Top 10 Reasons Your Best EMS Crews Quit
“If you pay peanuts, you get monkeys.” -Sir James Goldsmith
Admit it.
You’ve thought about it…
Quitting the whole EMS thing.
Being home every night. Spending holidays with your family. Going to all your kids’ ball games.
Maybe even putting a little extra money in your paycheck, right?
If you’re being honest with yourself…
You know you’ve thought about getting a “real” job from time to time.
But then the tones drop…
You save yet another life, and rationalize why EMS really is the best job for you.
That’s the typical (if there is such a thing) thought process I hear from INSIDER coaching students.
Maybe your story is similar?
From the perspective of EMS and air medical keeping good people, I hope so. Because EMS and air medical need good folks.
But there is one group of EMSers who consistently leave our profession.
They weigh all their options, and then they leave.
End of discussion.
End of story.
Want to know what group of EMSers I mean?
You probably already guessed it.
I mean the top 1%.
The Crème de la Crème.
They very best EMS employees.
Why do the very best EMS employees leave?
Before I answer, do a gut check and make sure you understand the purpose of this article.
Knowing why EMSers quit is actually a secondary reason for this article.
The bigger goal is learning how to keep your best EMSers on board.
That’s the prize—keeping your best people. And it’s important to keep this in mind.
Why?
Because it will help you avoid the negativity trap. It’s really easy to jump on the EMS negativity train. But remember, that’s not the goal. The idea is to figure out the best way for EMS to keep its best people.
So why do the very best EMS crews quit?
Here are the top 10 reasons your best EMS crews quit:
1.) Grossly Under-qualified Managers
Nobody expects perfect managers. And the truth is —EMS managers have a tough job.
It’s difficult to manage independent, highly motivated, Type-A personality EMSers in groups. Think of it like trying to herd cats. Not easy.
Where do most EMS companies fail?
Most fail at step one. They make no effort to support their top performers by hiring or promoting qualified managers.
If you work EMS, you’ve seen it. Promotions based solely on friendships or the knowledge the new manager will do exactly as told to do.
How do you fix this problem?
Start by reaching reasonable levels of manager competence. Here’s what I mean:
There’s a reason trauma surgeons don’t work for housekeeping, right?
The same thought process applies to EMS. Pilots don’t work for mechanics, nurses don’t work for EMTs, Paramedics don’t work for dispatchers.
Start here. Fix the obvious.
If this all sounds like no-brainer, common sense . . . Good!
That means your EMS meets at least minimum expectations. This is important. It makes a big difference in employee retention.
Breaking industry norms (to the downside) causes you to lose your best people. Your top employees won’t complain or question your motives, or even come talk to you about it.
They’ll just think you’re stupid and move on.
2.) Punish Free Thinking
You can’t have your EMS cake and eat it too. It just doesn’t work that way. Here’s what I mean:
You can’t expect highly educated aviation and medical professionals to operate independently and save lives in extremely challenging conditions…
And then never question your motives. Or never voice their opinions.
It just doesn’t work that way.
People who work in flying (or ground) emergency rooms, ask questions. A lot of questions.
It’s a mistake to punish their initiative and squash their ideas. Remember that taking time to listen doesn’t mean you have to implement all (or any) of their ideas.
Throw a top EMS performer out of your office for suggesting post-it notes instead of the same stone tablets you’ve always used, and I guarantee she’s moving on. It’s just a matter of when.
Hint: she’ll probably attach a post-it note to the top of her resignation letter. The fact EMS managers don’t get the irony, is the point.
3.) Trailer Park Quarters
There’s a reason the world famous Mona Lisa painting hangs in the Michelangelo room of The Louvre museum, in Paris, France.
The reason is simple.
It’s THE Mona Lisa, right?
Keeping the world’s most famous painting, in one of the world’s most famous museums, makes good sense.
In fact, if the Mona Lisa were for sale at your local flea market, it would change your whole perception of its value, right? You’d probably wonder if it’s the real Mona Lisa?
Following this same simple logic, why then do we put real $6 Million dollar helicopters on cement blocks next to Conex-box trailer crew quarters? Conex boxes deemed unfit to haul plastic chew toys from China? Yet good enough to house our air medical crews.
