What Drives Paramedic Job Satisfaction? [2024 EMS Trend Survey]

Editor's Note: In August 2024, EMS1 and Fitch & Associates released their annual EMS trend survey, What Paramedics Want, proudly sponsored by Pulsara. Because the articles and advice found within contain such critical subject matter, we've elected to publish each segment one at a time here on our blog. Read, enjoy, share, and take to heart the following information brought to you by the most prestigious thought leaders in EMS. Today's entry is written by Maria Beermann-Foat, PhD, MBA, NRP, EMS training coordinator for Eugene Springfield Fire in Oregon and former battalion chief of operations for MED-ACT Emergency Medical Services.

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What EMS’s biggest advocates tell us about creating meaningful opportunities to retain talent

We can agree that EMS is a critical component in the healthcare system. However, our profession continues to face significant challenges. Many of these, such as employee retention, job satisfaction and the impact of work-life balance, continue to appear year after year.

To better understand the results of the 2024 EMS Trend Survey, I was curious to see how various factors impacted how likely respondents were to recommend EMS as a career to others, e.g., respondents’ experience levels (i.e., years of service), job title, and service model. I was also curious to see how these factors correlated to comments in the next survey question, “Please let us know why you would or would not recommend EMS as a career.”

As the EMS Trend Survey collected responses from EMS professionals with a variety of experiences, from those new to the profession to veterans with more than 30 years of service, identifying common themes within stratified groups could be useful in developing agency-focused efforts for specific employee groups. As most agencies operate with tight budgets, it seems beneficial to know which 20% of solutions will provide 80% results. 

• Service model. The first factor I explored was service model, as this is often a debate point in EMS discussions. The median scores for recommending EMS as a career (0 = not likely; 10 = very likely) were 6-7 across all service models, with Public Third Service, Public Utility and Fire-Based models all tied at 7, and the rest at 6. Therefore, service model does not appear to have a significant impact on this question.
• Job title. Next, I wondered if maybe the respondent’s job title made a difference. Score averages hovered between 4.5- 6.5, with Dispatchers averaging 8.3, followed by Medical Directors (7.5) and Chief/Administrator (7.2). The two lowest scoring groups were Flight Paramedic/ Nurse (4.5) and Field Provider Ground (5.5). Interestingly, of all the job titles included, these two have the most direct contact with patients and a purpose that most aligns with why EMS exists.

Key themes and findings

Exploring the free-text response to the question, “Please let us know why you would or would not recommend EMS as a career,” the data became more interesting. Using Python script and QualCoder 3.5 software, I created two score groups: 0-4 (low scores) and 6-10 (high scores) for identifying common themes.

I identified the following overarching themes and phrases used by the group least likely to recommend EMS as a career (those who scored 0-4):

• Pay and mental health: “pay,” “respect,” “stress,” “burnout,” “mental”
• Working conditions and support: “poor,” “pay,” “retirement,” “advancement,” “shifts,” “support,” “schedule”
• Career advancement and benefits: “lack,” “advancement,” “opportunities,” “retirement,” “paid,” “benefits”
• Hours and physical demands: “hours,” “long,” “stress,” “hard,” “body,” “time,” “appreciation,” “demanding”
• Work-life balance and family: “money,” “family,” “toll,” “time,” “physical”

In contrast, for those most likely to recommend EMS as a career (those who scored 6-10), the five overarching themes were:

• Rewarding and challenging career: “rewarding,” “challenging,” “community,” “profession,” “physically,” “extremely,” “stressful”
• Pay and benefits: “pay,” “low,” “poor,” “benefits,” “high,” “stress,” “respect,” “nursing,” “management,” “lack”
• Career and fulfillment: “career,” “recommend,” “good,” “person,” “field,” “right,” “work,” “fulfilling,” “experience”
• Helping and community impact: “great,” “people,” “help,” “helping,” “need,” “community,” “love,” “time,” “opportunity”
• Work hours and family impact: “hours,” “long,” “stress,” “low,” “family,” “stressful,” “away,” “life,” “health,” “work”

We can readily see that there are some overlaps between these groups, particularly in pay, benefits and health (e.g. stress, demanding, toll, etc.).

Areas where the low-rating versus high-rating groups seem to deviate are centered around career fulfillment, challenges being perceived as a positive, and contribution to the community as a positive. Respondents who indicated a high likelihood of recommending EMS perceive EMS as a rewarding and challenging profession. This theme resonated strongly across experience levels, but it was mainly noticed in the 21-30 years and more than 30 years of experience groups, with the 11-20 years group not far behind. These professionals emphasized the rewards of the EMS profession, drawing attention to the personal satisfaction and professional challenges that come with the job.

Career fulfillment and helping/community impact were key themes predominantly influencing those with higher recommendation scores. These emphasize the importance of career development, job satisfaction and sense of accomplishment.

Conversely, pay and benefits emerged as a critical concern, especially among those less likely to recommend EMS as a career (0-5 scores). This area was the highest-rated concern for professionals with 6-10 years and more than 30 years of experience. It indicates that while intrinsic rewards are significant, tangible benefits like salary and compensation packages are equally important. The dissatisfaction with pay and benefits suggests a need for industry-wide improvements to attract and retain talent.

Working hours and their impact on family life were significant concerns across all experience levels but were particularly pronounced for those with 0-5 years, 11-20 years and 21-30 years of experience. This issue was consistently examined as a key obstacle to the EMS recommendation which focuses on the need for better work-life balance management within our profession.

Recruitment-retention recommendations from the data

The survey results point to several areas where improvements can enhance job satisfaction and career recommendations within EMS:

• Increase compensation. There is a need to address dissatisfaction with compensation and benefits. Competitive salaries, comprehensive benefits packages and clear pathways to economic development can help attract and retain EMS personnel. Of course, this is nothing new. This struggle has been going on for a long time and seems to get worse as the economy changes and the cost of living rises.
• Establish or enhance performance development programs. Companies should implement strong performance development programs that can help maintain high levels of job satisfaction. Opportunities for advancement, career advancement and recognition can lead to long-term job satisfaction as they provide achievable future goals as employees grow within the profession.
• Support work-life balance. Introducing flexible schedules and mental health support, and ensuring adequate working hours can reduce the negative impact of EMS work on employee family life and individual well-being. Agencies that promote employee wellness through system modifications gain employee trust and loyalty.
• Emphasize community impact. Leaders should reinforce the value and impact of EMS work in the community to help maintain motivation and pride in the profession, especially for those starting their careers. It’s a cliché to get into EMS “to help people” because it’s true. Sometimes we need visual reminders of this, so agencies should find tangible ways to show providers’ impact on those they serve.

The findings of this year’s EMS Trend Survey shed light on the multifaceted nature of job satisfaction and career recommendations in EMS. By addressing key concerns about pay, career advancement and work-life balance, as well as reinforcing meaningful work elements, the EMS profession can provide employees with more satisfaction and increase commitment. These changes are necessary to ensure that EMS remains a viable and attractive profession for current and future employees.

Download the full digital edition: What Paramedics Want 2024

About the Author

Maria Beermann-Foat, PhD, MBA, NRP, has over 20 years of prehospital emergency care experience in privately-owned, hospital-based and county government-based emergency services. She is EMS training coordinator for Eugene Springfield Fire in Oregon. She retired as battalion chief of operations for MED-ACT Emergency Medical Services in 2021.

Dr. Beermann-Foat holds a Ph.D. in Organization Management from Capella University and a Masters of Business Administration from MidAmerica Nazarene University.

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