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Why Your Best EMSers Quit Banner

“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.


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.


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:

  1. New pilots do as they’re told (for the most part)
  2. New pilots don’t know any better
  3. Senior aviation managers are too lazy to fix a broken system
  4. 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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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.

    11 replies to "Top 10 Reasons Your Best EMS Crews Quit"

    • George Bevilacqua

      Drama alerts! This is what they are called. In EMS everything is a crisis. Followed closely by nurses running programs. Nurses do great work don’t get me wrong but you wouldn’t hire a college professor to run your towing business. If they had EMS exposure first then became a nurse they have a better grasp on how things work. If they come from a hospital background that is the only exposure they have and try to bring that culture into a program it just doesn’t work.

      • Troy Shaffer


        Thanks for commenting. I appreciate you sharing your perspective.

        Clear Skies & Tailwinds

      • Michael Hennig

        T0o much about ems in the air….it is such a small small part of what we do. Also I am from Canada and we do not have your huge under paid issue, join a union.
        Other wise ems has the same global problems under resourced, hospital waits, and fire fighters should fight fires ems should do ems.

    • Larry Wilson

      Great commentary.

      I may have missed it in the mix, but I only lasted 7 years because of all those issues, plus one major reason that might be a little more subtle in your post, and that is because the majority of the work we did was absolute nonsense.

      Launching out at 0100 in a January winter to retrieve a 90 year old woman with a stable fracture that had been all tucked in and warm for the past three days, had to be awakened for the middle-of-the-night transfer in the frigid wind, and could’ve gone by ground.

      Hauling a specialty team to get a toddler with a lump on his nuts because it was close to the end of their shift and they didn’t want to get off work late.

      Those were the big straws that broke this camel’s back.

      • Troy Shaffer


        Thanks for sharing your experience. Sorry to hear EMS lost another top performer.

        You make some really good points. All of the issues you mention are tied directly to EMS leadership, or lack thereof. Here is a link to the article “The 20-60-20 Rule of Helicopter EMS” that speaks directly to the issue you mention.

        Thanks again for commenting.

        Clear Skies & Tailwinds

    • claude

      This sums it up perfectly.
      Being a manager myself I can relate to the hurding of cats.

      Regards from South-Africa.

    • Jodi Riker

      New company hired thirty EMTs and two On Call Nurses. Company paid federal minimum. Boss claimed EMTs were a dime a dozen.

      I responded that good ones will keep you out of court, and simply worth their weight in gold. Claimed nurses went on high risk calls and billed accordingly. But no nurse went, just someone dressed up like one! He didn’t get it, and lost EVERYTHING in two years. Spent the next with Federal Labor Agency as he bounced pay checks and shorted pay checks, he is serving time for fraud.

    • Michae

      Every day and time when I think I’ve had enough…I will also ask myself “Is it worth it”. I’m still looking for for that answer.

    • Dave Shrader

      Troy, I am submitting a report to a healthcare system about ground services this week. May I have your permission to attach this excellent article, with attribution and a link? I believe they also provide air services through a separate part 135 provider.

      I consult in public safety, including ground and air EMS, Fire and sometimes Law and compliance issues.

      My background is 3rd service, private, corporate, hospital based, Fire and volunteer Fire and EMS. I was an EMT, Paramedic, Rescue Tech, Swat Medic (LEO) and flight medic since the 80’s. 42 years of EMS and now I work with high profile municipal departments and agencies as well as well as health systems, the Department of Justice and some whistle-blower attorneys on compliance issues.

      I also provide some advice to public and private investors, with several notably about air medical. I am also a pilot with single engine land and sea and multi-engine land ratings. Took our float plane from Atlanta to AK to support a NatGeo Whale research project, only landing on water. I have a little rotary time logged in a Robinson, and more time not logged “holding the cyclic” for pilots on medical flights.

      I like your take on things and would like to talk at some point.

      • Troy Shaffer


        Yes, of course you may share this article as you requested.

        I hope it helps you. Thanks for sharing your experience.

        Clear Skies & Tailwinds,

    • Mark Edenfield

      Hi Troy –

      Good article as it hits most of the points about attrition in EMS. I was a paramedic in the State of Florida for about 32 years with most of my career in leadership positions. I’d like to say I’ve seen, done or heard it all but that’s far from the truth. If you ever hear that statement, stay clear of that individual. Right?
      A medical philosopher (no such thing, lol) once told me that a physician who has a great bedside manner and communicates well with his (her) patients has less malpractice suits than one who doesn’t. Whether that’s true or not really doesn’t matter as it only paints a clear picture of how we should treat one another. And we also don’t have to travel very far to read the most basic philosphy of life which is to treat others as you would have them treat you. That seems fair, right and simple but it’s not easy for some “managers” to do and that’s where the difference between a manager and leader appears. The most basic sign for leadership effectiveness is to turn around to see how many followers you have. And in most cases, just as your article points out, people leave because thay are being managed and not led. We manage “things” and lead “people.”
      Thanks for taking the time to write your article. I could go much deeper into why medics grow out of their current environments and head out for bigger and better things but I think the subject has been beat up so much that most people have already heard it and understand it. We just don’t fix it and that’s the sad part.
      It reminds me of the Seinfeld episode about the car rental agent that can “take” a reservation but can’t “hold” the reservation. We know whats wrong but rarely do we fix it. Take care.

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