paramedics. Of that, only about 20,000 work for ambulance services. The rest are in emergency rooms and doctors' offices."2 In the same article, Lt. Larry Leinhauser, a spokesman for Manatee County EMS, says, "We used to have waiting lists of people who wanted to work for us. It used to be so hard to get a job here. Now, we are trying to fill positions."

Managers or directors work for months to put a staff of dependable medics together, then they move on. Jim Turner, director of a Georgia EMS system, told Coastal Courier reporter January Holmes that medics do one of three things: "They move into another field, go into management, or go into EMS education. The majority of them move into another vocation."3 Mostly, the move is for more pay and better benefits. This can turn into a vicious cycle that forces some agencies to take units out of service because they can't staff their ambulances.

EMS managers clearly have a problem, especially in the rural setting, where funds aren't always available. Faced with rising equipment and operation costs, and Medicare cuts, most ambulance services can't appropriate funds for employees. Some services have been forced to close because of financial and staffing problems. Some services force their remaining, already overworked, medics to pick up the slack while they spend months recruiting, which, in turn, leads to more burnout. The problem should be obvious when five to seven years classifies you as a seasoned veteran.

What can be done to end this circle? EMS systems need to look for additional funding, possibly through taxes, grants and better collection rates, etc. People never want to pay more taxes, therefore public education is needed. Grants should always be sought for equipment. Better collection rates may be achieved if staff stay educated on "what it takes to get paid" (i.e., what paperwork needs to be done and how). Ambulance companies may need to expand their "services" in an attempt to bring in additional income. Separate services may find regular communication on "what works and what doesn't" helpful, instead of appearing to be on two different teams. Unity, locally as well as nationwide, is drastically needed in EMS. On the local front, management can use employee surveys to check morale and keep medics and administration on the same page. Finally, small gestures by management can help employees feel appreciated. This includes awards for achievement, as well as yearly raises based on the individual medic's performance.

Management and staff must work together to bring the quality of EMS life up, not just to the top of the EMS average, but beyond. Until then, some employees will continue to move on. Services will continue to suffer medic shortages, and some patients may suffer and die.

References

1. Reeves W. Huntsville Times. Requirements, pay, keep the numbers low for paramedics. www.al.com/news/huntsvilletimes.
2. Jones B. Bradenton and East Manatee Herald. Paramedic shortage hurts Manatee. www.bradenton.com.
3. Holmes J. Coastal Courier. EMS tries to avert shortage. www.paramedic.com.

A special note to the memory of paramedic Shawn Skelly: Your input and opinion of this article was greatly appreciated, and you will always be remembered as a mentor, role model and friend. This article is also dedicated to the memory of my good friend and mentor, critical care paramedic Shane Gilmore. Both medics lost their lives in the line of duty.