BARRIERS TO PROFESSIONALIZATION OF EMERGENCY MEDICAL SERVICES: AN ANALYSIS OF WAGES AND COLLECTIVE IDENTITY CONFLICTS NEGATIVELY AFFECTING EMS WORKFORCE RETENTION

Abstract

Emergency Medical Services (EMS) in the United States has suffered from chronic low workforce retention since the 1990s. This three-paper dissertation explores two of the barriers to improving workforce retention in EMS: wages and collective identity crises. The first paper explores the relationship between the EMS delivery system utilized by metropolitan areas and the area EMS wage progression by addressing the age-old question of which system is better, public or contracted private agency. Analyzing wage data over two decades through a two-sample two-tail t test resulted in initial findings that metropolitan areas that contract with private agencies to provide 911 services have a minimally stronger correlation to wage progression than publicly provided EMS services. However, neither system promotes sufficient wage progression to combat increasing inflation and living expense. Paper two expands wage analysis to an international level by comparing wage progression of EMS in the United States to EMS in the United Kingdom. This preliminary research follows a ground theory framework for future research by developing the taxonomy and initial theoretical reflection that correlates national health care model to wage progression and the economic cycles of the EMS industry. The results indicate that both systems fail to follow labor supply and demand theories and that the U.K. has experienced a wider variance in the identified economic cycle. The final paper conducts a scoping review of the development of EMS in the U.S. to offer three primary research contributions: 1) identification of key deep-structured legacy occupational identities, 2) characterization of occupational identities and associated conflicts, and 3) identification of developing non-occupational identity conflicts that threaten to exacerbate current conflicts. Legacy identities and their conflicts were categorized as either role-based (task-oriented conflicts) or politically-based (subject-based conflicts). Discussion points considered how these identities and their conflicts work to prevent the creation of a cohesive occupational collective identity. All three papers open discussions on various aspects affecting EMS workforce retention that can be used as foundations for future research and inform policy makers and industry leaders.