*|MC_PREVIEW_TEXT|*The cost of turnover | Recruiting in the gig economy | 5 Delta variant facts
July 22, 2021 | View as webpage


The last 18 months have been a lesson in supply and demand, from medical equipment, to goods and services. As more industries feel the impact of staffing shortages, wages, benefits, work schedules, childcare and work-life balance have been brought to the forefront of the national conversation.  

In this Paramedic Chief Leadership Briefing, Rob Lawrence shares insights from the 2021 American Ambulance Association/Newton 360 2021 Ambulance Industry Employee Turnover Study, from the costs of replacing a provider, to strategies to create a psychologically healthy workplace. And, we get a closer look at how the gig economy is further challenging EMS recruitment and retention from Cumberland Goodwill Emergency Medical Services’ Nathan Harig.  

What is your biggest barrier to retaining providers? If you could change one thing to keep from losing talent, what would it be? Share with us at editor@ems1.com and we may feature your challenges and solutions in a future article.  

Stay well, 

— Kerri Hatt 
Editor-in-Chief, EMS1


Turnover: We have measured it, but can we manage it?
By Rob Lawrence 

As a former military officer, I am constantly reminded of the adage from British General, Rupert Smith, who said “there is one certain outcome of any operation and that is casualties.” We’ve passed the 18-month point of the public health emergency, and one prediction I made early is that the real casualty of the pandemic could well be EMS itself. 

Our hard-pressed EMS workforce has risen to the challenge despite the workforce shortages and has consistently stepped up by offering solutions, including establishing testing, tracing and vaccinations operations, as well as augmenting hospitals and care facilities around the country. While we have turned out to everything, we have also turned over, with organizations losing a fifth of their workforce in the past year; many, probably to higher-paying, better terms and conditions opportunities or simply throwing in the towel on EMS altogether.

One of our deepest battle scars is that of recruiting and retention, and this was recently examined in the third annual American Ambulance Association (AAA)/Newton 360 Ambulance Industry Employee Turnover Study. Employee turnover and conversely, employee retention, have been identified by AAA members as two of the most critical human resource issues facing ambulance service providers. 

Measuring attrition

The AAA surveyors corresponded with 19,688 employees working at 258 EMS organizations. The occupations included were full-time EMTs, part-time EMTs, full-time paramedics, part-time paramedics, supervisors and dispatch employees. The survey revealed that despite the impact of COVID-19 on the economy, turnover rates were similar, or even slightly improved, compared to 2019. That said, voluntary and overall turnover remained in the 20-30% range for EMTs and paramedics. As many EMS organizations calculate their workforce needs on unit hours required to meet peak demand, even “normal” turnover places every agency on the back foot. 

This is borne out in the now frequent news reports of crew shortages, missed response times (and that’s not including hours lost on the hospital wall) and well-publicized episodes of the dreaded, “No units available.”

The cost of replacing an EMT or paramedic

The survey also collected data on the cost to replace an employee, defined in terms of the cost to attract, screen, select, onboard and train a new EMT, averaging about $6,780. Larger organizations reported higher costs, $8,811, compared to smaller organizations ($5,149.58) to replace an employee. To replace a full-time paramedic, the total estimated cost was $9,113.

An interesting and important data point identified was that 32% of employees who are going to leave depart in the first year. If we take a moment to calculate the cost of turnover in an organization with 100 employees who lose 25 staff members a year (a median rate of $6,780 x 25), the annual cost of maintaining an operational status quo is in the region of $170,000. Of that total, $56,000 would be expended on staff that has only recently been recruited, inducted, precepted and cut loose on the streets in the previous 365 days. While we must invest considerable amounts of cash in recruiting, one must ask, how much is in the budget line marked retention? It may well be an invest to save opportunity.

Reasons for departure

While it can take just one day or a couple weeks to lose an employee (depending on the voluntary or involuntary nature of the departure), it can take more than three months to replace them, while at the same time relying on or mandating staff to work overtime to fill the gaps. This creates a law of diminishing returns as those who remain, in turn, consider departure. The AAA survey identifies that primary exit reasons are for career or occupation change, followed by dissatisfaction with pay and/or benefits. Poor performance was listed most frequently as the reason for involuntary turnover.

Retention recommendations 

Recommendations included in the survey focus on implementing organizational interventions associated with a psychologically healthy workplace:

  • Increased attention to employee health and safety
  • Programs to allow for career growth and development outside of traditional career ladders
  • Scheduling to allow for increased work-life balance
  • Increased employee involvement
  • Performance management programs

Collected and collated data on this vital HR area of our operation is sparse and the development of effective strategies for the managing turnover requires the availability of reliable and valid data on turnover frequency. While we are enduring the effects of the pandemic, poor reimbursement, political pressure to do more with less and the heightened stress that operating in 2021 has brought us, if we don’t measure this essential HR metric, we have little chance to manage it. The AAA survey recommends that organizations systematically collect data on their workforce, including the reasons for turnover. 

