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Recruitment or retention – Where is your budget focused?

Organizations frequently have larger recruitment budgets that they do for retention, but is this the best approach?


“With companies desperate to fill sufficient vacant positions to keep the required and contractual number of trucks on the street; the easiest way to attract staff is via lateral transfer. The one way to grab attention and bring workers in is via sign-on bonuses,” writes Carly Alley.

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The current EMS staffing shortage has highlighted the number of sign-on bonuses that are now stretching up to tens of thousands of dollars. This issue has raised eyebrows across the industry as agencies “rob Peter to pay Paul” with the back-and-forth exchange of staff between organizations bidding for medics. While we may add one or two to the roster with an attractive sign-on bonus, it doesn’t solve the problem and, most certainly, disenfranchises employees that have been with an organization from the get-go who may receive little-to-no overall reward for their loyalty and service.

The healthcare industry, especially ground ambulance services, are suffering from an acute staffing crisis. Healthcare workers are exiting the industry due to the stress of a prolonged pandemic, PPE fatigue and burnout in general. There is also a lack of interest in entering the field of emergency prehospital care. Adding to this exodus is the fact that many EMT and paramedic schools have closed or have significantly reduced class sizes at the height of the pandemic. In simple terms, the bathtub has been emptying faster than we can fill it and the resultant bidding war for staff has caused concern.

With companies desperate to fill sufficient vacant positions to keep the required and contractual number of trucks on the street; the easiest way to attract staff is via lateral transfer. The one way to grab attention and bring workers in is via sign-on bonuses.

The current situation has created a buyers’ market and started a bidding war. Organizations and agencies understand they are not simply gaining new employees, but rather buying another organization’s experienced employee with a sign-on bonus. Companies find themselves needing to increase their sign-on bonuses to stay competitive when their neighboring agency increases theirs and so on. Imagine it like dueling banjos, does it ever end or does one player just quit because they have nothing left? This practice is guaranteed to keep all organizations understaffed with a revolving door of new employees shopping for the next sign-on bonus. There are no real winners with this recruitment methodology which, in fact, represents a kick in the morale gut for our current employees.

Invest in your current employees

In knowing that there is no net gain to this practice, perhaps we should all take the dollars we have for sign-on bonuses and instead reward our current employees for staying with it. This could well be an investment in the stability of our organizations. This will also boost morale, which is at an all-time low due to the prolonged pandemic. For nearly two years, our employees have worked through some of our most challenging times – showing our appreciation to them is necessary. If we compare a nice sign-on bonus for new employees versus rewarding our current employees for their dedication with a longevity bonus, we might prevent our neighboring organization from gaining our experienced employees.

Longevity bonuses are not the only way we can show our appreciation for our current employees. Quarterly or monthly incentives for things like the crew or individual with the fastest overall chute times, leadership staff hosting a pancake breakfast at your operations base (a fun and inexpensive way to perk up any group), delivering lunch to crews on busy days, a special treat for those working on holidays, birthday and anniversary cards signed by leadership, are all great ways to show your appreciation. We can think outside the box and have fun with it! Investing in our current employees is one of the best tools we have to help this staffing crisis. Employees who are happy and feel appreciated enjoy coming to work. Creating this culture within your organization will keep your current workforce and can also attract new employees.

In the final analysis, if we do the math, the cost of losing an employee is expensive. It takes a staff member about two weeks to leave (after giving notice) and employers about three months, if they are lucky, to recruit, onboard, precept and clear someone new. The cost associated with this includes the necessary overtime to plug the gap created, the time spent advertising and recruiting (now add a hefty sign-on bonus to this number), and salary for new staff as they ride third member while being inducted into the organization. The net cost of this process sits somewhere in the range of $10,000-$30,000 dollars per new employee. Imagine if you invested that amount into keeping, rather than finding people.

It’s probably not going to get any better any time soon, but there are plenty of ways to boost morale and show your appreciation for your employees and retain them. What we have seen is, while we gain one employee with an attractive bonus, we also lose one – so there are no winners. Look at your budget, adjust your focus and retain; it may well keep your bathtub full to an acceptable level.

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Carly Alley is the executive director for Riggs Ambulance Service in Merced, California. Earlier in her career, Alley served as a firefighter-EMT in the U.S. Forest Service while earning her paramedic certification. After being hired by Riggs, she transitioned to the agency’s tactical EMS program, where she spent 10 years as the team leader before moving into administration.