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Journal Watch: The Impact of Extra Work

Reviewed This Month

The Impact of Working Overtime or Multiple Jobs in Emergency Medical Services

Authors: Rivard MK, Cash RE, Chrzan K, Panchal AR 

Published in: Prehosp Emerg Care, 2019 Dec 20; 1–8  

Almost everyone reading this knows EMS providers often work more than the typical 40-hour work week. Field providers often have multiple jobs and sometimes end a shift at one agency only to go straight to another agency to begin another shift. This is not just anecdotal; studies have found EMS providers work an average of six hours of overtime a day, and most have more than one job. 

However, previous studies did not provide a national-level assessment. Further, while it is known that EMS providers are often paid less than firefighters and law enforcement, it is unknown what percentage must rely on multiple jobs or overtime to pay their bills. Additionally, work and financial stress have been shown to negatively impact mental and physical health, but this association has not been previously studied among EMS providers. 

With all this in mind, the objective of the study we review this month was to “evaluate the association between job satisfaction, intention to leave EMS, and dependence on overtime or working multiple jobs.” To address their objective on a national level, the authors utilized data from the National Registry of EMTs. As many of you know, to maintain a national certification, nationally registered EMS professionals are required to recertify every two years. The authors attached a voluntary survey to the recertification application. EMTs, AEMTs, and paramedics were given an optional online survey after submitting their recertification application. The authors also collected demographic data from the recertification paperwork: sex, age, race/ethnicity, community size, EMS certification level, number of EMS jobs held, and how many hours a week on average worked collectively at any job over the past 14 days. 

The survey focused on topics regarding dependence on overtime or multiple jobs to make ends meet, satisfaction with one’s job, and intent to leave the EMS profession. The authors noted that “the term ‘make ends meet’ was used to measure what each individual person needs to maintain their cost of living, such as working an additional job or working overtime…to make a living and pay their bills.”

Data were collected from October 1, 2017 to May 31, 2018. All EMTs, AEMTs, and paramedics recertifying in the 2017–18 cycle had the opportunity to complete a survey. The authors excluded anyone who was not providing patient care, not working for an EMS organization, working for a military agency, or younger than 18 or older than 85. The analysis included the calculation of descriptive statistics as well as logistic regression modeling to describe the association between dependence on additional work and three separate outcome variables: 1) job satisfaction, 2) intention to leave EMS within a year, and 3) intention to leave EMS within five years. Each of these models adjusted for sex, age, race/ethnicity, certification level, EMS agency type, employment status, and community size. 


There were 22,626 individuals who completed the survey, representing a response rate of 22%. Of those, 18,285 (81%) met the inclusion criteria. Most respondents were male (74%) and white/non-Hispanic (89%), with a median age of 41. More than 60% worked in urban settings, and more than a third worked for two or more EMS organizations. Almost three-quarters worked full-time for their main EMS agency, with 40% working 24-hour shifts and 28% working 12-hour shifts. Almost three-quarters reported working at least 41 hours or more a week on average in the last 14 days. 

Overall, 71% of respondents indicated they depended on additional work to make ends meet. This included 57% who indicated they depended on overtime and 56% who depended on more than one job. Nevertheless, the majority of respondents were satisfied with their EMS job, with only 7.7% indicating they were dissatisfied, 6.1% indicating they intended to leave within a year, and 27% indicating they intended to leave within five. 

After controlling for potential confounders in the logistic regression models, the authors found dependence on extra work (overtime or multiple jobs) increased the odds of job dissatisfaction (OR 1.92; 95% CI, 1.64–2.44). Dependence on extra work also increased the odds of reporting intentions to leave EMS within one year (OR 1.32; 95% CI, 1.14–1.54) and five years (OR 1.16; 95% CI, 1.07–1.25).

As far as limitations, this study only assessed nationally certified EMS professionals. These results may not be generalizable to those who are not nationally certified. The study was also not able to evaluate whether overtime hours were mandatory or voluntary. Furthermore, most respondents either worked 24- or 12-hour shifts. Therefore, working two or four shifts, respectively, would mean these individuals would be in the 41-hours-or-more category. 

The response rate was also notably low, at 22%. However, the study population included more than 18,000 EMS professionals. To address this the authors compared the demographics of those who replied to those who did not and found no substantial difference in sex, age, agency type, full-time status, or volunteer status. However, they did find a substantial difference in community size and the certification level of the respondents, as well as a smaller difference in minority status. 

This was a well-done study that significantly adds to the available literature on the impact of additional work on EMS professionals. In addition to their high-risk and high-stress jobs, many respondents in this study had the added burden of needing additional work to make ends meet. This additional work appears to be detrimental to the satisfaction and stability of the EMS workforce. EMS professionals should be able to earn a living without depending on multiple jobs or overtime hours.   

Antonio R. Fernandez, PhD, NRP, FAHA, is a research scientist at ESO and an assistant professor in the department of emergency medicine at the University of North Carolina–Chapel Hill. He is on the board of advisors of the Prehospital Care Research Forum at UCLA. 


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