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Leon County
Board of County Commissioners Cover Sheet for Agenda #8 December 14, 2021 |
| To: | Honorable Chairman and Members of the Board |
| From: | Vincent S. Long, County Administrator |
| Title: | EMS Recruitment and Retention Strategies |
| Review and Approval: | Vincent S. Long, County Administrator |
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Department/Division Review and Approval: |
Alan Rosenzweig, Deputy County Administrator Andy Johnson, Assistant to the County Administrator |
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Lead Staff/ Project Team: |
Chad Abrams, Chief, Emergency Medical Services |
Statement of Issue:
This item seeks Board approval of proactive strategies to support the recruitment and retention of Emergency Medical Services (EMS) personnel. The strategies recommended in this item are intended to mitigate the effects of a nationwide paramedic shortage which has occurred in recent years and which has been further exacerbated by the COVID-19 pandemic.
Fiscal Impact:
This item has a fiscal impact. The cost to implement the proposed EMT to Paramedic Trainee Program for the remainder of FY 2022 would be approximately $220,000. The fiscal impact to provide the proposed Extra Shift Incentive Stipend and Special Day Stipend would be $364,000 and $84,000, respectively, for the remainder of FY 2022. These costs would be partially offset by unexpended personnel costs associated with existing vacancies within the EMS Division, and adequate funding is available from EMS fund balance to support remaining costs.
Staff Recommendation:
Option #1: Authorize the creation of the EMT to Paramedic Trainee Program as discussed in this item and approve associated revisions to Section VI of the Leon County Personnel Policies and Procedures Manual (Attachment #1).
Option #2: Authorize the implementation of shift incentive stipends as discussed in this item and approve associated revisions to Section V of the Leon County Personnel Policies and Procedures Manual (Attachment #2).
Option #3: Approve the associated Budget Amendment and Resolution (Attachment #3).
Report and Discussion
Background:
This item presents and seeks Board approval of proposed strategies to further support the recruitment and retention of Emergency Medical Services (EMS) staff members. The strategies recommended in this item are intended to mitigate the effects of a nationwide paramedic shortage which has occurred in recent years and which has been further exacerbated by the COVID-19 pandemic. Specifically, as discussed in the Analysis section below, this item proposes both immediate and long-term strategies including the creation of a sponsored Emergency Medical Technician (EMT) to Paramedic Trainee Program and the implementation of new shift incentive stipends. Additionally, consistent with County policy, the EMS Division and Leon County Human Resources will be conducting an extensive update of the EMS Pay Plan as part of the upcoming FY 2023 budget development process. Based upon this evaluation, any recommendations that may be warranted to maintain the County’s long-term competitiveness in recruiting and retaining key talent in the EMS Division will be presented to the Board as part of the FY2023 budget process.
In response to the nationwide paramedic shortage discussed above, the Florida Department of Health (FDOH) statewide EMS Advisory Council appointed an Ad Hoc Paramedic Shortage Committee which found that during the 10-year period between 2007 and 2017 there was an 18% reduction in the number of licensed paramedics; during the same period, the number of ambulance responses in Florida increased by 52%. Leon County experienced a similar increase in requests for service during the same period (45%). Since FY 2005, the first year during which Leon County provided EMS services, calls for EMS services in Leon County have increased 80% (27,240 requests for service in FY 2005 and 49,502 requests in FY 2021). Employment opportunities for paramedics have also recently expanded into primary healthcare, public health, and hospital roles, further accelerating competition and labor market pressures. Several fire-based EMS systems that previously required all EMS members to be dual-certified in EMS and firefighting have also modified their requirements to allow for single-role paramedics to work for the organization.
In addition to the trends discussed above, the COVID-19 pandemic has created unprecedented healthcare staffing challenges and has exacerbated the paramedic shortage. Throughout the pandemic, paramedics have been called upon to provide healthcare and public health services, demonstrating the effectiveness of utilizing paramedics in non-traditional roles and further expanding employment opportunities in hospitals, doctors’ offices, and other medical settings. Many of these settings offer a lower workload and fewer weekly hours while offering wages competitive with what Leon County and similar EMS providers offer.
Over the past several years, Leon County has taken a variety of proactive steps to mitigate the impact of the paramedic shortage and remain an employer of choice by implementing a professional development plan, increasing hourly pay rates, implementing alternative scheduling options, enhancing shift pay differentials, and continuing to focus on fostering an environment that facilitates long-term EMS careers. The County also identified a means to allow Tallahassee Fire Department members to work in as-needed (PRN) capacity for EMS; however, the County has received no applications under this program. Until now, these efforts have largely insulated the County from experiencing the major impacts of the shortage that have affected other jurisdictions across the Country. Most recently, Leon County has conducted an aggressive advertising campaign to recruit EMS personnel including social media, conventional advertising strategies, direct recruiting at four area paramedic training programs, and the creation of an EMS recruitment webpage. The County has had limited success in in finding qualified paramedic candidates and continues to have unfilled full-time positions with limited applications being received.
