Research analysis: Addressing attrition of EMS professionals

An NREMT study demonstrates the factors that lead to attrition in EMS and areas important to EMS retention efforts


The National Association of EMS Physicians hosted its second Twitter Journal Club on April 17, 2018 under the hashtag #NAEMSPJC, discussing the “Prehospital Emergency Care” publication Exiting the Emergency Medical Services Profession and Characteristics Associated with Intent to Return to Practice by Cash et al.

By Catherine R. Counts and Jeremiah Escajeda

In October 2013, all 310,000 providers with a National EMS Certification and an active email account were sent a questionnaire including questions based on the Longitudinal EMT Attitudes and Demographics Study (LEADS). Of the 32,114 that responded, 1,248 (3.9 percent) indicated they currently worked for zero EMS agencies, indicating that they are no longer working in EMS.

These 1,248 individuals not currently practicing were asked additional questions regarding their intent to return to EMS along with why they originally left. Analysis of this subgroup of EMS providers was published in “Prehospital Emergency Care” in June 2017.

Of those EMS professionals not currently practicing, 72 percent intended to return to the industry. Two in five had worked for private EMS agencies prior to leaving, while another 20 percent had worked with fire departments. However, there was no difference in agency type and intent to return found. While respondents who identified as ethnic and racial minorities were significantly more likely to intend to return, there was no difference in intent to return found between genders.

The longer a professional had been in practice prior to leaving, the less likely they were to return. While some of this could be explained by retirement, most respondents cited higher pay or a desire to continue their education as contributing factors in their decision (Figure 1).

On the other hand, the majority of those respondents not practicing EMS (49.6 percent) had worked two years or less, whereas the same career length made up the majority of those with an intent to return to EMS (82.8 percent).

Memorable quotes on EMS attrition and intent to return to practice

Here are four memorable quotes on EMS professionals’ intent to return to practice:

“These EMS professionals who express an interest in returning should be the target of future interventions to help maintain a stable EMS workforce.”

“Minority EMS professionals reported a greater intent to return to the profession compared to their white, non-Hispanic counterparts.”

“The longer an EMS professional is displaced from the EMS setting, the harder it may be to transition back into the unique role they once had.”

“The implications of this study are important to help inform stakeholders interested in retaining current employees as well as recruiting new employees.”

Key takeaways on EMS attrition

The most poignant takeaway from the study is the list of factors that respondents noted as the most important reasons in making the decision to leave EMS. Most of the noted reasons require complex solutions to adequately address EMS retention, such has higher pay. However, there are also simpler elements that our systems can address, such as providing better patient outcome data to crews and more comprehensive provider performance feedback. Here are five takeaways on EMS attrition and intent to return to practice.

1. EMS is often a stepping stone to other careers

Given the often-cited low pay received by EMS professionals, it is not surprising that nearly 50 percent of those not practicing had been in EMS for less than three years. This is further supported by the fact that 60 percent of respondents desired to pursue additional education after leaving the industry. Also, the majority of respondents who left EMS had lower career lengths.

We need to engage and challenge the younger generation of EMS professionals by offering in-career opportunities for advancement in training. Rather than shame this cohort, recognizing the unique role EMS plays in the development of other professions may provide an opportunity to institutionalize its place within the larger healthcare spectrum.

2. Compensation is a big problem in EMS retention

As this study points out, the number one most noted factor (65 percent) for leaving EMS is “desire for better pay and benefits.” Providers are often forced to work long hours and multiple jobs to make ends meet, so it’s no surprise that many would leave to search for careers with better pay.

3. This type of cross-sectional research has significant limitations

Providers who have left EMS are inherently less likely to respond to a survey about the industry. As such, this study potentially underestimates the size of this cohort. Those who have permanently left EMS versus those who have only temporarily left are also likely to respond at different rates, further skewing the results.

4. Researching the EMS workforce is critical to the growth of our profession

The team at NREMT is quickly becoming known for research on line-level providers. Although such surveys have their limitations, gaining a better understanding of the EMS workforce will allow educators, leaders and other key stakeholders the opportunity to look internally at what they can do to continue to advance the industry.

5. There is no easy answer to EMS retention but this study helps shine light on the issues

Everyone should look at Figure 1. Think about what those factors mean to you as an EMS professional and how we can address them.

About the author
Jeremiah Escajeda, MD, is assistant professor of Emergency Medicine at the University of Pittsburgh School of Medicine, emergency physician at UPMC and EMS medical director and prehospital physician. He has an interest in EMS education and currently serves as chair of the NAEMSP Education Committee and is on the PEC podcast team. 

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