EMS agencies face small labor pool, pay cited as issue
This week, Wiscasset EMS hired three per diem Emergency Medical Technicians (EMTs). But Wiscasset, like other Midcoast ambulance services, is having a hard time attracting and keeping EMTs. Over the last few weeks, Chief Toby Martin conducted a survey to determine if Wiscasset’s pay is in line with other agencies in Lincoln County.
They are. A new advanced EMT (AEMT), with slightly more training than a basic EMT, earns between $14 and $17 per hour whether in Wiscasset; at CLC Ambulance Service in Damariscotta; in Waldoboro or in Boothbay. However, in Bath and Brunswick, AEMTs right out of school are earning $20 per hour; in South Portland, AEMTs are earning $25 per hour and may also receive a signing bonus.
There are three levels of EMTs. A basic EMT can conduct basic first aid and CPR, drive an ambulance and move a patient from bed to gurney and gurney to ambulance. An advanced EMT can also begin an IV and administer certain medications, including epinephrine, when a patient is allergic to bee stings or shellfish. AEMTs, sometimes called intermediates, are still limited in what they can do. The highest level is a paramedic, who can perform some emergency surgical procedures, administer various drugs, and do more advanced resuscitation.
CLC, a nonprofit, pays basic EMTs $14, Advanced EMTs $15 and paramedics $16 to $19 per hour. Waldoboro pays basic EMTs $13.29, advanced EMTs $15.20 and paramedics $17.63. Boothbay Ambulance pays $13 for basic EMTs, $14.90 for advanced EMTs and $18 for paramedics. Wiscasset’s rate is $13 on weekdays and $15 on weekends for basic EMTs; $15 on weekdays and $17 on weekends for advanced EMTs; and $17 on weekdays and $20 on weekends for paramedics.
All of the EMS services in Lincoln County except Wiscasset and CLC have full-time employees. All of CLC’s and Wiscasset’s employees except Martin and Chief Warren Waltz from CLC are per diem. Martin said EMTs at the other departments get a similar salary and also get benefits such as health insurance and vacation time. Most of Wiscasset’s employees work for other agencies full or part-time and work an average of 24 hours per week for Wiscasset. Martin said the per diem employees often call in and say they can’t work a shift for Wiscasset if the full-time job has overtime hours available, which means Martin is often working 50-60 hours per week as the only paramedic available over the weekend.
At a budget meeting Feb. 27, Martin asked for a dollar an hour raise for all his per diem employees. Selectmen countered with a two percent raise, which translates to a raise of between a quarter and 35 cents per hour. The percentage is the same percentage other town employees are receiving in the new fiscal year.
While other schools have certificate programs, Maine has one school that offers an associate’s degree in paramedicine, Southern Maine Community College in South Portland. The paramedicine program is a two-year associate’s degree program, but it also offers certificate training for basic EMT and AEMT levels. The college turns out paramedics and EMTs every year. After the educational component, there is a practicum, called a preceptorship, with an EMS department. Most preceptorships do not end with the student becoming an EMT for that agency. According to Bath’s EMS chief, Captain Rick Chipman, many students have already accepted a job with another agency when they accept the preceptorship.
Chipman said pay is a big issue, but the issue of supply and demand is bigger. “There is a shortage of available EMS providers. The pool used to be quite a bit deeper, and part of the reason is that requirements for licensing are much different than in the past. Fire departments used to hire someone and send them to training, but that's no longer the case. There’s been a steep decline in volunteerism in Maine, at a time when the Bureau of Labor placed a high standard on volunteer departments.” Prior to that change, more people were participating as volunteer EMTs, he said.
“But now the volunteers would have to jump through the same hoops as a full-time paid EMT, and the cost to them and to a volunteer department would just be prohibitive.” Chipman said. Add to that Maine’s aging population, and the EMS systems and fire departments are in a pre-crisis, he said. “We’re not calling it a crisis yet, but if things don’t change, we’re headed in that direction.”
Departments are no longer guaranteeing a paramedic is on board an ambulance. When a team without one arrives at a scene and a paramedic is needed, the agencies must now call for a traveling paramedic from Mid Coast Hospital; Martin said it costs the town hundreds of dollars every time he joins a crew at a scene. Insurance will pay for only one agency ambulance, so the town must absorb the paramedic’s cost.
Also, other towns who respond to a town with a contract with an EMS service also charge hundreds, even thousands of dollars, Martin said. Until now, Wiscasset has not charged towns with whom they have a mutual aid agreement, but they have had to pay for Gardiner responding to calls in Dresden, or Bath responding to Wiscasset.
Chipman said agencies are working together to try to determine why there is a shortage in the area. While some towns, especially in Southern Maine, may be garnering most of the candidates who are graduating from the college, there is also evidence that paramedics, especially, are being drawn out of state to places in New England and beyond where pay is better. Chipman said the program’s cost, ranging from $3,000 for an AEMT certificate to $10,000 for a paramedicine degree, may be causing young graduates to look elsewhere to recoup their tuition costs.