Bad EMS Manager Mistakes That Make Good People Quit

It’s pretty incredible…

how many EMSers secretly hate their jobs.

And how many top-performers up and leave EMS and air medical.

At first glance, it makes no sense.

Why would anyone loved and respected by their co-workers, considered expert in their field and top of their profession, suddenly quit a job most people would kill to have?

From the outside looking in, getting paid to fly a helicopter and save lives is incredible.

Most people would kill for the opportunity.

So why then do some of the very best in the field consistently leave EMS and air medical?

Two words:

Bad managers.

Don’t get me wrong.

There are good EMS managers.

But one bad manager can scare away a lot of good people.

Managers tend to blame their high employee turnover on everything under the sun, while ignoring the truth of the matter.

Here’s the truth:

People Don’t Leave Jobs; They Leave Managers

The sad irony is how easily this can be avoided. All that’s required is a new outlook and some extra effort on the manager’s part.

Is correcting EMS Manager mistakes worth the time?

Yes, absolutely.

Organizations know how important it is to have motivated, engaged employees, but most fail to hold managers accountable for making it happen.

When organizations don’t hold anyone accountable, everyone suffers.

Gallup research shows that a mind-boggling 70% of an employee’s motivation is influenced by his or her manager.

So the next time you hear about how horrible employee XYZ is doing, consider the source and remember it’s a direct reflection of the manager in charge.

Managers of course don’t like or want to hear these facts. But it doesn’t matter.

“Heavy lies the crown,” as the saying goes. Or, if you’re ex-military, this probably rings more familiar – “With great authority comes great responsibility.”

Regardless of your training or background, managers play a huge role in your success or failure in EMS.

So, let’s take a look at some of the worst things that managers do that send good people packing.

Bad EMS Manager Mistakes

#1) They overwork people

If you work EMS or air medical, you are no stranger to fatigue on and off the job. Sadly, it’s a lot easier for managers to ask their top performing employees for help than others.


Because they know their best employees will help them without a fight.

The challenge is to spread extra work as equitably as possible. It’s easy to do. All it really takes is self-awareness about who does the lion’s share of extra shifts. On a side note: if you’re one of the top performers working all kinds of extra shifts and thinking your manager notices and cares, you’re more than likely fooling yourself.

Managers care about shifts getting covered, not so much about who works them.

Change may require going to your manager and showing them why you’re not taking extra shifts the next time she asks you. Show her how many shifts you’ve already worked and the reasons why you believe others may be a better and fairer choice.

This gives your manager an easy option of showing the same information to less helpful employees.

#2) They Don’t Recognize Contributions And Reward Good Work

When I consult with air medical companies, I’m always stunned by how few recognize employee milestones.

Keeping track of how many flights or cases individual employees have responded to is easy work. If you’ve already spent thousands of dollars on software to track other “more important” details, adding this to your software system is usually an easy and almost zero-cost, fix.

Here’s why it matters:

Recognizing your top performers matters. Top performers keep score, and they want their managers to keep score too.

You don’t want extra money for working extra shifts to be the only incentive. It’s not enough to keep your top performers on board.

#3) They Fail To Develop People’s Skills

Some EMS and air medical managers are anti-education. You read that correctly.

Some EMS and air medical managers are threatened by employees with solid educational credentials (and skills). It’s true and it’s easy to spot.

When I first started flying, I of course included all my experience and education on my resume. It seemed an easy decision.

But when I gained more experience in air medical, I quickly starting updating my resume by downgrading my experience.


Because it was obvious EMS and air medical managers didn’t want the best candidates, they wanted candidates they could control. Candidates they considered non-threatening. And one easy way to make yourself non-threatening is ensuring you have less education (on your resume) than the person interviewing you.

I’m not encouraging you to do the same, but I am encouraging you to do your homework.

Research the education of the managers in charge of the positions you’re applying for. Then do what makes the most sense.

#4) They Don’t Care About Their Employees

This is a big one.

