When Dominique Johnson, 28, imagined her life as an emergency medical technician, or EMT, she pictured lots of drama. “I thought it would be like 9-1-1,” she said, “but it really hasn’t been. It’s more like transport.”

Johnson is not complaining because when she pivoted from day-care worker to someone caring for a patient in an ambulance, she wasn’t searching for excitement.

After several years of minimal raises, Johnson was looking for a steady job with regular pay increases, overtime opportunities, and scheduling flexibility. She wanted to be in a medical field that led to her lifelong ambition of becoming a pediatric respiratory therapist.

“It’s a stepping stone,” she said.

Last year, Johnson finished EMT training at District 1199C Training & Upgrading Fund in Philadelphia, a union and management-run institute that provides training to members and the larger community. She earns $16.50 an hour at LifeMed Ambulance in Juniata Park. Johnson regularly works 50 to 60 hours a week. She said LifeMed pays about average for EMTs – she has seen postings for as much as $17.50 an hour for first-timers such as herself.

To become an EMT, Johnson had to obtain a CPR certification, complete an EMT course, and pass two exams – one a review of physical skills and the other a knowledge-based test. Johnson can ride her EMT training to advance to a paramedic position after more classroom and hands-on practice followed by another pair of tests.

First-year paramedics can earn $56,227 working for the city of Philadelphia, where annual paramedic pay currently tops out at $85,901.

Johnson doesn’t worry about being replaced by a robot or artificial intelligence. When it comes to the future of work, there’s a future for Johnson as she keeps track of patients’ vital signs and guards against anything going wrong.

“I don’t think EMTs can be automated,” Johnson said. Even if machines become more proficient at tracking aspects of patient conditions, “you need someone to interpret what’s going on. You need people to learn about the body, and when things are going wrong within the body, to know how to respond.”

The U.S. Department of Labor bears out Johnson’s assessment, with a projected job growth rate of 6% for EMTs and their more advanced counterparts — paramedics — through 2029. That’s higher than the 4% growth rate for all occupations.

There’s a shortage of emergency medical service personnel, said Heather Sharar, executive director of the Ambulance Association of Pennsylvania, a trade group. “It’s like that all over the country.”

The COVID-19 pandemic didn’t help. Exposure to COVID-19 would put EMTs out of commission for two weeks, if not longer. Short staffing meant that ambulance company executives were pulling shifts to meet demand. “That’s how bad it was,” Sharar said.

Sharar said there has been a decline in the number of people certified for occupations in the field of emergency medical services (EMS). From least to most skilled, job titles that fall under this category include emergency medical responder (EMR), EMT, Advanced EMT, paramedic, and pre-hospital registered nurse.

Between 2012 and 2016, the number of certified EMS personnel in Pennsylvania fell from about 58,000 to 48,000, according to statistics that Sharar’s organization compiled for the Pennsylvania State Association of Township Supervisors. Currently, she said, there are 39,844 EMS providers, including EMTs, certified by the state, a 31% decline since 2012.

In an even more telling statistic, only 22,509 of the 39,844 EMS personnel, just over half, are currently active.

That’s because it’s a tough job — physically and emotionally. And, for EMTs in particular, the pay isn’t great.

“Sometimes an EMT is making $9 an hour,” Sharar said. She added that government and private insurance reimbursements for ambulance services are so low that companies can’t afford to pay more.

“It’s a great vocation, but we need to get them paid more so they don’t have to work two and three jobs,” Sharar said.

And then there’s the stress from the job.

“Burnout is very, very real,” said Amanda Rock, who teaches EMS classes at Drexel University’s EMS Training Center. Dealing with patients at vulnerable moments in their lives takes its toll.

Johnson is not interested in pursuing the paramedic path. Instead, she wants to return to college to complete respiratory therapy training. At that point, she can reduce her hours and still bring in some money while studying.

Sharar said that it’s not unusual for EMTs and paramedics to move into other positions in health fields. It’s part of what contributes to the sector’s high turnover.

Helping people such as Johnson move along their career paths prompted District 1199C Training & Upgrading Fund to develop an EMT training program last year. The Training Fund’s program is on hold because there is no grant funding for it. However, qualified union members of District 1199C can receive tuition reimbursement to take the training through a training partner of the Fund.

“We’re doing our part and our students are doing their part going to this field where, honestly, people are calling them heroes,” said Stephanie Webb, program manager at the T&U Fund.

“There are opportunities for actual employment with good wages,” she said. “Since there’s a shortage, they can get a job and there’s opportunity for growth.”

The Future of Work is produced with support from the William Penn Foundation and the Lenfest Institute for Journalism. Editorial content is created independently of the project’s donors.