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AAA study sets a benchmark for turnover in the EMS industry

Voluntary turnover and involuntary turnover of part-time and full-time EMS providers was studied to determine the overall EMS turnover rate


Turnover is a major healthcare challenge that is poorly understood because there is a lack of good data and benchmarks.


By Greg Friese

EMS has an employee turnover rate higher than other occupations, according to a recently completed study and report by the American Ambulance Association. The employment sector – private versus public – is the top predictor of voluntary turnover.

To better understand turnover in the EMS industry, the AAA partnered with Avesta to conduct a survey, managed by the Center for Organizational Research at the University of Akron. This study – the first one of its size and comprehensive scope – sought to quantify and understand the turnover rate in different EMS occupations, including part-time and full-time paramedics and EMTs.

The report and webinar, available to AAA members, has set an important benchmark for turnover and is a crucial first step to reducing EMS employee turnover. Dennis Doverspike, Ph.D., the primary investigator and a psychology professor, presented the study results and was joined by Scott Moore, Esq., an EMS human resources and operations consultant; and Greg Lawton, president of Avesta.

EMS employee turnover study methodology

Doverspike collected data using a survey of EMS organizations in the spring of 2018. Seven-hundred organizations were invited to participate, and 119 organizations submitted responses. Most organizations who responded had less than 100 employees. About one-third of responses came from private, for-profit organizations, just under one-third came from private, not-for-profit organizations, and a final one-third of responses were received from public-sector stand-alone organizations. No responses were received from public-sector fire departments and the balance of responses came from hospital-based EMS organizations.

Data was collected at the organization level, not at the individual level. Thus, the study doesn’t report the aggregated reasons individuals chose to leave. A representative for each organization cited the top reasons for voluntary or involuntary separation.

The study asked organizations to report 2017 data for these occupations:

  • Full-time EMT.
  • Part-time EMT.
  • Full-time paramedic.
  • Part-time paramedic.
  • Supervisor.
  • Dispatch.
  • Wheelchair vehicle.

The organization representatives were asked to report:

  • Separations: the total number of people in each job classification who left the organization at any time in 2017.
  • Head count: the total number of filled positions plus the number of open positions at the end of 2017.
  • Turnover rate: the rate for each job classification is determined by dividing separations by headcount.

Study results: EMS industry turnover rate

Turnover was described as overall turnover, voluntary turnover and involuntary turnover.


A 25-percent turnover rate means 100 percent turnover in an organization’s staffing every four years. Organizations should expect a certain percentage of turnover because of unpredictable life circumstances (e.g., a spouse’s job is relocated to a different state).

Organization representatives cited career change and pay dissatisfaction as the top reasons for voluntary turnover. Poor performance is the top cause of involuntary turnover.

The EMS industry turnover rate, according to Doverspike, compares favorably with the Bureau of Labor Statistics data for all occupations, but generally is high compared to research conducted by the Society for Human Resource Management. Healthcare occupation rates are higher than all U.S. occupation.

The research team attempted to identify predictors of turnover. The best predictor, based on data analysis, is sector. Working in the private sector is predictive of higher voluntary turnover. Geography and organization size were not predictive.

Memorable quotes on EMS industry turnover

“The percentage of involuntary turnover for the EMS occupations (EMT, paramedic) is surprisingly low and far less than voluntary turnover.”

“Most of the organizations use pre-employment testing, which is good news. That might be contributing to the low rate of involuntary turnover.”

—Dennis Doverspike, Ph.D., ABPP

“Everyone believes their region is the toughest in which to recruit (EMTs and paramedics). The turnover problem is across the board.”

“We (in EMS) don’t do a great job at communicating and providing fairness in the organization. We can do a better job at performance management, which can have an impact on reducing turnover.”

—Greg Lawton

“When individuals go from full-time to part-time, there is often a reluctance to cut the tie because there is always an opportunity to continue doing the work. You can maintain a relationship with the profession.”

—Scott Moore, Esq.

Top takeaways on EMS industry turnover

Turnover is a major healthcare challenge that is poorly understood because there is a lack of good data and benchmarks. With U.S. unemployment levels at their lowest rates in years, the job market is extremely competitive. Across all occupations, more people indicate they are looking for a new job or wanting to leave their job than at any time since 2001. Doverspike expects the problem of EMS turnover and retention to worsen.

Here are my four top takeaways on the EMS industry turnover.

1. Benchmark for EMS turnover rate is set

The findings of the study are unlikely to be surprising to EMS leaders, managers and field providers, but it’s critical to have benchmark data. Now methods implemented to lower turnover and improve retention can be measured to assess their impact on the organization.

2. Determine causes of voluntary retention

Doverspike described pay, benefits and career advancement opportunities as three important factors which drive voluntary turnover. Managers, especially field supervisors, have a limited ability to impact those factors. Where they can have a greater impact on reducing voluntary turnover is:

  • Frequent, regular and respectful communication with personnel.
  • Ensuring field providers perceive assignments, discipline is fair.
  • Following organization policies and procedures for performance management.
  • Assisting their team in maintaining a healthy work-life balance.

It’s important to regularly ask personnel who stay on the job why they are staying. Determining the attributes of the occupation that improve retention is just as important, if not more important, than asking people why they leave. Doverspike encouraged the audience to analyze the results for any differences between experienced and inexperienced EMS providers.

3. Healthy organizations have lower voluntary turnover rates

Improving and maintaining an organization’s overall health has more potential to improve retention than compensation changes. Most organizations have a limited ability to significantly increase pay rates. Instead there is more potential to effect improvement by:

  • Introducing programs to allow for career growth.
  • Improving work schedules for better work-life balance.
  • Involving employees in process, policy and protocol changes.
  • Improving health, wellness, and workplace safety programs to reduce injuries and enhance physical, mental and emotional health.

4. What’s next for EMS turnover research

The American Ambulance Association is planning an annual study of EMS turnover rates. The data collected will be used to develop education programs for leaders and innovate methods for EMS provider recruitment, selection, hiring and turnover.

Further study is also needed to calculate the cost of turnover and to better understand the causes of turnover. Researchers also want to learn from EMS organizations that have high rates of retention.

Learn more about EMS recruitment and retention

View other webinars from the American Ambulance Association, read in-depth coverage on recruiting and retaining police officers and firefighters, and learn more about recruitment, hiring and retention from these EMS1 articles:

Greg Friese, MS, NRP, is the Lexipol Editorial Director, leading the efforts of the editorial team on Police1, FireRescue1, Corrections1 and EMS1. Greg served as the EMS1 editor-in-chief for five years. He has a bachelor’s degree from the University of Wisconsin-Madison and a master’s degree from the University of Idaho. He is an educator, author, national registry paramedic since 2005, and a long-distance runner. Greg was a 2010 recipient of the EMS 10 Award for innovation. He is also a three-time Jesse H. Neal award winner, the most prestigious award in specialized journalism, and the 2018 and 2020 Eddie Award winner for best Column/Blog. Connect with Greg on LinkedIn.