An Exit-Interview for EMS personnel

On EMTlife.com, the question “Why are paramedics paid so little?” is getting looked over like a kid whose Momma is picking lice out of his hair! Since I’m one of the Community Leaders I had to be especially careful about hijacking the topic, and naturally, I have a bit of a twist on the whole thing.

I agree with what seems to be a general connecting thread running through the postings; the reason pay isn’t better is because WE are NOT furthering the profession by organizing better, raising our standards of education, and lobbying for change. We’re not putting in the work, pure and simple. But I think you need to look a bit below the surface to identify the reason for this:

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I keep going back to turnover being the biggest problem with medics not getting decent pay. Our personnel don’t stay with the field long enough to invest in themselves as professionals and into EMS as a profession.

Logically, as is being done in the thread noted and on every other EMS Forum in the Universe (Shameless plug – of which EMTlife is the most active!), much focus goes on pay and what an un-remunerative gig ambulancing is. But I believe the REASON for this has more to do with not enough people sticking around long enough to raise the standards
so they get paid what they deserve.

And why don’t people stick around long enough to make elevation of pay part of the elevation of the profession?

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Because they burnout on the pressures of the work! But I’d have to add another element to my equation here because it’s not only about matters of the head — the incredible illogic of investing every aspect of your life in service to the health and well-being of those of us in need of emergency intervention and being unacknowledged, disrespected and poorly compensated. It’s equally about:

Heartbreak! These are the human-being-like challenges; the psychological, emotional, moral, psychic and spiritual conflicts that go unresolved and build up until, one day — compounded by the dismal career/economic path and the toll it all takes on your personal relationships, BOOM! You’re outta there!

The systems that most EMS folk are working in are responding to this steady circulation of personnel rather than creating it. At worst, they’re exploiting it.

By not looking at it squarely and putting into place systems of support for their personnel, they are, in a sense, taking advantage of the situation and in my opinion, compounding the pressures on our society by using workers until they burn out and sending many of them as walking wounded back into the streets.

Oddly enough, the damage they go back to their lives with is usually not the kind that active ambulance workers transport a lot. I’m not saying EMS creates its own customers, but what appears to be true is a lot of ex-medics have real challenges in regaining the personal and career equilibrium they lost over the years they were in the field.

The truth is, MOST people can’t handle this work, but lots want to try!

You get so many coming in who shortly down the road (within about five years) silently admit to themselves that the pressure they’re putting themselves under just ain’t worth it. When it becomes time to gather the numbers to move the profession forward, they just aren’t strong enough for a MOVEMENT to gain traction.

Unless we make this a Movement, nothing is going to move!

As you can see, I’m working on spiffing up my blogs with graphics. I’m also working on keeping them shorter which is like asking me to not speak with my hands, so it’s failing! In the searching images for “turnover” I found this:

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If someone has done this simple thing in EMS I’d sure as hell like to know about it!

What an incredibly simple concept; Ask the medics who leave WHY they’re leaving. Why depend on my guesswork? Let’s get some Evidence-based stuff going! (Do you like that one coming from me, Rogue?)

One of the problems we face is that, for the most part, our higher-ups aren’t talking to us. WE are the last ones to be asked of our personal experiences in the field and why we are leaving it in droves. Any business knows that employee-retention is good business and worth investing in to assure future viability. That is, any business that doesn’t depend on high turnover to keep financially stable.  Unfortunately, that is the EMS business model.

And that’s what we have going here. It’s a kind of “We really DON’T want to know” sort of thing. I think it’s something we need to get really clear on; all of us. To date, I don’t think we’ve really figured out that it might be a good idea to actually TALK to our medics as they go out the door. Those of us left are just guessing!

So as a start, I’d like to advocate for ONE SIMPLE THING:

An anonymous EXIT-INTERVIEW FORM, standardized and sent to every medic who leaves an EMS service. The forms would be mailed to a central address (not mine!) for tabulation. Off the top of my head, let’s start with something like this:

Please take a couple of minutes to answer a few questions. We are doing a survey of individuals who are choosing to leave Emergency Medical Services. We are seeking to identify common factors amongst personnel that can be addressed in the future to help the profession become more stable.

EMT            Paramedic           1st Responder              LEO            Fire             Other_____

Years in EMS   <1  1  2  3  4  5  6  7  8  9  10  11  12+

State:

Urban   Rural   Mixed

Medical only     Medical/Fire     Private      Municipal      Hospital     Volunteer    Other

Volume of calls   High      Medium       Low

Please rate each of the following according to its weight of importance in your choice to leave EMS. A rating of 1 would indicate a reason of no great importance while a rating of 10 would indicate a reason extremely important to you.

pay

benefits

hours

schedules

policies

travel distance

condition of physical facilities

equipment maintenance

partnering

overtime- lack of

overtime- excess

workload- high

workload- low

supervision

upper management

union/representation

absence of career ladder

absence of raises

stagnant/absent/reduced benefits

business scrutiny

politics:         company         municipal             county            state

professional scrutiny

physical safety

BELOW CATEGORIES, please rate        Work Related        Non-work related

physical injury

medical condition

medication use

substance abuse

problems at home

relationship with children

relationship with significant other

relationship with extended family

emotional health

moral conflicts

psychic issues

spiritual conflicts

anger issues

Please rate each of these statements on a 1 – 10 basis, 1 being least true for you and 10 being most true.

I am burned out           physically___  emotionally___  morally___ politically ___

other (specify)_____

There is no future in EMS

My interpersonal relationships are suffering too much as the result of my job

I’ve lost my compassion       Personally               Professionally

Patient care has become a burden

I’m tired of the business/system/political fight

Now, of the strongest responses above, please choose ten and list them below from most important (10) to least important (1) in your decision making to leave EMS.

10)

9)

8)

7)

6)

5)

4)

3)

2)

1)

We also invite you to submit up to 200 words any comments you would like to offer to either clarify your reasoning for leaving EMS or suggestions for other factors we may have missed.

Thank you for your time and we wish you the best for your future!

I don’t think there’s a Forum for burned-out EMS medics yet. I suppose somebody ought to start one, but by the time they get there, who the hell wants to talk about this stuff, anyhow? But that would be the perfect place to post this.

This isn’t at all the point I started with, but right now, all over the internet everyone in EMS is talking about the instability of the industry and why so many people are transients in it. Maybe it’s time for us to REALLY find out!

Who has some ideas, time and connections to help carry this further?

(P.S. We’ve been infiltrated by a Smiley; I never invited it in, the little Gremlin showed up on his own!)