EMS Workforce Report

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EMS Workforce Report

• Rural and Frontier EMS and Trauma
• Summit at the Lake
• May 2008

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• EMS Workforce Issues Newly on the Radar

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• EMS Agenda For the Future - 1996
• Diversity
• Career ladder
• Standard categories of providers
• Reciprocity
• Occupational health
• Skill maintenance

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• 1998 shortages start to be reported
• Health/safety issues start to surface
• Sources
• Media reports
• Trade magazine surveys
• Isolated research
• LEADS

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Other issues

• Pay and benefits
• Professionalism
• Safety health
• Wellness
• Career ladders

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EMS Workforce for the 21st Century - Project

• Center for Health Professions
• University of California, San Francisco
• Funded by
• NHTSA
• HRSA
• EMSC

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EMS Workforce for the 21st Century

• Assessment
• Workforce Agenda for the Future
• Implementation

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Project Staff

• UCSF
• Susan Chapman, PhD, RN
• Vanessa Lindler, MA
• Jennifer Kaiser, BA
• Kevin Grumbach, MD
• Timothy Bates, MPP
• Laurie Hailer, MS

• U. Washington
• Susan Skillman, MS
• Davis Patterson, PhD
• Gary Hart, PhD

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Steering Committee

• Roger Levine, PhD
• Gregg Margolis, PhD, NREMT-P
• Richard Patrick
• Jane Smith, NREMT-P
• Ellen Weber, MD
• Ed Wetzel
• John Becknell

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Assessment
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Research Goals

• To conduct a systematic assessment of the
  national EMS prehospital workforce including
  interviews, surveys, key stakeholder meetings,
  and an assessment of existing data and research
• Address size and demographics of workforce,
  training and education pathways, supply and
  demand trends, volunteering, and compensation

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Key Question
Will the EMS workforce supply be of adequate size
and composition to meet the needs of the U.S.
population in the future?
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Key Question
How can potential workers be attracted to and
encouraged to stay in the field of EMS
(recruitment and retention)?
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Key Question
How can adequate EMS workforce resources be
available across all populations and geographic
areas?
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Key Question
Does the EMS community have the data and
information needed to address the future demand
for and supply of EMTs and paramedics in the
U.S., and what information is lacking and how
might it be obtained?
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Assessment Methods

• Literature review and analysis
• 53 key informant interviews
• focus on rural and volunteer workforce
• Analysis of secondary data from national data
  sets (BLS OES and CPS)
• Survey of training directors
• Analysis of LEADS data and NREMT re-reg survey
• Moderated blog discussion
• Ride along for project staff- SF primary site

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What did we learn?
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What Did We Learn?

• National data has limitations
• EMTs/paramedics combined in OES/CPS
• Cross-trained firefighters classified in OES
  CPS as EMT/P or firefighter
• No comprehensive or reliable source of volunteer
  data
• Workforce size and wage data has measurement bias
• Uneven data collection at the state level

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DATAWorkforce Demographics
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EMS Workforce Size Compared To Public Safety
Professions

• Underestimated due to problems with BLS data
• Smallest of 3 major professions?
• Some percentage of FF best classified as EMS
• Dont know number of FF doing EMS
• Fastest rate of growth this is probably correct

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Volunteer EMTs and Paramedics

• Larger proportion of volunteers in rural EMS than
  urban EMS
• lack of standard definition of rural
• Difficult to assess total workforce contribution
  of volunteers because
• Not in most national data sets
• Are variable, part-time, and/or on-call workers

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Demographics of the Rural and Volunteer EMS
Workforce

• 58 volunteer are male (LEADS survey)
• 39 average age for volunteers (LEADS survey)
• Most volunteers are EMT level

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Demographics of the Rural and Volunteer EMS
Workforce

• Problems
• Volunteer rosters not reflective of those working
• People working multiple agencies
• Compensation

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DATAWage Comparisons
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EMS Worker

• Agency (fire, private, hosp. etc.)
• Agency (paid, combo, volunteer)
• Level of training
• Compensation
• Benefits
• Pension

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DATAEMS Education
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AMA Accredited Paramedic Programs in the U.S.
1985 2004 Source American Medical Association
Health Professions Career and Education Directory
and Data Book
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AMA Reported Counts, Paramedic Graduates,
Accredited Programs 1997-2004Source American
Medical Association Health Professions Career and
Education Directory and Data Book
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Integrated Postsecondary Education Data System
(IPEDS)

• Core postsecondary education data collection
  program at National Center for Education
  Statistics (NCES)
• Battery of surveys -- all institutions with
  higher education as primary purpose
• Programs not located in college/university
  unlikely to report
• Cant distinguish EMT from paramedic programs
• Most comprehensive education data available

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IPEDS EMT/Paramedic Graduates by Type of Award
N 19,833
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National EMS Workforce Projections

• Changing population demographics
• Exits and entrants into the occupation
• Economic projections
• Historic employment rates

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National EMT/Paramedic Employment Projections

• 27.3 growth over next decade
• BLS classifies as much faster than average
• BLS projections are likely low due to data
  limitations no volunteers or cross-trained
  firefighters included

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Workforce Shortages

• Qualitative data (KI interviews) shortages in
  some markets, esp. of rural/volunteer workers
• National wage data dont support widespread
  shortage
• Wage growth may be masked in OES data
• Failure to distinguish EMTs from paramedics

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Issues

• current data is insufficient and has severe
  limitations that impede national EMS workforce
  planning.

