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March 5, 2018
Focus: Health Care

Recruitment of emergency medical workers proves challenging — particularly in rural Maine

Photo / Jim Neuger
Photo / Jim Neuger
Butch Russell is CEO of Scarborough-based North East Mobile Health Services, Maine's largest EMS provider.

What EMTs and paramedics do

Emergency medical technicians (EMTs) and paramedics care for the sick or injured in emergency medical settings.

A basic EMT cares for patients at the scene of an incident and in the ambulance en route to the hospital, and has the skills to assess a patient's condition and to manage respiratory, cardiac and trauma emergencies.

An advanced EMT is trained in more advanced procedures, such as administering intravenous fluids and some medications.

•Paramedics, besides doing what EMTs do, can give medications orally and intravenously, interpret electrocardiograms, which monitor heart function, and use other monitors and complex equipment.

All states require EMTs and paramedics to be licensed. Requirements and licensing information for Maine can be found at www.maine.gov/ems

Source: Occupational Outlook Handbook, U.S. Bureau of Labor Statistics

Breeanna Zoidis shuttles between jobs in Biddeford and Kennebunk as a paramedic and firefighter and teaches cardiopulmonary resuscitation on the side.

"For a lot of us in the field, we work two or three jobs, some even crazy enough to work four," says the 26-year-old alumna of Southern Maine Community College's fire-science program.

As Maine's population and its health care workforce age, emergency medical services will need more workers like Zoidis, not only paramedics but also emergency medical technicians (EMTs), including volunteers in rural areas and smaller towns and cities.

Looming shortage

The Maine Department of Labor projects a 6.6% increase in EMT and paramedic jobs in the 10 years to 2024, compared to 0.8% for all professions. Glenn Mills, chief economist at the MDOL's Center for Workforce Research, underscores that the vast majority of openings won't come from growth, but to replace those who retire or leave for other reasons. The MDOL will publish its next 10-year projection this spring.

Most paid EMTs and paramedics work full time. One out of three in the country worked more than 40 hours a week in 2016, including nights and weekends. Volunteers have variable schedules and some may work just a few days a week.

As a rural state, Maine relies heavily on volunteer emergency services, particularly in remote areas where there are fewer calls, while most ambulance services in southern Maine and the main population centers are paid and go on more calls.

The state's nearly 275 emergency rescue services include small municipal fire departments and a handful of private for-profit companies. All are competing for a shrinking talent pool amid rising equipment costs and limitations on what they can pay workers because of what they're reimbursed by insurers or Medicare and MaineCare.

Like hospitals and clinics, smaller services in rural areas are hit the hardest, but all are struggling with recruitment and retention.

"I don't know if there's a workforce crisis, but what I can say anecdotally at least, is retention is always an issue," says Shaun St. Germain, director at the Maine EMS, part of the Department of Public Safety that oversees licensing and monitors the EMS system.

Eric Wellman, who heads SMCC's EMS department, says that most people who come into the profession leave after about five years, some for financial reasons if they're not in a job with a guaranteed pension.

"EMS is also a physically intense working environment," adds Wellman, still a part-time paramedic in Cape Elizabeth. "The job itself can hurt you, and there's also a psychological toll."

Bucking the high-turnover trend himself, he's been a paramedic for nearly 25 years going back to a program in high school he hadn't expected to take to. "I didn't like blood, I hated needles and I definitely didn't like vomit," he says.

After encountering all three on his first call and finding that "it wasn't terrible," he decided to continue and make a career out of it. "Once I started doing it, I stopped doing other activities. I just wanted to get good at it so I focused on it, EMS and firefighting." He laments the fact that young people today are encouraged to be good at everything and concentrate on getting into four-year colleges, making it harder to run programs like SMCC's.

It's had mixed success with a more recent EMT program targeting new Mainers, some of whom have been unable to land jobs without a driver's license or driving record. "It's interesting some of the barriers we came up against," Wellman says.

Others see emergency services as an entry-level chance to work with patients before pursuing another health-related profession with higher pay, more prestige and regular hours. In Maine, the median wage for EMTs and paramedics in 2016 was $16.12 an hour, slightly above the U.S. median pay of $15.71. National data show that those employed by hospitals earn the most at $35,390 a year median pay, followed by local government excluding education and hospitals at $35,000 a year and ambulance services at $30,380 a year.

"The pay is terrible," says Rick Petrie, executive director at Winslow-based Atlantic Partners EMS, a nonprofit contracted by the state to be an education, quality improvement and administrative resource to ambulance services. Even as a paramedic with 37 years of experience, he earns $24 an hour. "If we ever pass a minimum wage of $16 an hour," he predicts, "we're going to put ambulance services out of business."

Ambulance services respond

At North East Mobile Health Services in Scarborough, CEO Butch Russell says, "Staffing is our biggest concern."

The company, one of the state's few private, for-profit organizations, bills itself as Maine's premier medical transportation provider serving southern parts of the state from depots in Scarborough, Sanford, Biddeford, Brunswick and Rockport. Its fleet includes traditional and van-style ambulances, neonatal and pediatric intensive-car mobile units, wheelchair vans and shuttles.

Russell says the volume of calls has grown every year except for last year, when it did about 25,000 ambulance transports, compared to a peak of 30,000 about three years ago. Lately it's been educating hospitals and nursing homes it's working with to choose better between transport options, given strict rules for billing Medicare and MaineCare, which together make up 70% of its income.

"Both of those payers do not pay enough to cover the cost of covering the business," he says. For that reason, the company can only offer a starting salary of $12 an hour, which it recently raised from $10.50 an hour in a cost-of-living increase it introduced to attract more employees during a crunch about six months ago. It also offered a signing bonus.

"I would love to give them all more," he says.

Delta Ambulance, a nonprofit serving 17 towns in the greater Augusta-Waterville area, has also had to up its recruitment game, in the form of sign-on bonuses and benefits like reimbursements for education and uniforms, gym memberships and "whatever we can add on to try to recruit somebody," says executive director Tim Beals. "We can't compete on salary."

Community paramedicine

One way to retain more workers might be to practice community paramedicine, a system introduced in rural New Mexico in the 1990s to expand the scope of EMS services to include preventive care in an out-of-hospital setting, including patients' homes.

"The catch is right now that there's no reimbursement," says Beals, "and you don't get paid to do those visits, but we're working on it." United Ambulance Service, serving southern and central Maine, is also holding off until there's reimbursement, says education director Dennis Russell; in the meantime, it's expanded its education and training offerings including in continuing education.

But community medicine is gaining traction in Maine where 15 to 20 services are now practicing it following a four-year pilot program by Maine EMS recently given permanent status.

In the long run, Maine EMS Director St. Germain is hopeful that if there's data showing cost savings from community medicine, then reimbursement will follow. "Three's some light at the end of the tunnel," he says.

Rewarding job

Despite the long hours and hard work of her profession, paramedic and firefighter Breeanna Zoidis is in it for the long haul and tells anyone thinking of pursuing the same path to "give it all you've got." She conveys a similar message in a new video for the Maine Municipal Association, part of a campaign called HoMEtown Careers aimed at luring young people to jobs like her full-time position in Biddeford.

"With the community supporting us, it definitely allows us to hire more people, and as long as we keep making them proud and serving them well we hope they will continue to support us."

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