Have you heard the adage “people don’t care how much you know, until they know how much you care?” It’s true in EMS and air medical.

Narcissistic EMS managers are easy to spot and easy to manage. To manage them, all you have to do is smile and nod your head occasionally when you listen to them. Basically, “happily” endure being in their presence and move on as quickly as you can.

But it’s also this type of manager that chases away the very best employees. Sooner or later, top performers get tired of pretending their managers are competent.

Top performers notice every time a manager rewards friendship over merit or hard work. They know they can get another job anytime they want.

So when bad managers exhaust them, top performers leave.

#5) They Have No Honor

Say what you mean, mean what you say.

Sounds simple, right?

And it is simple, until managers start making promises they can’t keep.

You see this phenomenon a lot with promotions that have no performance merit attached to the promotion. An EMS manager’s friend gets promoted because of the friendship.

The newly promoted manager genuinely means well and is highly motivated to create positive change.

Two weeks later reality sets in when the new manager tries to implement…anything. It then becomes brutally obvious their management authority is paper only.

No decisions allowed without 100% prior approval of the manager “friend” who promoted them. It’s a real problem and lack of honor extends well beyond promoting friends. It permeates all aspects of the job.

#6) They Hire And Promote The Wrong People

In the 13 years I flew civilian EMS, I never saw a performance-based promotion. Never.

Every single promotion (including my own) was based on past friendships, past relationships (military) or recommendations from friends or colleagues.

Performance was rarely even considered, and when it was considered, it was always after the real decisions were already made. A rubber stamp to protect the human resources department and current management team from litigation.

The bad karma of promoting friends instead of the most qualified employees always catches bad managers. In the moment, it seems like there’s no justice, but over time there is.

How do you spot a non merit-based promotion?

The same way you spot a fractured sternum or half missing skull. It’s obvious. Nothing but common sense is required to spot the most egregious efforts of bad managers attempting to hire and promote the wrong people.

Here’s a couple quick examples:

  • Mechanics in charge of pilots.
  • Medics in charge of nurses.
  • Housekeeping in charge of surgeons.

You get the idea.

The results of hiring and promoting the wrong people are quick and obvious.

Here’s the disturbing part: poor results almost never reverse the decision.

You can watch your flight program shrink from five or six helicopters to 3 or 3 1/2 helicopters, and nobody lifts a finger to rid the organization of the manager. Why?

Because the high level decision makers who promoted the manager are more concerned about protecting their own reputations than fixing the problems. It happens a lot in EMS.

#7) They don’t let people pursue their passions

It takes about six months to get a 90% comfort level with flying EMS. After six months, things quickly become routine.

The EMS honeymoon ends.

Motivated employees start looking for new ways to contribute to the organization’s success.

This is a huge opportunity for both the manager and the employee. Done well, it’s the proverbial “win-win” situation.

Bad EMS managers fail at letting top performers pursue their passions for two reasons: first, they don’t know what their employee’s passions are. Second, they don’t care enough to find out.

Why not assign the person with a marketing background or interest in marketing to the outreach committee? Why not take a minute to learn how new employees want to contribute to success?

It seems obvious, but reality is that it rarely happens.

EMS is full of examples of missed opportunities and wasted talent.

#8) They fail to engage creativity

Imagine calling your current EMS boss and saying something like this:

“Hey boss, I have this idea about how to increase our outreach in the southern portion of our operations area. Myself and a couple others at our base would like to head down there and do some public relations stuff for the good of the program.

Do you have any problem with that?”

If you’re experienced EMS and laughing, stop. I’m being serious.

The sad truth: an employee who asked a question like the one above would be lucky if all they got was reprimanded, and not fired.

Bad EMS managers are not secure enough to let other people make decisions. Any decisions, much less decisions dealing with the public at large or outreach.

The irony of course is that dealing with the public and outreach are baked in to almost all EMS and air medical jobs from the start.

#9) They don’t challenge people intellectually

When you have people on your team who literally bring people back to life, it’s important to challenge them intellectually.

