'We Are Lowest on the Pay Scale'

Across the Canadian prairie province of Saskatchewan, a lack of paramedics is stretching EMS care thin. According to the Paramedic Services Chiefs of Saskatchewan (PSCS), there are approximately 200 vacant paramedic positions province-wide. This shortage is occurring as call volumes have doubled.

Although the provincial government has introduced bursaries of up to $10,000 to attract new students to the profession, EMS leaders say recruitment is only half the battle. Stagnant wages, high attrition rates, and the allure of better-paying jobs in firefighting, policing, and industry are just some of the problems facing Saskatchewan’s EMS agencies.

EMS World spoke with Jennifer Larre, president of the PSCS and owner/operator of WestMed Paramedics, to learn more about this crisis and what it means for the future of patient care in Saskatchewan. WestMed Paramedics serves the communities of St. Walburg and Pierceland.

EMS WORLD: Your association recently reported that there are about 200 primary care paramedic positions open across the province. What is causing so many of these vacancies?

JENNIFER LARRE: We believe there are a variety of reasons. First and foremost, many people take their primary care paramedic (PCP) schooling as a steppingstone to other first responder positions—primarily fire—because the pay is so much more than what paramedics get.

We did some comparisons, and an advanced care paramedic with five years of experience makes roughly what a starting firefighter makes. We max out on our pay scale after about five years based on our union contract, whereas in fire, they continue to get wage increases throughout their entire career.

They’re also using the PCP course as a steppingstone to get into policing. We have many who go work industrial jobs in mines or the oil field. On top of that, many students don’t make it through the course—the attrition rate is high.

EMS WORLD: Why is there such a significant disparity in wages between paramedics and other first responders?

LARRE: I don't know. We lobby for paramedics to catch up with the other first responder professions constantly. Across Canada, Saskatchewan does have a competitive rate for paramedics, but when you look at all first responders locally, we are about the lowest.

We continue to ask the government: Why are our wages so much lower? We feel we have the same responsibility and the same pressure to perform. We're in the same dangerous situations, and often, we are the first and only ones there. It's not like we have the RCMP [Royal Canadian Mounted Police] attending every single call with us. Many times, we are quite isolated in the rural services we respond to.

EMS WORLD:The provincial government has started offering bursaries of up to $10,000 for new students who commit to a two-year return of service. Has that helped?

LARRE: It has definitely helped get some paramedics to stay in ground EMS for those two years. As much as we appreciate that, it has also caused a little bit of a rift. You have paramedics who have been carrying the services for many years and are training these new paramedics, but they aren't receiving that kind of financial bonus.

When you look at the statistics from the Saskatchewan College of Paramedics—who hold all our licenses—we’ve only increased our total number of practitioners by 5% over the last five years. It kind of blows our mind that so many people must be leaving the profession because there is a two-year waiting list just to get into the schooling.

EMS WORLD:If classes are full and there is a waiting list, why isn't the number of working paramedics increasing?

LARRE: Sask Polytech is the only educational institution that trains paramedics in our province. They've added an extra 100 seats over the last two years, yet we still have only gained roughly 96 practitioners over a five-year span.

Furthermore, many of those new practitioners are emergency medical responders (EMRs). Years ago, EMRs weren't typically working on an ambulance—you'd find them more at sports standbys or on a transfer car because their skill set isn't as high. Now, in many places, using EMRs on the ambulance is becoming the standard of care to fill the gaps. The number of actual advanced and primary care paramedics hasn’t increased by much.

EMS WORLD: Are the students who take the $10,000 bursary staying in EMS after their two-year commitment is up?

LARRE: We are just getting to the point where those initial two-year commitments are finishing, so the Saskatchewan Health Authority is following up to see if they are staying in the profession.

Years ago, fire departments were rarely hiring. People wanted to get into fire, but we usually had them for about 10 years before they could get a spot. We found that after 10 years, many of them realized they loved being a paramedic and stayed. Now, they go straight out of school into the fire department. Fire departments are telling them, "If you can get your PCP training, we'll train you on the rest." I’ve even heard students at our own service say, "I got the $10,000, so I'll stick around for two years, but I'm not staying here."

EMS WORLD: Call volumes are also increasing dramatically. What is driving that demand?

LARRE: A major factor is the closures of rural hospitals or hospitals frequently going on bypass. We are getting called because a 90-year-old who might have previously had a neighbor drive them five minutes into town for the local hospital now has to travel an hour away. They can’t get themselves there, so they call an ambulance.

The population of Saskatchewan has also increased quite a bit. It feels like we are on a model that is entirely reaction-based. We aren't prepared and ready to respond based on trends; we are just reacting to the calls as they come in.

EMS WORLD: What do you think needs to change to solve this crisis?

LARRE: That is the million-dollar question. We’ve been lobbying for Sask Polytech to reserve seats specifically for EMRs who want to become primary care paramedics, allowing them to bypass part of the waitlist to hold their interest. We've also asked if they could designate a certain number of seats for people who sign a commitment to work in ground EMS. Right now, I have high school students saying, "I want to be a paramedic, this is my calling," but they are told they have to wait two years to start school. We worry they will find another career path in the meantime.

But the biggest thing, honestly, is wages. We need to get on the same playing field as other first responder groups. If someone is teetering on which career path to choose, it’s tough for them to ignore what firefighters and police officers are getting paid.

EMS WORLD: As a final thought, what is your greatest fear for the healthcare system if this paramedic shortage isn't addressed?

LARRE: I'm kind of scared. Paramedics used to be the safety net of healthcare. We could step into a lot of roles and adapt to what was needed. We've done community paramedicine, home risk assessments, and started IV antibiotics in living rooms to keep people out of the hospital.

Now, we are being pulled back from all those extra community initiatives because we can't even fulfill our main duty: responding to emergency calls. We have patients waiting hours after they call 9-1-1, which is absolutely not what you want to happen. Or we have neighboring services that have to leave their areas to take our calls because we just have no ambulances available.