Paramedics are NOT a Commodity

All agencies of all sizes, from mountains to the coast struggle with staffing at times. Recruitment can be difficult for everyone, as all branches of public safety and healthcare struggle with pay scales, work schedules and public opinion. Perhaps we should focus on things we have more control over, such as employee retention. Instead of asking why we cannot find enough qualified applicants perhaps we should instead ask ourselves why do employees leave faster than we can recruit new ones?


There is a subset of EMS agencies that have more applicants than open positions and retention rates remain high. These agencies must be doing something vastly different from the others, as they continue to thrive during a time that is difficult for so many others. After visiting many EMS agencies and talking to lots of medics I have developed a paradigm on how to create a destination agency where people line up to apply and few want to leave.

There are three main components to creating such a destination agency.

Create a Culture of family

One of my fellow emergency medicine physicians who is former military once told me, “If people feel like their organization cares about them then they will run through walls for it.” People want to belong to a group that does something special. They want to be valued and they want a job that has value. Destination agencies that I have visited consistently use words like “we” and “family.” They treat everyone in the agency as an important part of the whole. They consistently give feedback to providers regarding why they do what they do. Destination agencies also treat providers like professionals by showing flexibility and understanding in how they treat and schedule their providers. They also never let providers forget that they are valued and have an important job. Management tries to be seen by employees, leading by example and ensuring they do not forget where they come from.

In contrast agencies with high turnover often make providers feel like a commodity or like “just another cog in the wheel.” Providers may be judged only by their numbers. Scheduling might be arbitrary and inflexible. There is often times a lack of understanding in why things are done as they are, and they have little say in possible ways of improving processes.

Develop Leaders Who Excel at Leadership

Leaders in EMS organizations must have skill in dealing with people and managing people. For people to be effective leaders they must have appropriate training and mentorship. Just because someone is a good paramedic does not mean they will be a good supervisor. It’s not fair to either the person placed in the supervisory role or the people they are supervising if appropriate training and mentorship is not given. Without this training the supervisor will become frustrated, as will the people they are supervising. There are courses in leadership and management provided by the National Fire Academy, the National EMS Management Association (NEMSA), and other organizations often at low or no cost. The military has mandatory training for every level of advancement before a person can lead at that level. Some leadership training is universal, much like ICS, and can be applied to various disciplines, such as business management, human resources, or nonprofit development. Look to outside sources for various training that could bring some new perspective on how things are done. It’s not fair to either our supervisors or the people they lead if that training is not provided. Set up a new leader for success and not failure. Just as field personnel must continually train to stay sharp with their skills, management should be required to train and participate in continuing leadership education.

Challenge Providers to Practice at the Full Scope of Their Skills

Providers want to be challenged. Most want to have the ability to learn new things and perform at a high level. For them to achieve this they must receive high level training with expert teachers and medical directors. This does not mean that every system should adopt every new device or treatment that appears, but providers do want to be able to provide the highest level of care. They also want to have access to new and innovative ways of caring for their patients.

Part of performing at a high level requires solid medical oversight with good feedback to providers. Providers want to feel like they are being held to a high standard. Medical direction and oversight must focus on giving solid feedback in a positive manner. It’s very easy to simply blame the provider and label them a bad medic if there is a problem. This negative approach to performance improvement and medical oversight is counterproductive. It will not improve care and will alienate providers. The optimal method of medical direction involves thoughtfully looking at care concerns, finding the systems, cognitive, or skill issue at play and then addressing that issue in a positive and supportive way. We should never yell at, demean, or speak down to any of our providers. I firmly believe that every EMS provider went into EMS to help people. They want medical directors and supervisors who will help them achieve that goal.

In summary EMS should be a Destination Profession. Each EMS agency should strive to make itself a Destination Agency. Agencies cannot treat their providers like a commodity. EMS providers are professionals who carry out a very challenging job. Agencies must create a family like organization that people want to be a part of. Agencies must provide leadership training and mentorship to their supervisors. Providers must also be challenged to provide the highest level of care possible at the full scope of their abilities.


EMS1 Article on Turnover

National Fire Academy

National EMS Management Association

Dr. Winslow has worked at Baptist Hospital in Winston-Salem for the past 11 years. He was appointed as the Medical Director of the NC Office of EMS in 2011. This document contains all protocol, procedures, and policies for all EMS agencies in North Carolina.

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