There are multiple paid departments in the area, however I have heard of no plans for exams in the near future; also the volunteer culture is VERY strong, so unless it's RFD, the chances of a department taking on somebody who hasn't been around as a volunteer with them or a neighboring department are slim. As far as municipal/department based EMS, as I said, volunteer culture is strong, however most "volunteer ambulances" will staff a crew during the day. These are primarily Paramedic crews, as the area is saturated with them and the protocols are very ALS heavy; some will pay Basics, but once again it's very "good ol' boys club". The hospitals do hire ER techs, so keep your eyes open and their scope varies by hospital. The primary system's are Rochester General Hospital system (RGH and Newark/Wayne), U of R Healthcare (Highland, Strong and F.F. Thompson), Unity Health System and Finger Lakes Health (Geneva General); these guys have a stranglehold on most "private practice" at this point and use primarily trained Medical Assistants and RN's, not EMT's. Coming into the area, if you can't line up an ER tech position, your best bet would be the private ambulances.
Finger Lakes Ambulance is based out of Clifton Springs (under an hour commute south using expressways), they are primary 911 in the City of Geneva and are second due 911 for all of Ontario County when the volunteers can't drum up a crew; they also hold multiple private contracts in the area. Equipment can range from brand new to a bit dated but fully operational and well maintained and crews average ~3 calls in a 12 hour shift.
Rural/Metro is the 911 provider for the City of Rochester, Village of East Rochester and has its eye on a few of the other 'burbs, as well as a few private SNF and hospital contracts. It's like R/M anywhere else (if you're familiar) and is the largest EMS employer in the area, so networking will be plentiful. Calls per shift are usually one an hour or so, busy system.
Monroe at this point has been beaten out of all primary 911 in the area (except for one obscure county based contract in the Southerntier), they have made up for it by winning multiple private contracts and special event contracts (hockey, soccer, baseball, college events). Much more relaxed environment, if you like CCT they dabble in that quite a bit. Call volumes are moderate but nowhere near exhausting and their equipment is for the most part late model and kept in the best of shape.
My best advice for you would be move to the area, get established and working (private ambo or ER), joining your local volunteer department will also help keep you in the loop on municipal careers. Once you've been here a few years and people know you, unless you have a sweet paid fire gig, DO YOUR MEDIC, it's basically the only to get anywhere career wise with EMS in the area. Hope this helps.