Adult coloring books will more than likely fall short…

Although, adult coloring books are very popular as of the writing of this article (seriously).

The days of you drive the ambulance from point A to point B to point C, ask no questions, and never complain or question anything, are pretty much over.

Top performers expect to be challenged. They’re easily bored and wicked smart.

This is the reason you see a fair amount of flight nurses leave their flight nursing positions and move on to nurse practitioner or higher education opportunities. They simply get bored with flying and the politics that surround flying and working for bad EMS managers.

What To Do Now

So what do you do now?

If you want your best people to stay, you need to think carefully about how you treat them. While good EMS employees are as tough as nails, their talent gives them an abundance of options. You need to make them want to work for you.

What other mistakes cause great employees to leave? Share your thoughts in the comments section below.

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Troy Shaffer
Troy Shaffer

About the Author: Troy is an Air Medical Career Expert passionate about a team approach to improving air medical safety from the ground up. Troy is a former Army medic, Army pilot, Coast Guard pilot and EMS pilot. Troy has taught hundreds of wannabe flight medics, flight nurses and EMS pilots the exact steps needed to launch air medical careers.

    12 replies to "Bad EMS Manager Mistakes That Make Good People Quit"

    • Robert Senter

      Excellent, concise article wrought with good points. So often, promotions are based upon friendships or “buddy buddy” situations….which almost always creates a shitty manager. After all, the people doing the promoting would prefer someone they know…because it’s more comfortable. If an average manager promotes an excellent employee based upon ability and merit, they know that employee may shake things up (for the better)…and most managers feel uncomfortable with that.

      • Troy Shaffer


        Thanks for the feedback. I sincerely appreciate it.

        Clear Skies & Tailwinds

    • Thom Dick

      I think this is a great piece, full of sound wisdom. The Cleveland Clinic and the Mayo Clinic have both advocated Servant Leadership as a preferred leadership style for leaders of health care workers; SL addresses each of these issues and makes great practical sense. Read more here:

      I don’t think people leave because of the work. I think they leave because of the stuff that gets in the way of the work (including bad leaders and a lot of other things). A good leader’s most important job is keeping that stuff out of people’s way.

      • Troy Shaffer


        Thanks for sharing your experience. The article you referenced makes some interesting points.

        “A good leader’s most important job is keeping stuff out of people’s way” -I like it!

        Clear Skies & Tailwinds

    • Daniel C Foulds

      Well said Troy, and sadly, all too true. Like all good bits of writing, it stirs the imagination and dredges up memories…

      1. A pilot inadvertently flew over a body of water in a single engine HEMS ship without floats. It was noticed by the OCC, and reported to “leadership.” After several weeks, in the middle of a transport and while refueling at a fuel stop, his phone rang. The call was a manager telling him he was fired, right there, on the spot. Ground transport had to be arranged to pick up the medcrew from the hospital. Imagine how this was perceived by the dozens of people working for that company in that market. Happy ending? The pilot is back in HEMS with another operator – same market.

      2. A pilot inquired in writing about a position with the same company in another state. No response. Then, several days later he is included in an email string with an offhand comment that he is to be transferred. He is alarmed and says “WAIT, I was only asking about the job.” No one thought to actually speak with him about this. Too bad, he is either going to move or be fired – the company already has another pilot slotted into his position. Only after much writing and discussion with multiple levels of management does this fellow undo the damage and keep his job.

      3. A mid-level manager walks into a hybrid base, with employees of the program partner on hand. The manager looks at the duty pilot and says, “YOU, in that office!” Then the manager looks at a medic and says, “YOU make coffee!” (I swear to God I am not making this up). What did these actions say to the partner organization about the aviation company?

      I am friends with a pilot who recently received a promotion into management. Whenever we visit he tells me about the problem employees he has to deal with. I think he is surprised at how much time he spends dealing with a small trouble-making segment of his employees; and what he must be careful to avoid is coming to a place where he regards ALL of his employees as trouble-makers.

