A Response to a Decline in First Responders

American Medical Response takes action to hire and retain EMTs and paramedics in a tough market

American Medical Response (AMR), the nation’s largest private ambulance company, brought 4.4 million patients to hospitals in 2015. As it integrates its recent acquisition of Rural/Metro—the once number-two company, which added over 7,000 new staff members—that number is set to balloon this year.

But as AMR grows, it faces a dilemma: how to attract and retain EMTs and paramedics to work in its fleet of thousands of emergency vehicles.

As VP of human resources for AMR, a subsidiary of Envision Healthcare Companies, Richard Barr is tasked with addressing the dearth of available employees. “There’s a tremendous shortage of paramedics for the number of jobs available across the country,” he says. “During the great recession, things kind of slowed down and were okay, but since 2011, it has turned the other way and it has gotten worse each year.”

In what adds a layer of irony to the situation, AMR also trains EMTs and paramedics through its National College of Technical Instruction training facilities, but historically has only been able to retain about half of them. Those in the other half often go to fire departments and other private ambulance companies. AMR’s training arm is currently a revenue center, Barr says, so they have to open the doors to all comers, whether or not they intend to work for AMR. Barr has a short-term goal of bringing recruitment rates from classes up to 60 percent.

“We just want to make sure we give them the tools to make it as easy as possible to provide the best service to our patients.”

One of the ways he is doing that is by encouraging his operational leadership to provide sponsorships to incumbent EMT-Basics. If a student agrees to work for AMR after the training, the company will pick up the cost of the classes. The standard agreement is that the graduate will spend at least two years with the company and the loan will be forgiven.

Barr says the company is also constantly looking for ways to attract more part-time employees to help fill some of the gaps.

“These may be people who work at the fire department two days a week,” he says. “On their two days off, we’d love to have them work for us. We have to be creative with the shift schedules. However, it is difficult to get part-time employees to work nights and weekend shifts, so our full-time employees may end up filling those hard-to-fill slots.”

There is upward mobility for the EMTs and paramedics. They can become field training officers who provide orientation and on-the-job training to new hires. They can also move into a critical-care technician role, which requires extra training so that they can use clinical pumps and vents in transporting patients. These positions most often come with higher pay.

As part of a patient-care business that relies on all of its team members, Barr says that about 75 percent or more of the company’s total expenses is wages and benefits, and that higher minimum-wage legislation across the country creates a struggle to control labor cost. It also creates some wage compression in the markets for operations that border states or municipalities that have instituted higher minimum-wage legislation.

“You have municipalities like San Francisco, San Diego, and Seattle who have instituted much higher minimum wages than their state minimum wage or the federal minimum wage,” he says. “Our employees must be at or above those levels. What municipalities and states don’t understand is the way we weigh our wages based on the shift types. So, even though we’re paying an EMT an hourly amount for a twelve-hour shift that is lower than the requisite minimum, if you convert that wage to a general eight hours, it would be fifteen dollars an hour, and we would clearly be over the threshold.”

EMTs and paramedics in other parts of the country may also rankle at seeing their brethren paid more, which Barr understands.

“Saying that there is legislation requiring higher pay in one area versus another is not a good answer for an employee,” he says. “They say, ‘If you do it out there for them, why not for us? We do the same job.’ We’d love to pay them the same, but our margins are limited, so we have to be careful.”

One way to help solve the problem is to lobby legislatures and help them understand the unique wage structure of the business, according to Barr. And, from a recruiting perspective, he also thinks that a single, nationwide standard for paramedic licensure would help. Just like how someone with a Texas driver’s license is legally allowed to drive in New York, there could be automatic reciprocity in paramedicine practice.

The tangle of HR intricacies and wage legislation can also obfuscate the fact that EMTs and paramedics are in it largely because they want to help people, as does Barr.

“That’s the driving force: to help people,” Barr says. “EMTs and paramedics learn quickly that it’s not a job where you’re going to get rich. We just want to make sure we give them the tools to make it as easy as possible to provide the best service to our patients.” AHL