Editor’s Note: This article originally appeared in the EMS1 industry report, “What Paramedics Want in 2026: The provider roadmap for EMS leaders.” Explore our full coverage in the What Paramedics Want resource hub.
By Kerri Hatt; Anthony W. Minge, EdD
EMS providers continue to point to staffing shortages, burnout and compensation as the profession’s defining challenges, but new survey data suggests another operational issue may be playing an equally important role in workforce dissatisfaction: unpredictability.
The What Paramedics Want in 2026 survey, conducted by EMS1 and Fitch & Associates, found that providers working in systems with less predictable workloads, inadequate downtime and frequent overtime were substantially less likely to recommend EMS as a career.
The findings suggest burnout may not simply be a function of long hours or difficult calls. Increasingly, providers describe exhaustion tied to operational tempo, deployment models and the inability to recover between calls.
The survey collected responses from nearly 1,000 EMS professionals representing urban, suburban and rural agencies across fire-based, third-service, hospital-based and private EMS systems.
Burnout remained the top-ranked issue facing EMS, followed closely by retention, funding and workforce recruitment. Respondents also expressed widespread dissatisfaction with wages and benefits, leadership and provider wellness support.
But deeper analysis of the operational questions revealed several strong relationships between deployment practices and provider morale.
The predictability problem
One of the clearest patterns in the data involved workload predictability.
Providers who described their daily workload as highly predictable were far more likely to recommend EMS as a career. Among respondents reporting highly predictable systems, 66% qualified as “promoters,” meaning they rated EMS career recommendation between 7 and 10 on a 10-point scale.
Among providers reporting low workload predictability, promoter scores dropped to 29%, while detractor scores climbed to 38%.
The relationship appeared consistently throughout the survey.
Static or station-based deployment models produced the strongest predictability scores, while dynamic deployment or system status management models were associated with significantly less predictable workloads.
Respondents working in dynamic deployment systems were also more likely to report:
- Inadequate recovery time between calls
- Frequent shift overruns
- Higher operational stress
The findings point toward a broader issue affecting workforce stability: providers appear increasingly sensitive not simply to workload volume, but to whether the workday feels manageable and controllable.
That concern surfaced repeatedly in the survey’s open-text responses.
Providers described frustration with:
- Constant post moves
- Unpredictable call surges
- Mandatory overtime
- Late calls near shift end
- The inability to mentally or physically recover during shifts
One respondent wrote, “Provide enough staff to support peak-hour units, full staffing daily, adequate rest between calls vs. 10 minutes back in station or never seeing station all shift.”
Another described system status deployment as “driving fatigue,” while others repeatedly referenced the lack of downtime between calls.
The overtime trap
The survey also highlighted how closely staffing shortages and overtime have become intertwined.
More than one-quarter of respondents said they are required to remain on duty past their scheduled shift end either almost every shift or several times per week.
Dynamic deployment systems showed the heaviest overtime burden. Providers working in those systems were substantially more likely to report staying late multiple times per week compared with providers in static systems.
Many respondents described overtime not as an occasional staffing tool, but as a structural necessity required to keep systems operational.
That dependence appears to be fueling a cycle of fatigue and attrition.
Respondents repeatedly linked burnout to:
- Excessive overtime
- Second jobs
- Mandatory holdovers
- Schedules that limit family or recovery time
Numerous providers stated they would work fewer hours if compensation improved enough to eliminate the need for overtime or multiple jobs.
Others argued agencies cannot solve burnout without first solving staffing shortages.
The operational consequences appear substantial.
Nearly half of respondents reported mandatory or forced overtime had a moderate or significant impact on their sleep and recovery. Similar numbers reported negative effects on physical health, mental health and family relationships.
Recovery time becomes a workforce issue
The survey suggests downtime between calls may be emerging as one of EMS providers’ most valued operational metrics.
Providers working in static or station-based systems reported significantly better recovery opportunities than those in dynamic deployment models.
More than half of providers in dynamic systems said they “rarely” or “never” receive adequate recovery time between calls.
By contrast, static systems produced much stronger reports of adequate downtime.
The issue goes beyond comfort or convenience. Respondents repeatedly connected recovery time to quality of patient care, safety, retention and long-term career sustainability.
Many providers described operating in systems where units remain continuously committed for entire shifts, especially in high-volume urban environments or combined 911/IFT systems. Others specifically called for:
- More units in service
- Dedicated downtime
- Fewer mandatory transfers
- Schedule redesigns such as 24/72 models
The debate over shift length itself remained divided.
Some providers strongly defended 24-hour schedules, particularly when paired with adequate downtime and staffing. Others argued long shifts become unsafe when systems run continuously without recovery periods.
The data suggests shift length alone may not determine burnout risk. Operational tempo, staffing density and workload predictability appear equally important.
Leadership and culture remain central concerns
While staffing and operational strain dominated the findings, leadership concerns remained widespread throughout the survey.
Providers frequently referenced:
- Micromanagement
- Poor communication
- Lack of transparency
- Inconsistent accountability
- Disconnect between administration and field staff
Several respondents specifically noted leaders should spend more time working operational shifts to better understand field conditions.
Others described feeling unsupported or unheard by management.
Leadership dissatisfaction appears closely tied to broader retention concerns. Respondents who described supportive leadership, stable schedules and adequate downtime generally expressed far more optimism about the profession overall.
Operational design may shape retention more than agencies realize
Taken together, the findings suggest deployment design is becoming a workforce issue as much as an operational one.
Systems associated with unpredictable workloads, constant deployment movement, inadequate downtime and frequent overtime also produced weaker morale and lower EMS career recommendation scores.
Conversely, agencies with more stable operations, predictable workloads and stronger recovery opportunities consistently produced more positive workforce sentiment.
The findings may carry important implications for EMS leaders confronting recruitment and retention challenges.
For years, conversations about retention have focused primarily on wages and staffing shortages. The survey suggests operational design — including deployment models, overtime practices and recovery opportunities — may play an equally important role in whether providers remain in the profession.
And increasingly, providers appear to be evaluating EMS careers not only by compensation, but by sustainability.
As one respondent put it: “More cars on the road. Less hours. More pay. More cars means less time on task for crews. Less hours means more time to be a human after your shift.”
ABOUT THE AUTHORS
Anthony W. Minge is senior partner, Fitch & Associates, coordinating the firm’s educational offerings and responsible for reimbursement, compliance and membership consulting services. He serves as the program co-chair for the Pinnacle Leadership Forum and as the partner responsible for the Ambulance Service Manager and Communications Center Managers certification programs. He has a Bachelor of Business Administration degree, an MBA in Strategic Leadership and a Doctorate of Education in Organizational Leadership.