Does that make any sense?
Does it seem like maybe we’re devaluing our own people and our own services?
Think I’m kidding? I’m not.
I admit a bit of hyperbole (the whole chew toy thing), but the rest is reality for many EMS and air medical crew quarters.
Here’s a reasonable-person litmus test for positive change. If you’re embarrassed to bring your own family to your crew quarters, it’s time for an upgrade.
4.) No FAA Babysitters
I won’t waste your time pretending the Federal Aviation Administration (FAA) is competent, or concerned about your safety.
If you’re air medical crew, you already know the deal. The only thing FAA safety inspectors truly care about is filling their paperwork quotas and protecting their 4-day work week. That’s it. That’s all the substance and safety they have to offer you.
But if you’re active EMS, you of course can’t say any of the above.
So how do you manage the FAA?
Easy answer.
You hire a babysitter.
You dedicate a full-time position (or more) to internally manage the FAA for you. You hire the most anal-retentive, rule-following, paperwork-loving babysitters you can find.
You need strong-willed company watchdogs willing to counter every single FAA visit with meticulous questions and follow-up. Employees you trust, willing to spearhead the “FAA resistance,” and record the FAA’s every comment, suggestion and directive.
Then, when the FAA jumps into accusatory mode, your “hired-gun” babysitter politely shows them in writing how their current suggestion, contradicts their last three suggestions. It’s an important position and it needs filled… all the time.
Don’t get me wrong.
There’s no reason to be difficult, disrespectful, or anything other than 100 percent cooperative with the FAA. Hint: It’s even in your best interest to think of FAA safety inspectors as human-like.
Why does managing the FAA matter?
One obvious reason is they control your company’s viability and longevity.
A second reason is…
EMSers who fail to manage the FAA bureaucracy lose their best people.
Nobody wants to drown in meaningless paperwork, least of all your top performers.
5.) Salary Leaks
One of the first helicopter companies I worked for leaked pilot salaries.
It was ugly. Really ugly.
Operations kept a folder on the company hard drive with an alphabetical listing of all pilots and salaries.
I don’t think they did it to intentionally cause heartache or problems. I think they simply weren’t smart enough to set permissions on windows folders.
Whatever the reasons…
The damage was substantial.
Want to lose your best EMSers fast?
Publicly disclose that your top-performers only make $50 bucks more than your weakest links.
They’ll leave you faster than an FAA inspector late afternoon on day 4… of their 4-day work week.
Keep salary data confidential.
Sharing salaries kills morale and almost guarantees losing some of your best employees.
6.) Lack of Leadership
I write about EMS leadership a lot.
Why?
Because I believe it’s one of the biggest opportunities in EMS.
Leadership (or lack of) in EMS is usually obvious.
Is your station or base growing and expanding? Or shriveling up and dying? Are you upgrading your aircraft and equipment? Or looking for cheaper options?
The answer is directly tied to your EMS leadership.
Most EMSers are street-smart realists. You can't bluff them.
They know whether their leadership is looking out for them, or sucks. My best advice is remembering that actions speak louder than words.
If you want to keep your top performers, you need competent leaders willing to take positive action on behalf of their employees.
7.) Trauma Drama
EMS work is challenging in and of itself.
There’s no good reason to add to the challenges by creating unnecessary drama. What do I mean by unnecessary drama?
Any rumors or early announcements about what might happen, without anything to substantiate the rumors, is what I consider unnecessary drama.
Why would anyone resort to rumors or drama?
Weak managers motivate employees through fear. The fear mentality is often stimulated by unfounded rumors and speculation. Managers know once they get everyone emotionally invested in their “cause,” they have a much greater chance of support and buy in.
Top performers see the drama for what it is. If they love their job (which many do) they’ll put up with it for a little while. But not forever.
8.) Play Favorites
Favoritism is a big challenge for EMS.
I flew EMS for 13 years. And I don’t have any merit-based examples of aviation promotions. It bothers me, but it’s true.
Here’s how aviation promotions typically work in helicopter EMS:
The aviation base manager is usually the most junior pilot at the base. That’s not a typo. Why is the most junior pilot typically in charge?
