Quick take: Attrition or attraction

Steve Grau; Brett Lyle; Scott Moore, JD, MBA; and Mike Poynter share strategies to compete for caregivers in a post-pandemic world


MARCO ISLAND, Fla. — Service disruptions, recruitment hurdles and providers exiting the industry have continued throughout the pandemic. Agencies struggle to address staffing, many because they don’t really understand why caregivers are leaving in the first place. Quick fixes, including sign-on bonuses, are falling flat.

In a session at the Pinnacle EMS 2022 leadership conference, a group of EMS experts explained how organizations that take the time to learn why caregivers are leaving – and act thoughtfully – will have an edge in attracting and retaining talent.

About the panel

  • Steve Grau is CEO and owner of Royal Ambulance. In the last few years, Royal has been recognized by the San Francisco/Silicon Valley Business Times, Modern Healthcare and Glassdoor as a best place to work.
  • Brett Lyle, founder, Brett Lyle Coaching, serves the EMS industry in business development and public relations roles, coaching at multiple conferences, leading virtual events, and hosting industry renowned leaders on her podcast, Emergent Leadership.
  • Scott Moore, JD, MBA, is a Massachusetts licensed attorney and possesses certifications as both a Professional in Human Resources (PHR) and the Society for Human Resources Management Certified Professional (SHRM-CP). He is a member of the Northeast Human Resource Association and the Society for Human Resource Management. He is an active member of the American Ambulance Association and has been a site reviewer for the Commission for the Accreditation of Ambulance Services (CAAS) for many years.
  • Michael Poynter is executive director for the Kentucky Board of Emergency Medical Services, commissioner for the American College of Paramedic Executives and on the Board of Directors for the National Association of State Emergency Medical Services Officials.
Left to right: Steve Grau, CEO and owner of Royal Ambulance; Brett Lyle, founder, Brett Lyle Coaching; Scott Moore, JD, MBA; Michael Poynter, executive director for the Kentucky Board of EMS, commissioner for the American College of Paramedic Executives and on the Board of Directors for the National Association of State Emergency Medical Services Officials. 
Left to right: Steve Grau, CEO and owner of Royal Ambulance; Brett Lyle, founder, Brett Lyle Coaching; Scott Moore, JD, MBA; Michael Poynter, executive director for the Kentucky Board of EMS, commissioner for the American College of Paramedic Executives and on the Board of Directors for the National Association of State Emergency Medical Services Officials. 

Quotes on EMS recruitment and retention

Following are some of the points the presenters drove home about recruitment and retention challenges and strategies.

  • “Everyone is up against the same challenges; people are people everywhere.” — Brett Lyle
  • “People will tolerate where you want to go. They will even tolerate where you are for a while, as long as you have somewhere you want to go.” — Scott Moore, JD, MBA
  • “If we collectively elevate the experience of our profession, we can expand the pool of candidates.” — Steve Grau
  • “Whatever you measure is what will get managed.” — Scott Moore, JD, MBA

Takeaways on developing implementable recruitment and retention plans

As moderator, Lyle facilitated group conversations centering on examining trends, understanding caregiver’s needs, and developing implementable plans for retention and recruitment.

Here are 3 takeaways from the interactive session.

1. The compensation issue has not changed; innovative solutions are needed

The Kentucky Board of EMS began studying attrition in 2016. Poynter shared these top five reasons paramedics allowed their EMS license/certification to expire:

  1. Retirement (26%)
  2. Salary/benefits (24%)
  3. Relocation (16%)
  4. External factors/not by choice (10%)
  5. Poor management/hostile work environment (10%)

“They told us,” Poynter said. “They basically said, I’m burned out.” They’re running from poor work hours and high volume, to better hours and more pay, he noted.

“People’s relationship with what they do has changed, including mine,” Moore added. While in the past, medics would fight for overtime, younger generations place more value on a life-work balance. “They actually work so they can live; it’s a crazy concept,” he quipped, challenging attendees to consider how their recruitment strategies have evolved to compensate.

Moore and the panel encouraged us to consider progressive strategies to employee satisfaction, from on-demand scheduling to allow medics to pick up shifts that fit their needs, to pay-me-now compensation, to voluntary overtime credit that reduces medics’ chances of mandatory OT. Research tells us 75% of Generation Z wants to be entrepreneurs, Moore pointed out. Giving providers control over their schedule gives them a sense of working for themselves.

Take action by evaluating:

  • Flexible, on-demand scheduling
  • Upward mobility options
  • Student loan forgiveness programs
  • Childcare assistance
  • Mental health and wellness services
  • Alternative retirement plans
  • HSAs

Also, keep in mind priorities change throughout different phases of life. Don’t limit your organization to a one-size-fits-all benefits package, Moore cautioned. While retirement becomes more of a focus as we age, new medics are likely to place more value on compensation. Consider your messaging. Take away an expense by offering a stipend for Netflix or Hulu. “Put it in a language that is most important to them,” Moore said.

2. Frontline supervisors are essential to engagement

One predominate theme in the session was the importance of front-line supervisor engagement with personnel. Citing Gallop data, Moore said the No. 1 influence on engagement is relationships with direct supervisors. How often do your agency’s supervisors interact with providers? He asked, would you tolerate a spouse who only told you they loved you once a year? A dog who only came home once a year?

Grau explained how Royal Ambulance has adopted the Studer Group methodology of rounding for outcomes, the process of consistently asking specific questions of key stakeholders. Royal provided supervisors with little books filled with rounding reports to fill out after engaging with a provider, asking questions like, “What worked well for you today?” and “What could have gone better?” This opens an opportunity to identify trends and areas for improvement to give employees a voice and close the loop.

Moore encouraged leaders to ensure running calls is not preventing frontline supervisors from having the time for this regular engagement. “I know we need them to do calls,” he said, but, “are they there to do calls or to lead and hopefully start to move the needle?”

Start somewhere Moore advised. Ask supervisors how often they’re engaging providers and give them a list of names. Ask them to connect with five people this week. It may be progress measured in inches, not miles, but it is progress.


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3. Know your data and use it to tell the story

The panel enforced the importance of understanding and cultivating your agency brand in recruitmet and retention efforts: the set of attributes, qualities and intangibles that make each organization distinctive.

Moore noted 62% of candidates report researching jobs on social media and asked, “are you confident what message is being shared about your organization?” He advised being intentional with selecting who manages your organization’s social media presence and controlling the story being told, offering the following tips:

  • Get on as many platforms as possible
  • Research what employees are sharing on Glassdoor
  • Encourage staff to promote the organization: they are a force multiplier
  • Take control of the story being told about your organization

Saying “we have competitive wages” is like a hotel saying “we have beds,” Moore said. Potential employees are going to expect you to have the basics, like updated equipment and competitive benefits. In a competitive world, be different Moore advised. Share what makes your organization exceptional (e.g., what percentage of people get time off when they ask for it, or get off shift on time).

“Use your numbers,” Moore said. If you don’t know these statistics, “that’s a problem.” These metrics show employees what value proposition you place on their work-life balance.

Additional resources on employee engagement

Learn more about engagement and building organizational culture with these resources:

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