      If that attitude comes through in his voice or written communications with his “good guys.” Then he will have entered the ranks of the managers we all love to hate. This is a small industry, and every misstep made by a manager lives on in stories passed from person to person. And these missteps? They also cost money.

      • Troy Shaffer


        A big thank you for sharing your experience.

        You make excellent points and I love the reminder about keeping the real percentage of trouble-makers in perspective. It’s easy to get caught in a negativity spiral.

        Your reminder is much appreciated. All professionals can learn something from the examples in your comments. Myself included. Thank you again.

        I encourage all my readers to check out your work at:

        Clear Skies & Tailwinds,

    • Randy King

      Excellent article Troy…A good manager needs to lead by example.

      What’s leadership if there’s no goal or vision to lead to? A good effective leader utilizes his/her team of employees & other stakeholders to help achieve that vision with them pointing the way. As progress is made a good manager acknowledges & credits those involved in pursuant of that goal and reward & benefits come as we move closer to achieving that objective.

      Sometimes the progess is slow do to headwinds but perseverance is another great quality of an effect manager…. sooner or later we’re bound to get a good tailwind and as our ground speed picks up we all begin to see the benefits of teamwork organized by an effective leader leading the way!! With budgeting & proper planning we can all “Reach for the sky” ??✈️

      • Troy Shaffer


        Thanks for taking time to share your experience and perspective. I sincerely appreciate it.

        Clear Skies & Tailwinds,

    • Bunsen E Beeker

      It’s really sad that I have seen managers committing several of the mistakes you listed. In fact, my last manger did the following items: #2, #3, #4, #5, #6 (but I will say, there is nothing wrong with medics in charge of nurses, and if there is, than nurses should never be in charge of medics, especially if you do a lot of scene jobs), #7, #8 & #9. The only time we were overworked (IE, forced to work and not allowed to go home without being disciplined) was when we experienced staffing issues due to not hiring enough full timers to allow for minimum staffing, so if someone called out, someone was forced to stay for at least half a shift.

      My EMS agency did it all, ground ALS & BLS, communications, helicopters, and ground CCT. But we lost so many good people over the years, and people who came in with the best of intentions to make it a career.

      A good manager once told me that turnover WILL happen, and it’s not something to worry about. When people leave for supervisory positions, change careers, or to do something in the field that your service doesn’t offer, it’s the responsibility of management to wish them luck, as they weren’t able to provide what they were looking at within their organization.

      It’s when people leave to do the same job for another company, that’s when management should be looking at what they are doing wrong, and work to rectify it.

      I do have a question, one that is far above my pay grade: What should be done about the manager who is making those mistakes? Many who are in those positions have been with the organization for 10-20+ years, and other than saying “thanks for all your time, now get out,” what is a good solution? Especially if they are only doing what was done before they got there, or what they are being directed to by their higher ups.

      • Troy Shaffer

        Hi Bunsen,

        Thanks for sharing your experience. You make some really great points and I sincerely appreciate you sharing your EMS experience with EMS Flight Safety Network.

        I definitely agree that a certain amount of turnover is understandable and expected. And I think the advice your manager gave regarding this issue is spot on — “…turnover WILL happen, and it’s not something to worry about. When people leave for supervisory positions, change careers, or to do something in the field that your service doesn’t offer, it’s the responsibility of management to wish them luck, as they weren’t able to provide what they were looking at within their organization.”

        Thanks again for sharing your experience.

        Clear Skies & Tailwinds,

    • Lee Fuell

      One sentence summary: “EMS managers screw up by being managers, not leaders.” All of these “management mistakes” are really leadership failures, and we really won’t make much progress fixing these until EMS starts talking about leaders, leadership and leader development. The difference is significant and profound, as military vets will know.

    • Tracy

      This is such an important article and about time someone put it out there. I love love the article. I have been and am now in that type of agency. Its sad that those things happen to great providers and it begins to make you hate every moment of your job and the feeling that you can care less about the agency you work for and the work you do. This article can also pertain to other jobs out there and not just ems. I thank you for the wonderful article.

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