“If you pay peanuts, you get monkeys.” -Sir James Goldsmith
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.
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?
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.
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.
Here are four leadership articles to get you started: The Biggest EMS & Air Medical Leadership Mistake —And How To Avoid It!, The Navy SEAL Guide to EMS & Air Medical Leadership, 7 EMS and Air Medical Leadership Myths and The Great EMS Leadership Hoax.
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 blog comments section below.
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