IAFF June 25, 2007 Susan A. Chapman, PhD, RN UCSF Center for Health Professions

1. The National EMT/Paramedic Workforce: An Assessment of What We Know and Don’t Know Related to Supply and Future Demand IAFF June 25, 2007 Susan A. Chapman, PhD, RN UCSF Center for Health Professions UCSF Center for Health Profession

2. Description of Research 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 UCSF Center for Health Profession

3. Research Questions • What are the major challenges facing the EMS workforce? • What does the existing research and data suggest are the major factors impacting workforce supply and demand? • What models predict workforce needs for the EMS system? • How can the data and research contribute to developing a workforce agenda and strategy for the future? UCSF Center for Health Profession

4. Assessment Methods • Literature review and analysis • Key informant interviews • focus on rural and volunteer workforce • Analysis of secondary data from national data sets • Survey of training directors • Analysis of LEADS data and NREMT re-registration survey • Moderated blog discussion UCSF Center for Health Profession

5. Consensus Process • Steering Committee • Formulated research questions • Identified stakeholders and key informants • Reviewed drafts • Stakeholder Meetings • 14-16 organizations represented • Met twice, one more meeting planned • Formulated research questions • Identified key informants • Responded to drafts • Developed list of policy issues and prioritized • Next steps • Agenda for the future document • Stakeholder review • Implementation steps UCSF Center for Health Profession

6. Workforce Modeling • Workforce can be viewed from the perspective of: • Supply-what impacts the number of credentialed providers available • Demand-what impacts the number of jobs • Need- how many workers to meet needs of the pop • Conceptual models developed to understand inflow and outflow of workers • Theory comes from economics, organization behavior, public health, other disciplines UCSF Center for Health Profession

7. National EMT & Paramedic Workforce Supply UCSF Center for Health Profession

8. What Do We Know About the Current EMS Workforce? • National data has limitations: • EMT and paramedics combined in most national databases • Cross-trained firefighters; how to count, who to count • Data from other sources very limited • Uneven data collection at the state level UCSF Center for Health Profession

20. Is There Evidence of a Shortage? • Key informants: shortages vary by sector and geography • No data on sectors: govt, private • Data does not suggest that wages are outpacing inflation • No national data on vacancies • No national data on overtime worked • Some use of incentives, recruitment bonus UCSF Center for Health Profession

21. Workforce Projections • Changing population demographics • Exits and entrants into the occupation • Economic projections • Historic employment rates UCSF Center for Health Profession

22. EMT/Paramedic Employment Projections • 27.3% growth over next decade • BLS classifies as “much faster than average” • Net replacement is “positive”—”separations exceed entrants” into the profession • BLS projections are likely low due to data limitations; no volunteers or cross-trained firefighters included UCSF Center for Health Profession

23. UCSF Center for Health Profession

24. What Do We Know about EMT and Paramedic Education? UCSF Center for Health Profession

25. AMA: Accredited Paramedic Programs in the U.S.1985 - 2004 UCSF Center for Health Profession

26. IPEDS: EMT/Paramedic Graduates by Type of AwardN = 19,833

27. Reported Counts of Paramedic GraduatesAccredited Programs: 1997-2004

28. Key Informant Data: Supply/Demand Issues Dominated • Workforce Shortage • Retention • Recruiting • Getting higher or more fair pay/benefits • Professionalizing/career ladders UCSF Center for Health Profession

29. What is your major concern about the EMT and paramedic workforce? • “There ain't enough of 'em. It's a chronic undersupply.” • “We don't have enough of them and we don't know where to find them.” • “Our challenge is to slow down exit from the industry and retain workers longer.” • "Keeping up with attrition isn't good enough but I'd be happy just to do that. It will get worse as the baby boomers retire." UCSF Center for Health Profession

30. What Is Your Major Concern About the EMT and Paramedic Workforce? • “Professionalism and pay. Adapting to a changing patient population. The geriatric population will triple. It will require paramedics to be smarter and to have more pay.” • “The need to professionalize and have more career EMS. The need for appropriate training and job pathways; advanced opportunities. We need more uniform policies state-to-state and more appropriate pay.” UCSF Center for Health Profession

31. Key Informant Educators had a Range of Concerns • What skills should be taught at the basic and paramedic levels? What really makes a difference in patient outcomes? • One educator said enrollments had increased, but others said enrollments and interest in the field are down • Educators said clinical internships and field preceptors are in short supply, can prevent programs from growing UCSF Center for Health Profession

32. Educators on Recruitment and Retention • “Salary is somewhat of an impediment.” • Some programs mislead by romanticizing the work; creates mismatch between expectations and reality – must recruit right people for the job • Easier where services fire-based; better pay/benefits, a career ladder, 24-hour shifts lead to flexible scheduling and they can work on the side UCSF Center for Health Profession

33. 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 • Rural areas rely heavily on volunteers UCSF Center for Health Profession

34. VolunteerEMTs 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 UCSF Center for Health Profession

35. Quote from IOM • 40 years have gone by since the 1966 report- Accidental and Disability:the Neglected Disease of Modern Society marking the birth of EMS. • IOM- ”…today the system is more fragmented than ever, and the lack of effective coordination and accountability stand in the way of further progress and improved quality of care.” UCSF Center for Health Profession

36. Thank you Thank you to funders: National Highway Traffic Safety Administration Health Resources and Services Administration, Emergency Medical Services for Children Program UCSF Center for Health Profession