The challenge of recruiting and retaining licensed paramedics over the past year has required the County to frequently use mandatory overtime, realign job responsibilities, and modify ambulance deployment plans to fill ambulance schedules, all of which places additional pressures on the workforce and EMS system. As discussed in the Analysis section below, employers across the Country and in Florida have recently adopted various pay and bonus strategies to improve EMS staffing. Most notably is a recent surge in the number of employers offering stipends or hourly rate additives, sign-on and retention bonuses, and increases to pay plans. Some jurisdictions are also working to increase the number of individuals obtaining an EMT or Paramedic license through various incentive programs.
Analysis:
As discussed above, Leon County has implemented several strategies in order to remain proactively well-positioned to compete for qualified EMT and paramedic applicants. EMS staff has also reviewed best practices for recruitment and retention, particularly with respect to the workforce challenges presented by the COVID-19 pandemic. Based upon this review, this item proposes the following additional strategies to further mitigate the impact of the paramedic shortage on the County.
EMT to Paramedic Trainee Program:
In order to consistently develop a broader pool of potential paramedic candidates, this item recommends the Board authorize the creation of an EMT to Paramedic Trainee Program within the EMS Division. This program would establish a “talent pipeline” to enhance the County’s ability to fill critically-needed Paramedic positions.
According to data published by the Florida Department of Health, there are 9 licensed paramedics per 10,000 of population in Leon County compared to 15 statewide. There are 8 licensed paramedics per 10,000 of population in Jefferson and Wakulla Counties while Gadsden has 7. As a result, there are limited opportunities to attract additional paramedics from neighboring communities. Strong competition across the country, coupled with aggressive recruitment incentives, has limited Leon County’s ability to recruit from outside the local area. In response, Leon County has supported efforts for many years to increase the number of individuals entering the paramedic profession. Paramedic education programs are provided at local community colleges, with most Leon County Paramedics completing the EMS training program offered by Tallahassee Community College (TCC). Although the job market for paramedics has expanded considerably in recent years, the number of paramedic graduates from these programs has largely remained unchanged. The County and local community colleges have augmented recruitment efforts with no appreciable increase in the number of graduates from these programs.
Under this proposed program, five full-time (FTE) EMT positions would be created within the EMS Division. These candidates would enroll in and complete a Paramedic training and certification program while being employed by Leon County as EMTs on a full-time basis. These EMTs would be paid for the time they are in class, including required clinical training hours, as time worked and be eligible to work available hours on ambulances. The County would also pay all tuition and costs associated with the program. In exchange, participants would agree to a three-year commitment to work full-time for Leon County as a Paramedic. The cost of the EMT to Paramedic Trainee Program would be approximately $58,500 per participant, or a total annual cost of $293,000 for five full-time participants. Of this, payroll-related expenses would comprise approximately $53,500 of the per-participant cost, with the balance accounting for tuition and materials. With the Board’s approval, this program could be launched as early as January 2022; in this case, the total program cost for the remainder of FY 2022 would be approximately $220,000. The funding needed to support this program is available from EMS fund balance.
As a means of further enhancing pathways for students to enter a career in EMS, the County is also exploring the creation of a high school-based Emergency Medical Responder and EMT program. This would provide high school students with an opportunity to begin a career immediately after graduating from high school. Coupled with the proposed EMT to Paramedic Trainee Program, this would provide participating students the opportunity to move immediately from high school into a full-time job, enter the EMT to Paramedic Trainee Program and, within four college semesters, transition into a role as a full-time Paramedic with Leon County. Minimal to no financial impacts to the County are anticipated for the high school-based program. An agenda item with additional information regarding this initiative will be presented to the Board at a future meeting as tentative program details and partnerships are developed.
Incentivize Working Extra Shifts and Special Event Days
As discussed earlier in this item, the County has regularly utilized mandatory overtime to fill vacant shifts. Two shift incentive stipends are recommended to provide incentives for EMTs and Paramedics (i.e., personnel within all EMT, Paramedic, C1, and C2 pay grades) to work qualifying shifts:
This item recommends the Board authorize a stipend for EMTs and Paramedics for working qualifying shifts above and beyond their regularly scheduled shifts. If approved, the County Administrator would be authorized to allow extra shift incentive stipend payments during critical staffing periods and at times deemed appropriate, subject to funding availability within the EMS Division personnel budget, as follows:
This strategy is intended as a temporary, stopgap measure to retain existing EMS personnel by reducing employee burnout and providing employees an additional opportunity to earn extra income. As staffing levels improve and there are fewer open shifts to cover, the need for the incentive would be eliminated. As such, the EMT to Paramedic Trainee Program proposed in the previous subsection would help to alleviate the need to provide these stipends. The projected maximum fiscal impact of this proposed strategy for FY 2022 is $364,000.
