Having been an ambulance director for years for both rural and larger city services, turnover was always an obstacle to overcome.  It's seems there was no easy way to battle this problem.  Some of the common reasons I received as a director pertaining to the turnover issue:

A Few Typical Reasons EMS Professionals Quit Their Jobs   

No one appreciates what we do (perhaps one of the most common       comments)

    The good old over worked and under paid syndrome

    Don't get enough sleep

    Work to many hours

    Can't take the stress

    I don't get enough time with my family

The above are just a handful of reasons I as the EMS director received from employees upon termination of their employment.  Now would you think of comparing the EMT turnover rate versus the paramedic turnover rate?  For the first year or so of my EMS director time, I did not really think of this.  After words however, I did decide to compare this.  What would you think the highest turnover rate would be-EMT or paramedic?  If you guessed EMT you are completely correct.  EMT turnover rate was about 50 percent higher than the paramedic turnover rate. 

Why would the EMT turnover rate be higher than the paramedic turnover rate?  I personally feel this is because the paramedic is in higher demand and EMS administrators tend to work harder at keeping the paramedic happy with their job a goal.  The EMT tends to notice this and take offense to this.  I know this seems to be an unfair trend but it is the truth at hand.  Please don’t misunderstand me here, the job would not get done without the EMT, the EMT is as important as the paramedic but due to more abundance of the EMT, they are easier to replace.  This is a sad fact but a true fact that most EMS directors have to deal with.  It’s not as directors we enjoy this fact but we too have superiors to deal with.  Trust me here; I have fought many higher up administrators, county commissioners and hospital administrators over this matter.

As a director, I worked side by side with each of my EMS employees.  I ran calls with them, bunked with them and spent time with them as if I were a regular crew member.  I felt they had to trust me to put out 100 percent.  This worked for the most part.  At least I had the trust of my EMS employees and they were comfortable talking to me as if I were a regular crew member and not just the boss.  For this reason, most of my EMS employees were open to discussion when changing jobs, getting out of the profession or just taking a break from it.  I was able as a director to openly talk with my EMS providers and know why they felt the way they felt about their jobs.

Over the years, two reasons rank the highest for EMT and paramedic level as reasons for quitting their jobs.  (Please Note)  This is my own personal study I did as a director for the services I led; these are not calculated studies by any organization.

Two Most Used Reasons for Quitting

    Not appreciated enough for the hell they go through to do their job

    Don't make enough money for the hours they put in

We as EMS professionals all know for the most part, this is probably a true reason but as a seasoned EMT or paramedic, we all know this is a normal part of our work.  This is just a normal cycle of EMS.  Most well seasoned professionals expect this with any EMS job, it's a part of the EMS life.

Why then would one go through all of the training, work their tails off many times with no sleep, high call volume as most of them would say with little appreciation?  Could it be some get in to this line of work because lights and sirens are cool?  Is it because they can drive fast in a big truck?  Or could it be they feel people will think they are special because of the type of work they do?  It's hard to say, I know as a director for years, I could pick out a true if you will EMT or paramedic.  For the most part, I was able to keep my turnover rate a bit lower than most because I knew the EMT or paramedic that was in this work for the people, not because it was a cool job with lights and sirens.

We still as EMS professionals have a very high turnover rate.  Why is this with all of the available EMT and paramedics we have these days?

I think I should take a moment to state; I have 11+ years of EMS director experience.  I know this job very well.  I did not mention anywhere in this article that my director experience is all hospital based services.  I know no matter if it is hospital based or county based, politics dictates the EMS game.  Politics plays a major role in EMS like it or not.  Hospital based services is two fold.  Not only do you have the county commissioners and whoever else involved, we have the hospital administrator to deal with.

Hospital administrators are in it for the money.  Budgets, greedy people who think they know EMS who know nothing.  The EMT and paramedic does not deal with the everyday grind of the politics of this business and do not understand.  They simply feel they are not appreciated.  It is really sad, EMS professionals are not truly appreciated for the effort they put forth, and this is for hospital based services I speak of here. 

We as directors have very little control over how the hospital administration handles the everyday hustle and bustles of EMS because they simply choose not to care for the most part.  Let’s meet the budget!  That’s what hospital based EMS is about.  An even harder concept of this is; as a director, one our main goals is quality patient care.  We as the director wear the hats of many.  We worry about keeping our turnover rate down, keeping good EMT and paramedics on board and happy with their job.  Staying within budget, keeping good equipment and maintaining this equipment, training, budgets, scheduling and the list goes on and on.  Any good EMS director will tell you one the main concerns outside of providing the best patient care available is keeping the turnover rate low.

There is now some good quality EMS research going on about EMS turnover rates.  There is now some good quality EMS research going on about EMS turnover rates.  Finally some good research into this matter is underway by professionals that know how to figure out the problems EMS professionals face with their day to day job.

Here is a current presentation about EMS turnover rates.  http://www.emsresearch.org/files/turnoverpresentation3/joe.html.  This is a large file so please be patient while it loads.

I would be very interested to get your comments on this article.  Most of the content in this article is of my own personal opinion.  I arrived at this opinion due to the years of work I have into being an EMS director.  Please jump on board and post a comment about this article.  I would truly be very interested in your opinion of how you feel about EMS turnover rates.  Why do you feel EMS turnover is high?  How could this turnover rate be turned around?  Please post your comments!

Phillip Sampson

EMS Prime

www.emsprime.com