Agency-Level Turnover Rates of Emergency Medical Service Clinicians and Their Characteristics

Emergency medical service (EMS) clinician-level turnover is high and varies dramatically by agency type. There is a need to evaluate mean turnover rates, adjusted by agency characteristics, to provide standardized and comparable measures across workplace settings. Our objective was to leverage recent methods to evaluate agency-level mean turnover and describe the agency-level characteristics of those leaving the agency of record.

A 2-year retrospective evaluation of EMS clinicians from 2020 to 2022 was conducted to evaluate agency-level turnover. EMS clinicians and agencies from 9 states that required National EMS Certification to obtain/maintain EMS licensure were used. Demographic and EMS-related characteristics were collected, including agency-specific attributes (agency type, service type, majority full-time employees) and state-level identifiers. The percentage of those leaving each EMS agency was calculated, and multivariable linear regression was used to calculate adjusted agency-level mean turnover rates.

A total of 1137 EMS agencies with 20,881 EMS clinicians met the inclusion criteria. The adjusted agency-level mean turnover rate was 17.4% and varied dramatically based on agency type (14.3% to 23.7%), with the lowest being fire agencies and the highest being private. When we examined the EMS demographics and work-related characteristics, we discovered significant variability, which is consistent with the theory that each agency type may have different characteristics of clinicians leaving.

Adjusted agency-level mean turnover rates varied dramatically by agency type with associated variability in EMS clinician demographics and workplace characteristics. This suggests that the characteristics of agency turnover potentially vary by specific organizational culture, and identifying these variations may assist in developing interventions to enhance retention.