Increased competition requires a change in recruitment and retention strategies

New opportunities for EMS providers means agencies must be willing to address pay, morale and poor leadership


Since the first COVID-19 infection showed up in the U.S. on January 20, 2020, EMS and healthcare workers as a whole have been putting up the good fight against this disease. While there were full weeks and months it felt as if we were fighting a losing battle, we are finally starting to make up some ground and combat this disease. However, even with COVID numbers finally dwindling, a new battle for those in administrative positions in healthcare is emerging; trying to retain the employees we have, while simultaneously trying to attract new employees. All of this, at a time when there has been a mass exodus of many in the healthcare fields.

While COVID has, of course, played a role in individuals leaving healthcare, COVID may have just been the tipping point in a long line of reasons individuals are looking to get out of the EMS field and expand into other areas of healthcare, or a completely different career altogether.

The complaints from those in EMS have been the same for years: poor management, a lack of pay and benefits, favoritism, little room for advancement and time away from family, just to name a few.  Now, compile those issues with the threat of becoming infected with COVID and possibly spreading this disease to your loved ones, in addition to watching patients suffer and die from this disease, and those problems have been amplified even more, giving some that final push to walk away.

According to the Bureau of Labor and Statistics, nearly one in five healthcare workers have quit their job since the start of the COVID-19 pandemic, with another 12% being laid off.
According to the Bureau of Labor and Statistics, nearly one in five healthcare workers have quit their job since the start of the COVID-19 pandemic, with another 12% being laid off. (Photo/George Washington University)

There are many reasons why so many have chosen to leave the healthcare field in recent years, and for many, it centers around COVID and the mental, physical and emotional toll it has taken on the individuals who have put their own health at risk to care for those infected with this disease.

The mental toll of treating a patient, and watching that patient deteriorate and eventually succumb to this disease is emotionally taxing on anyone. Now, imagine having to watch that play out with literally dozens of patients over a few short months. Knowing you’re fighting the best you can, but ultimately accepting many of these patients will not survive, and there will be others to take their place shortly after they die. This emotional roller-coaster has proven to be too much for many in healthcare.

New territory for EMS jobs

According to the Bureau of Labor and Statistics, nearly one in five healthcare workers have quit their job since the start of the COVID-19 pandemic, with another 12% being laid off. The Bureau also reports that more than 500,000 seasoned nurses will retire by the end of 2022. With so many nurses leaving the field, a large nursing vacancy has been created and travel nurses are being brought into facilities at a rate never before seen prior to COVID. However, for the first time, we are also seeing many of those nursing vacancies, especially those in the emergency department, filled by paramedics, even travel agency paramedics, on contract. While traveling healthcare workers are nothing new, the avenue for paramedics to find as many lucrative travel assignments as a registered nurse was very slim, prior to COVID.

This is new territory for EMS agencies to have to contend with. Not only are many local EDs now allowing paramedics to come in and fill those vacant nursing roles, paramedics now, more than ever, have many travel agencies looking to send them all over the country, not just to work on an ambulance, but also in the hospitals. Currently, Indeed has over 100 travel paramedic jobs listed, many of them paying much more than the average 24-hour shift, and most are 12-13 week assignments. Some are for positions with ambulance services, and some of those positions are in EDs and other healthcare settings.

However, even with the new demand for seasoned paramedics all across the country, many other factors are affecting employee retention. Paramedic to registered nurse (RN) bridge programs are becoming more available. In some areas, in as little as 1-2 years, you can go from being a paramedic to an RN. Colleges with nursing programs all across the country are finally acknowledging the differences between a paramedic and an RN are not as large of a gap as once believed, and paramedics are all too willing to trade in their 24-hour shifts with little-to-no sleep and time away from their families, for a healthcare job that lets them go home to their families every night. And, in some areas, the pay difference is more than enough motivation.

According to the Bureau of Labor and Statistics, the average RN salary in 2020 was $75,330 per year. That same year, the average paramedic salary was only $36,650; with only the highest 10% of paramedics making more than $62,150.

A proactive approach needed

Even with these new nursing or travel paramedic opportunities, there are other obstacles affecting the retention of good employees at your local agency. Those paramedics who are not looking to cash in on a travel assignment or those who are not interested in going back to school are looking for the highest bidder in their field. The EMS agencies that can pay more, will pay more, leaving the smaller and not as well-funded agencies trying to compete with larger agencies that can offer more money, better benefits, incentive pay and other perks.

This is not only a problem for agencies looking to attract new, full-time employees. Those seeking part-time work are also looking for the agency that is going to pay them the most money, or for an ED job that doesn’t require picking up a 24-hour shift just to make some extra income. Many EMS agencies across the country rely on their part-time employees to fill their schedules. Many of these part-time employees work for other EMS agencies or fire departments as their full-time job, so they are already away from home for 24-48 hours multiple times each month, so finding part-time work is more about the money than the agency.

With paramedics currently being able to choose from so many different employee options and locations, many EMS agencies are taking a proactive approach to attract new employees. Some agencies are offering experience pay, others are holding fast-track EMT classes in an attempt to bring in those interested in being an EMT for their service. These services are essentially paying those individuals to go to EMT school, with the agreement they will work for their agency for a set number of years once they have completed their EMT course and have passed the national registry. For those agencies that are able to offer sign-on bonuses, they are willing to go big to attract new employees. According to Glassdoor, multiple EMS agencies are offering huge sign-on bonuses right now, with two-year contract agreements. Several of these paramedic positions are offering $16k-$20k in sign-on bonuses, along with healthcare benefits and other incentives. Many of these positions are for ground and air EMS services.

There is no doubt, COVID-19 has changed the landscape of healthcare, forever. Just as hospital administration has adapted to its ED nursing shortage by hiring paramedics, those in EMS administrative positions are going to have to find a way to adapt to their own shortage, or risk being left behind.

Those agencies that recognize the problems within their own agency and are willing to make changes in order to keep and attract new employees are moving in the right direction. However, for those agencies that are not willing to address pay, morale, poor leadership and many other issues, they may be forced to learn the hard way that their employees now have more options than ever before.


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