Competition Intense to Attract EMS Providers in Texas

Dec. 17--Rapid growth and a changing health care market have increased competition among some suburban emergency service providers, driving up starting wages and challenging Fort Bend County and other communities to fill vacancies.

"We've had an unusual number of openings," said Daniel Kosler, Fort Bend County's director of emergency medical services.

Of the 76 paramedic positions budgeted for 2015, he had as many as 15 positions open at any one time. He said it drove up overtime spending, left the county unable to deploy some units and made it difficult for the remaining paramedics to use vacation time.

County commissioners on Tuesday approved a one-time exception allowing paramedic employees to exceed a cap on the number of vacation hours they carry over to the new year. One employee will start January with more than 300 vacation hours, almost twice the county's limit.

Demand for health care workers, including paramedics, has been rising around the nation. The U.S. Bureau of Labor Statistics projects that the number of jobs for emergency medical technicians and paramedics will increase 26 percent between 2012 and 2022, more than double the rate across all industries. In the last five years, Texas has seen median wages for those positions rise 10 percent, more than the national average of 4 percent, based on federal statistics.

Paramedic and EMT employment

Some suburban emergency medical service providers report more competition for qualified paramedics as demand rises. The U.S. Bureau of Labor Statistics says the median hourly wage of Texas paramedics and EMTs has risen 10 percent in the last five years. The Houston-Baytown-Sugar Land metro area is on par with the national average of 4 percent wage growth, although the number of new jobs is increasingly slightly faster. Wages vary based on experience and specialized training from $9 to $26 an hour.

Although local governments have employed a third or more of EMTs and paramedics for decades, the expanding health care industry will shrink that share, the bureau predicted.

Dr. Richard Bradley questioned the federal bureau's projections, noting that EMTs and paramedics serve different health care roles and attract different people. EMT certifications require less training, which limits what they're authorized to do for patients. Paramedics build on EMT education to perform more advanced kinds of emergency medical care and make critical care decisions faster in high-risk environments. Bradley said few who push through the intense two-year paramedic training do so to be employed as an EMT transferring patients between hospitals rather than as a paramedic rushing to the scenes of accidents.

"The 911 jobs are what every paramedic wants to do," said Bradley, who worked as a paramedic and firefighter before becoming a doctor and the University of Texas Health Science Center's chief of emergency medical services and disaster medicine. "You don't see many paramedics leaving a government job for a private sector job."

Harris County Emergency Corps. also reported a slowdown in applications received for recent openings. Marketing Director Abbey Lee attributed the shift to changing qualifications and on-the-job expectations that have limited the number of people who complete training.

"The paramedic role is in a period of transition from vocation to profession," she said. "Education requirements to become a licensed paramedic have changed in the last decade, making the paramedic role not as achievable as it once was."

In part because the jobs are more demanding and often require specialized skills, government employers on average pay paramedics and EMTs more than many private-sector businesses do, according to federal labor statistics from May 2013. Average wages by employer type ranged from $9 to $26 an hour.

The Houston region's growth could push salaries even higher, Bradley said.

"A lot of our outlying neighborhoods are growing so quickly we're seeing an increase in the number of ambulances that have to be available to answer 911 calls," he said.

He has heard reports from Houston EMS providers that they are losing employees to positions elsewhere that pay more and have better schedules.

Lee reported that the rise of combined Fire-EMS departments also has increased job competition.

Kosler agreed those factors contributed to Fort Bend's slew of vacancies, as well as a handful of retirements. He expects that a job fair held Monday helped fill some open positions, but not all.

Kosler warned that retention problems likely will remain unless the commissioners court approves recommendations he plans to make in January, including pay increases to make the county more competitive with other EMS services.

"To be competitive," he said, "you have to be in the marketplace."

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