Recruitment and Retention: A Perennial Problem in EMS

Whenever I speak with my colleagues around the country, we inevitably end up discussing how best to attract staff and keep them with our EMS agencies for the long term. Employee recruitment and retention is an issue we constantly wrestle with and seemingly never solve. As with any problem, the most important step in solving it, is to understand it.

Research on this subject has been conducted over the years as it is relates to the healthcare industry in general, with some even focused specifically on EMS practitioners.

Examining the Data

In a survey study conducted by the Montana Department of Health in 2009, over a thousand EMTs were contacted and asked about their plans to remain in the EMS profession. Thirty-three percent of those responding indicated they expected to leave the profession within the next five years. Of that third, almost half said their reason for leaving was retirement.1 So, approximately 16% of the thousand EMTs questioned, were anticipating retirement within five years.

Arguably, it’s doubtful we would be able to affect the retirement group, nor do I think we would probably desire to dissuade individuals from that move. However, for the others who indicated they would be leaving EMS within five years, they cited as a few different reasons: a desire to change careers, family issues, organizational issues, working hours, job stress, and pay and benefits. These seem to be motives we could address in the paramedicine profession in an effort to retain staff.

In 2005, a survey study conducted at a national EMS conference found a majority of respondents indicated EMS wasn’t their primary career path. It also found that a majority of those questioned entered EMS either as an alternative to another career, such as nursing, or following their military service.2 Knowing our employee candidates’ prior work experience and their predetermined future career desires can help us construct workplace environments that are conducive to retaining them over a longer period of time.

Another survey study, this one conducted in 2016, discovered new EMT-Basics tended to be older and lacking a college degree when compared to new paramedics. There was also a difference in the reasons these individuals entered the field and what made them satisfied with their employment.3 These differences need to be taken into consideration when developing recruitment and retention programs or designing our compensation packages for staff–one size apparently won’t fit all.

Lastly, Avesta, a nationally known company specializing in EMS human resource management, and the American Ambulance Association published a study this year on employee turnover. They conducted a national survey in which 119 EMS organizations participated. Generally, the AAA/Avesta report found that the turnover rate for EMS in the Unties States is lower than that for the average of all occupations, as reported by the U.S. Department of Labor, Bureau of Labor Statistics. However, they’re worse than those reported by the Society for Human Resource Managers. Of interest to note, the report indicates that the majority of organizations which responded to the AAA/Avesta study used pre-employment testing for applicants. It’s unknown what impact this may have had on improving the retention of employees.4

In this study, the two most prominent reasons for individuals leaving EMS employment were: 1) a desire for a career change; and 2) dissatisfaction with pay and benefits. This correlates with previous studies. Notably, however, at the agency level, paying above market wasn’t found to be consistently related to changes in turnover rates. What this study found to be the best predictor of turnover was the “sector” the EMT or paramedics worked within; private or public. Specifically, private sector EMS organizations showed a higher turnover rate than public agencies, and the study further found that the public sector’s lower rate is not due to higher pay.4 (See Figure 1 and 2 and Table 1.)

The authors of the report concluded that two areas of the workplace environment that would improve retention are: 1) increasing career and promotional opportunities; and 2) increasing pay rates. Specifically, it recommends implementing organizational interventions that include:

  • Increased attention to employee health and safety;
  • Programs that allow for career growth and development;
  • Scheduling that allows for better work/life balance; and
  • Increased employee involvement in the work experience.4


We can interpret from these studies and the information they provide that our industry’s turnover rate sits at an average nationally of 20—30%. Further, about 10—15% of our staff leave our employment to retire, which is something we probably can’t, and shouldn’t, attempt to change. Of the remaining 15% that voluntarily resign each year, we can implement some workplace changes that could substantially reduce this number, and this does not necessarily require increasing their salaries significantly.


1. Perkins BJ, DeTienne J, Fitzgerald K, et al. Factors associated with workforce retention among emergency medical technicians in Montana. Prehosp Emerg Care. 2009;13(4):456—461.

2. Patterson PD, Probst JC, Leith KH, et al. Recruitment and retention of emergency medical technicians: a qualitative study. J Allied Health. 2005;34(3):153—162.

3. Chapman SA, Crowe RP, Bentley MA. Recruitment and retention of new emergency medical technician (EMT)-Basics and paramedics.

4. American Ambulance Association, Avesta Inc. (May 1, 2018). AAA / Avesta 2018 ambulance industry employee turnover study. NEMSMA Google Group. Retrieved Nov. 19, 2018, from

Figures & Table

Figure 1: Reasons for voluntary turnover for full-time EMTs
Source: American Ambulance Association, Avesta Inc. (May 1, 2018). AAA / Avesta 2018 ambulance industry employee turnover study.
Figure 2: Reasons for voluntary turnover for full-time paramedics
Source: American Ambulance Association, Avesta Inc. (May 1, 2018). AAA / Avesta 2018 ambulance industry employee turnover study.

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