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Issues

• EMS presents a complex workforce picture that
  defies broad generalization and requires in depth
  understanding of its various segments.

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Issues

• Workforce analysis and planning are needed at
  local agency, community, state, regional, and
  national levels.

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Issues

• Existing sources of EMS workforce data do not
  provide data that is adequate for conducting
  valid and effective research, planning, and
  assessment nor is it likely they will provide
  adequate data in the near future.

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Agenda
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Vision

• A future where all EMS systems are able to
  recruit a sufficient number of well educated,
  adequately prepared, and appropriately
  credentialed EMS workers who are valued,
  esteemed, well-compensated, healthy, and safe.

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Meeting and Sustaining this Vision Depends on

• Understanding the workforce (Data and Research)
• Preparing the workforce (Education and
  Certification)
• Managing supply and demand (Workforce Planning)
• Keeping workers healthy (Health and Safety)

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• EMS Workforce Planning Development
• Data collection and analysis to understand supply
• State and local education in workforce planning
• Development of workforce planning tools
• Identification of best practices in recruitment
  and retention
• Forecasting gaps

• EMS Education and Certification
• Implementation of EMS Education Agenda
• Tracking education data
• NIMS National Emergency Responder Credentialing
  System

• Health Safety
• National EMS Workforce Injury and Illness
  Surveillance Program (EMS-WIISP)
• Development of EMS health and safety standards
• Education and training in safe and healthy
  operations

• Data Research
• National EMS Workforce Data Definitions
• Promote research on all aspects of the EMS
  workforce
• In depth assessment
• Volunteerism
• Management

Stakeholder Involvement (EMS stakeholders at the
local, State and National levels)
Stakeholder Involvement (EMS stakeholders at the
local, State and National levels)
National EMS Workforce Technical Assistance
Center Dissemination of EMS Workforce best
practices Technical assistance to local, State
and Federal EMS Offices
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What Basic Workforce Data Do We Need?

• Workforce size and demographics
• Certification and licensure status
• Health and safety stats
• Turnover rates
• Common definitions
• Efficient data collection
• Shared data

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We Need Information on Future Workers

• How to attract future workers
• Who is coming through the supply chain
• Number
• Geographic area
• Education Level
• Certification
• Licensure
• Coordination and information sharing

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Information on Workforce Need and Demand

• Assess population needs- aging, chronic disease,
  uninsured
• Worker turnover
• System configuration
• Analyze the information we do have on demand

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Needs in EMS Workforce Research

• Need good questions- from those who know best
• Need good data
• Need cadre of well-trained researchers
• Partnerships and collaboration

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Education Data Needs

• Common definitions
• Common data collection
• Up to date information on students and programs

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Education and Certification Needs

• Education Agenda Implementation
• National certification
• Accreditation
• Other steps
• NIMS Credentialing
• Maintenance of certification/competency

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Workforce Planning

• Enough of the right workers, with the right
  preparation, in the right place at the right time
  for the right price.

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Workforce Planning

• Turning what is known about theworkforce into
  plans, activities, and tools to ensure there will
  be enough workers to meet future demand.

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The Workforce Tub
Supply
Pipeline
Demand
Need
Turnover
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Supply/Pipeline Modeling
Population
Employment rates
Pop growth
Interest
Lose interest
marketing
Non-completes
Enrolled in Ed
marketing
Completers exit
Cert/license
requirements
Exit
Expire/revoc
Other employ
Package
Retire/leave field/other job
Your employee
Package
Retire/leave field/other job
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Health and Safety

• This is a high risk occupation
• Employers and workers concerned about illness and
  injury
• National data is collected by several different
  surveillance systems

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• EMS Workforce Planning Development
• Data collection and analysis to understand supply
• State and local education in workforce planning
• Development of workforce planning tools
• Identification of best practices in recruitment
  and retention
• Forecasting gaps

• EMS Education and Certification
• Implementation of EMS Education Agenda
• Tracking education data
• NIMS National Emergency Responder Credentialing
  System

• Health Safety
• National EMS Workforce Injury and Illness
  Surveillance Program (EMS-WIISP)
• Development of EMS health and safety standards
• Education and training in safe and healthy
  operations

• Data Research
• National EMS Workforce Data Definitions
• Promote research on all aspects of the EMS
  workforce
• In depth assessment
• Volunteerism
• Management

Stakeholder Involvement (EMS stakeholders at the
local, State and National levels)
Stakeholder Involvement (EMS stakeholders at the
local, State and National levels)
National EMS Workforce Technical Assistance
Center Dissemination of EMS Workforce best
practices Technical assistance to local, State
and Federal EMS Offices
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What About --

• Pay and benefits
• Professional identity
• Management
• Career ladders