This item also recommends the Board authorize a stipend for EMTs and Paramedics for working “Special Days” that do not fall on County holidays. Certain days, such as holidays and days with major special event coverage demands (e.g., Florida State and Florida A&M University home football games, etc.), are designated as Special Days under EMS Standard Operating Guidelines. EMTs and Paramedics are not permitted to utilize leave time or trade shifts during Special Days. As such, Special Days that are not County holidays present additional difficulties in filling all the required shifts. Some Special Days require EMS to deploy up to 50 additional personnel to provide the required coverage.
Under current policy, EMTs and Paramedics that work Special Days on a County-designated holiday qualify for holiday pay. For Special Days unrelated to County holidays, it is recommended that a stipend be provided, as follows:
The projected fiscal impact for implementing this proposed stipend in FY 2022 is $84,000. It should be noted that a majority of Special Day coverage results from requests for Leon County EMS to provide ambulance and medical coverage at special events. Event sponsors for whom these services are provided are required to pay the County $75 per hour per EMT or Paramedic in attendance at the event. This revenue is contemplated in the budget process as revenue that supports the overall EMS Division budget.
Annual Update of the EMS Pay Plan
As detailed in the Background section of this item, there are significant pressures on the EMS labor market including an insufficient number of licensed paramedics, increased calls for EMS services, and the expansion of job opportunities for paramedics. These challenges necessitate an in-depth evaluation of the EMS Pay Plan. Consistent with County policy, the County’s EMS Pay Plan is market-based, and Leon County Human Resources evaluates the pay plan as compared to the market and makes recommended modifications during the budget process.
Historically, the County’s EMS Pay Plan has provided compensation levels near the median of the market. As a result of changing market conditions in recent years, however, hourly pay rates in the EMS market have rapidly changed and required the County to increase pay rates to keep pace. In FY 2022, the County implemented an increase in starting EMT pay rates from $13.27/hour to $16.81 and Paramedics from $18.27/hour to $21.81. However, the market continues to evolve at unprecedented speed. Less than a month into FY 2022, Escambia County increased Paramedic pay rates from $19.19/hour to $25.32. Alachua County providing a $7,500 annual paramedic incentive and is offering a $10,000 recruitment bonus. Pinellas County provided additional funding to its EMS system to increase Paramedic pay rates to $22.04/hour with plans to increase to $26.04 / hour in FY 2024 and is providing various recruitment bonuses.
In 2018, the American Ambulance Association assessed paramedic turnover in EMS agencies and found dissatisfaction with pay as a top reason that employees leave EMS agencies. As discussed above, many EMS personnel across the country have left their EMS employer to take positions elsewhere in the medical field for comparable pay. Research conducted by the National Registry of Emergency Medical Technicians, titled The Impact of Working Overtime or Multiple Jobs in Emergency Medical Services, found that 71% of respondents were dependent on overtime or multiple jobs to make a living and that those respondents had a higher likelihood of being dissatisfied with their jobs and leaving EMS within one to five years. As is typical in EMS, most of Leon County’s EMS workforce is working more than one job, which also limits their availability to work extra shifts for the County.
In addition to these evolving trends in compensation levels, many EMS employers have begun to also offer non-salary-based incentives, such as the implementation of 48/96 hour shift rotations. Under this model, an employee works 48 continuous hours and then has 96 consecutive hours off. Among other employers, this 48/96 hour rotation has been implemented in Jefferson, Wakulla, and Gadsden Counties. These counties have also increased their pay rates to levels where the shift schedules and lower call volume outweigh the minimal difference in hourly pay rates compared to those offered by Leon County. Additionally, local hospitals have implemented alternative scheduling, a lower number of required hours, a decreased workload, and competitive pay rates. In the last year, the County has lost paramedics to Tallahassee Memorial Healthcare, Capital Regional Medical Center, Wakulla, Jefferson, and Gadsden Counties.
As a result of the market trends related to EMS staffing discussed above, it has become much more challenging in recent years to remain competitive in recruitment for EMTs and Paramedics and may warrant increasing compensation levels within the EMS Pay Plan. Accordingly, the EMS Division and Leon County Human Resources will be conducting a comparative review of the County’s EMS Pay Plan against similar EMS providers and will provide recommendations to the Board during the FY 2023 budget process to maintain the County’s long-term competitiveness in recruiting and retaining key talent in the EMS Division.
Options:
Recommendation:
Options #1 through 3
Attachments: