Trending Topics
Sponsored Content

Flattening the turnover curve

The AAA and Newton 360 Industry Turnover Survey reveals increased turnover rates in full and part-time EMTs and paramedics

Sponsored by

“While many agencies offered stipends and increased wages to incentivize employees, it has not flattened the turnover curve” within the industry, Lawrence writes.

Photo/Getty Images

This episode of EMS One-Stop with Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit

The American Ambulance Association recently published its fourth annual survey of employee turnover in the EMS industry. The survey was prepared and authored by the American Ambulance Association; Newton 360; Doverspike Consulting; and Rosanna Miguel, PhD, and presents turnover data from 119 EMS organizations, representing more than 12,000 employees. This year, the survey included data regarding the percentage of positions reported to be open at the time of the survey, which showed that EMS agencies are having difficulty filling open positions.

Over the last few years, EMS organizations were impressive in meeting the challenges in the face of the continuing COVID-19 global pandemic. The EMS workforce rose to the challenge and battled the disease, despite the workforce shortages that have plagued the EMS profession and other healthcare partners for nearly a decade. EMS organizations have offered innovative solutions to public health crises, including establishing testing and vaccination sites around the country, suggesting that EMS employers and employees are prepared to expand their role to include greater provision of preventive services and community-based healthcare. Against that backdrop, the fourth annual survey was conducted.

Increase in turnover

Voluntary and overall turnover increased for 2022, with the turnover rate being in the 20-36% range for EMTs and paramedics, a 6% increase over the prior year – meaning that EMS agencies are experiencing a full turnover of all staff every 3-4 years. Greater than one third of all new hires turnover within their first year of employment. Not surprisingly, this converted into a relatively high rate of currently open positions, especially for EMTs and paramedics at EMS agencies around the country.

Reasons for turnover

In keeping with prior year’s responses, the primary reasons cited for turnover across all positions within EMS agencies is low pay and benefits, followed by a change in career. While many agencies offered stipends and increased wages to incentivize employees, it has not flattened the turnover curve. One of the key findings in this year’s survey is the significant increase in open positions for those EMTS and paramedics working in a part-time capacity. The open position rate for part-time paramedics was at a staggering 55%, suggesting that those who previously worked EMS as a second job no longer find it an attractive part time career choice.

Cost of replacement

In real terms, it takes one day to two weeks to lose or part with a staff member (depending on whether separation is voluntary or involuntary), but, under normal, non-pandemic, circumstances, it could take three months and beyond to advertise, interview, onboard and precept to a street-cleared standard. The survey estimates the average cost for replacing an EMT at $5,786 and $8620 for a paramedic. This cost does not include the cost of overtime to cover the gapped post and therefore the replacement cost may well be considerably higher.

What do employees want?

Breaking down the survey responses the following were listed as the wants and needs our employees:

  • Significant increase in income or benefits (64% up from 41% in 2015)
  • A better work/life balance (61% of from 53% in 2015)
  • Ability to do what they do best (58%)
  • Greater job stability/security (53%)
  • Diverse and inclusive work environments (42%)

Possible retention solutions

The to-do list in response to this year’s survey is probably well known and well-rehearsed, but nonetheless warrants repeating and action to offer and improve:

  • Mentorship programs
  • One-time bonuses for additional education or training
  • Employee recognition programs
  • Ongoing performance feedback
  • Increased community embeddedness
  • Diversity and inclusion initiatives
  • Encouragement of employee or peer bonding

The survey notes that 85% of HR leaders believe that ongoing feedback and check-ins are key for successful outcomes. Organizations that employ a regular and ongoing feedback model have turnover rates that are 15% lower than those that do not.

Further EMS workforce study

This study evidences a need to embark upon a larger initiative to collect data on the EMS workforce in the U.S. A report published by the Health Resources and Services Administration (HRSA) stated that there will be a need for an additional 40,000 EMS personnel by 2030, in part, because of the recognition of the valuable education, training, and experience individuals working in the EMS field offer in other healthcare settings. This will necessitate an extensive understanding of the nature and reasons for turnover in EMS-related occupations.

Turnover rates by year by occupational category

Screen Shot 2022-12-14 at 12.32.16 AM.png

Table/Courtesy American Ambulance Association

EMS One-Stop With Rob Lawrence

Listen for more as Rob Lawrence welcomes guest Scott Moore, Esq., owner of Moore EMS Consulting, LLC and an active EMT for over 30 years.

Moore shares one thing that has not changed in the 4 years of the AAA turnover survey: the dissatisfaction with pay and benefits.

Moore has held various executive positions, including chief executive officer, vice president, director of human resources and operations, at several ambulance services in Massachusetts. He is a licensed attorney, specializing in human resources, employment law, reimbursement, and compliance matters. Moore is the human resources and operational consultant to the American Ambulance Association and frequently lectures at EMS conferences.


Read next:

Proven recruitment and retention strategies

Readers sound off on what’s attracting new talent and keeping members satisfied

Rob Lawrence has been a leader in civilian and military EMS for over a quarter of a century. He is currently the director of strategic implementation for PRO EMS and its educational arm, Prodigy EMS, in Cambridge, Massachusetts, and part-time executive director of the California Ambulance Association.

He previously served as the chief operating officer of the Richmond Ambulance Authority (Virginia), which won both state and national EMS Agency of the Year awards during his 10-year tenure. Additionally, he served as COO for Paramedics Plus in Alameda County, California.

Prior to emigrating to the U.S. in 2008, Rob served as the COO for the East of England Ambulance Service in Suffolk County, England, and as the executive director of operations and service development for the East Anglian Ambulance NHS Trust. Rob is a former Army officer and graduate of the UK’s Royal Military Academy Sandhurst and served worldwide in a 20-year military career encompassing many prehospital and evacuation leadership roles.

Rob is a board member of the Academy of International Mobile Healthcare Integration (AIMHI) as well as chair of the American Ambulance Association’s State Association Forum. He writes and podcasts for EMS1 and is a member of the EMS1 Editorial Advisory Board. Connect with him on Twitter.