Because base manager is a thankless job that pays about 1/5th of what it’s worth. Senior aviation managers fill these positions with the least experienced pilots for four reasons:
- New pilots do as they’re told (for the most part)
- New pilots don’t know any better
- Senior aviation managers are too lazy to fix a broken system
- None of the experienced pilots will do it
The favoritism gets worse with higher level aviation positions. I don’t like it, but I do understand the reasons. Let me explain.
Medical professionals typically decide which pilots fill senior aviation positions within their flight programs. Due to no fault of their own, the medical professionals have no real way to evaluate pilot management skills or abilities.
So what do they do instead?
They pick who they like.
This pilot makes me laugh hardest, let’s make him director of operations.
This pilot makes me laugh second hardest, let’s make him chief pilot. And on and on it goes…
9.) Below Average Pay
Understand what I mean when I say “below average pay.”
I’m referring to below average market pay rates for your specific EMS job and geographic location. So if the average EMT in Danbury, CT, makes 32,000 a year, and your service pays 26,000 per year, by definition your EMS pay is below market average.
I’m not referring to the value of your lifesaving services. That’s where the real crime is committed. And that’s an entirely different subject.
The point is that if your EMS is paying below average market rates, you’re going to lose your top performers.
All other things being equal, your top performers will go somewhere else, where the pay is better.
10.) Phone Taps
It’s common practice for hospitals to record all emergency calls. It makes sense for hospitals to do this and there’s no conspiracy theory at work.
In today’s sue happy, litigious world, hospitals protecting themselves with taped voice recordings makes good sense.
Nobody rational disagrees with the theory behind this.
Where you need to be careful is working for EMS services that use voice recordings for purposes other than their intended use.
This does happen and it’s usually ugly.
My advice is a version of what your mother always told you…
If you’re not going to say something nice, don’t say it at all. Or, as a minimum, don’t say anything on the recorded line that you wouldn’t say in front of your boss. I’m sure Mom will agree with this part too.
Pretty straight forward stuff, right?
But you’d be surprised how many careers are ended by recorded lines.
It’s also common sense in regard to keeping your top EMS performers. Nobody wants to feel like their every conversation is scrutinized and recorded. It goes directly to trust. Keeping your best and brightest is about trust.
What To Do Now
Remember to focus on the positive.
Some of the points in this article are intense. Why? Because EMS careers are intense. You have to manage the good and the bad.
What’s more intensely positive than saving a life? Nothing I can think of.
By the same token, some of the negatives in this article are more intense than challenges you see in a typical office environment.
It goes with the EMS territory.
Here’s the good news:
You can start focusing on the positive lessons today. Use the tools above to develop strategies to keep your best and brightest EMSers on board for the long haul.
They’re worth it. You’re worth it. EMS is worth it.
Do you agree? Let me know in the comments section below.
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More Articles by this author:
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The 20-60-20 Rule of Helicopter EMS
An Open Letter To EMS Who Want To Fly
10 Warning Signs of Ambulance Induced Divorce Syndrome (AIDS)
Announcing a Great Deal for EMS Who Want To Fly
What Is EMS Flight Safety Network
Announcing The Military Medic To EMT Fast Track Law
10 Warning Signs Your EMS Base Is Toxic
5 Ways EMS & Air Medical Go From Good To Great
How A Special Agent's Biggest Mistake Saved EMS Flight Crew Lives
RN
8 年So frustrating. It's time to bring unions back so there are people looking out for the average worker.
National Planning Section Chief; New Jersey State Manager at Patriot Emergency Response Team, Inc.