In the final analysis, I, and possibly the AAA, probably didn’t tell you anything that you didn’t already know about our retention issues. But as the sign that has adorned the wall or whiteboard of every office I’ve ever occupied says, “If we do what we always did, we will get what we always got.” The AAA/Newton360 is to be applauded for conducting this survey and highlighting the size and scope of the issue and its commitment to understand the underlying causes of turnover in the ambulance industry and to develop strategies to address employee retention issues. The report can be read in full here.

Additional resources:
Verizon Frontline is built right for first responders

When lives are at stake, first responders need a network that's built right. Verizon Frontline is the advanced network and technology for first responders
Learn more
Recruiting paramedics, EMTs in the gig economy
By Nathan Harig, MA 

The words “staffing crisis” are nothing new in the realm of public safety. For years, chiefs and service managers have been sounding alarms, raising concerns and pleading for help to a wide variety of audiences seeking solutions to this problem. Anyone following post-pandemic labor reports in the U.S. knows that this staffing crunch has hit more industries, resulting in a nationwide conversation on wages, benefits, childcare difficulties, unemployment assistance, education, work ethic and more.

EMS surveys, including those conducted by Cumberland Goodwill EMS and the EMS Trend Report, have identified one of the most popular motivations for joining EMS is the desire to serve one’s community. Like many services trying to address recruitment and retention, we’re taking the steps to create our own internal academy to attract and evaluate candidates.

We’ve seen an incredible interest in our first class, but something unexpected kept popping up in applications: although the academy and position is a full-time commitment, many applicants were only interested in working part time. While we’re no stranger to paramedics wanting to work part time at multiple agencies, the idea that someone with no experience would have this same desire seemed odd to us and prompted us to do some additional digging.

Before we settle on a mentality that “no one wants to work anymore,” EMS managers need to look at just how disruptive the new gig economy has become.

The new normal: Working gigs

The gig economy refers to idea that workers take on several gigs, like driving for Uber, selling creations on Etsy or taking on jobs on freelance sites, like Fiverr, either in addition to or instead of working for traditional full-time employers. Gig workers set their own hours and take advantage of various advances in technology to effectively be a digital nomad, not tied down to down to working in a specific location.

The number of freelance workers in the U.S. has risen by 6 million since 2014, with over 59 million Americans now working a freelance gig. Fifty percent of Gen Z – those aged 18-22 years old – reported participating in the freelance economy, with 44% of millennials (23-38 years old) participating in some way as well. The pandemic has only accelerated these trends, with one study reporting 12% of the U.S. workforce taking on new gig economy jobs during the pandemic. Overall, 36% of all U.S. workers are participants in the gig economy, with an expected 50% participation rate by 2027.

The motivations for gig workers vary, but reports from that same study indicate that gig workers have higher job satisfaction and experienced a lower impact from COVID than did their traditionally employed peers. Respondents liked being in control of their own hours, being able to live the lifestyles they want, and earning on average $21 per hour across all sectors.

How a gig economy impacts EMS recruitment

The struggle for EMS, which has a reputation for sometimes long and difficult shifts, regulatory requirements and interpersonal conflicts on duty, will be to attract from generations where soon, more than half of their peers have experience working alone as their own boss, on their own time.

Treating EMS as a gig job in the U.S. could be seen as lowering standards and risking a situation where high risk, high skill, low frequency procedures suffer, so any movement towards “gigifying” EMS must come with a re-evaluation of certification levels, scopes of practice and continuing education delivery methods to appeal to those who may not have in-station down time to train without negatively impacting patient care.

Agencies today can, however, evaluate barriers to entry that may keep gig workers looking to serve their communities out of the workforce. Initial training may need to be more flexible, including using self-directed instruction where feasible, to appeal to the non-traditional schedule of a gig worker. If the future workforce continues to trend as expected, services of all levels and representing all population types and sizes will need to come up with plans to adapt, or find themselves with dangerously low staffing and overworked crews.

It’s clear that staffing troubles are nothing new for EMS agencies, but what has changed is the labor environment in which our industry is trying to recruit. With a rising share of the U.S. workforce participating in either a side gig or completely as a freelancer, services will need to adapt or struggle recruiting generations that have higher satisfaction from working for themselves. Wages, hours and benefits are only a part of this equation; training delivery, service structure and regulatory statutes all need re-evaluation as more people enter the gig economy.

The new generations entering the workforce are highly motivated to make the world a better place, but it’s on us to figure out how to be an attractive place for them to make their mark on the world.


spacer.gif Tweet of the Week: 5 facts about the Delta variant

spacer.gif 3 AND OUT...
3. Flipping the switch. "Lights and sirens should be applied as a clinical procedure with a risk/benefit analysis”

2. 5 surefire ways to ruin a field supervisor. Field supervisors are the kingpins of employee engagement

1. Why are we still stuck on oxygen? 3 ways to change the way we approach oxygen administration
EMS1 does not send unsolicited messages. You are receiving this email because you are a EMS1 member and subscribed to this newsletter.
If you do not want to receive this newsletter, you can opt-out here.
If you no longer wish to receive any email messages from EMS1, click here to unsubscribe from all mailings. 
Copyright © 2021 Lexipol. 2611 Internet Blvd., Ste. 100, Frisco, TX 75034.