8 年Troy, your article is spot on. An an EMT I worked in medical transport; then in 911 emergency response in cities; then was trained in TC3 & deployed to Haiti and Iraq as a civilian Federal employee. In transport, EMTs were treated like mules. We picked up and dropped off patients to and from dialysis, chemo, wound care, & various other Dr's appointments. Our Supervisors understood (being EMTs) that this business IS about people. It's about treating the patient; it's about caring and understanding that EMTs are emotionally invested in their jobs and patients. Our management only saw the bottom line. They failed to understand WE KNEW OSHA laws. WE KNEW HIPAA laws. We had a Duty to Act and report abuse, neglect, fraud, and above all, Advocate for our patients. I had the NJ Office of the Ombudsman on my phone!! I was a top performer - a great EMT, & I loved my job. I left it for more money. The range in NJ is from $11-19/hr depending on where you work. Management treated us all like we were mules; we had NO paid sick time; NO paid holidays off; NO paid personal time; NO PTO. If you didn't work, you didn't get paid. Yes, you could make overtime, but companies would circumvent that by hiring people to work 32-36 hrs/wk. ALSO - many companies hire EMTs as "At Will" employees. That allows the companies to hire and fire for no just cause. In NJ, Lifestar Medical Response (now Falck) HIGHLY discouraged a Union. There was also the issue of receiving medical, dental, & vision benefits. Often the benefits were costly to us, & provided minimal or inadequate coverage. The same applied to Temporary Disability. The compensation for on the job injuries was so poor I struggled after herniating a disc. Lastly, there was no retirement or pension plan provided. In the 15 yrs I've been an EMT, I sustained long-term damage to my back, right ankle, & internal organs. All thanks to lifting, carrying, & transporting very heavy patients. Do I love the job? Absolutely. I was able to help people during the best and worst times of their lives. I loved and cared for my long-term patients, & I stepped up and helped out during catastrophes, disasters, & mass casualty incidents. I did the best I could to help the living, & safeguarded and respected the ones who died. I knew how to write the paperwork so the companies I worked for got paid. I'm not working in the ambulance much anymore. Why? Because of everything you wrote, & all I added. I've lost 3 friends who were EMTs this year. Their bodies were worn out. All of them were in their mid 50s. I'm now working in dispatch for police, fire, & EMS. Why? The benefits are SIGNIFICANTLY better - as are the hours, the pay, the PTO, the other perks I never take for granted. Lifestar (Falcone) held the contract for East Orange, Orange, and Irvington. We had a Union there and had signed a contract with Lifestar for 3 years. 6 months into the contract, we discover via an Emergency Town Hall Meeting in Orange that Lifestar was leaving the STATE in 2 weeks!!! No prior notice given to us; no memos, no written messages, no conference call, NOTHING. This is how you treat your employees??? We are a CRITICAL, VITAL part of the infrastructure! And this is how we're treated. Might as well work for McDonalds. People there are getting paid $15/hr to flip burgers - $4 more/hr than EMTs who save lives and make a difference.
Operations, Corporate Communication, Regulatory, Administration, Aviation, Security, Aviation Management.
8 年A wonderfully compiled analysis. Absolutely true too. However misses out on the company's view point. Would have made a more balanced read.
clinical supervisor, emergency services director and manager...head flunky
8 年pretty much right on the money. this applies not only to flight crew but to all levels of responders...after 37 yrs of trauma....military, civilian, ed to or, as IDC , CST-T and PA/FA..one day it was just "put a fork in me...i'm done"..."take some time off and come back....nope, i am done...i quit"...now work in emergent services, mangt...no pay but so much better..crews treated exactly as i treat myself, sleep when and where i do (or at least the same number of hours) and lots of little things...without their asking....training, physical "things", do't have them do anything i won't/don't do myself....more. i have zero turn over rate. long hours, not very good conditions, but they are the same as i do/have. each person works to the best level they can and rises from that as training and time build...all teach not only new but other staff members...me included......this weekend our comms person reminded me a fine point of digital radio comms...lkke make sure to check your tx/rx setting on the laptop.....i had spaced it out after a month vacation.....laguhing and good natured teasing, but all good. each person is a human, and en extension of yourself......to keep good, the best staff/crews treat them as your self.all things such as quarters, food, down time, goodies, training and teaching...all aspects of your work life and work family the same...the same as you do/treat yourself....oh we get no pay, but do work long hrs and 7 days a week, on call when we are not at the site....thanks Troy, people afre tierd of being trated and told they are disposable, or "if you don't like it...go somewhere else". we have a good team, highly motivated, who work long hours, wierd shifts,,,and from what i hear...no desire to leave....good team, good family, good crew...my brothers and sisters.
IT Specialist at MILWAUKEE VA MEDICAL CENTER
8 年I did not pursue career because the pay was not enough to raise family, for me. it is really too bad because I really enjoyed it and wanted to do more but the investment of training was more than the compensation.