The EMS Exodus: Why Clinicians Are Leaving and What It Means for Public Health
Across the United States, we rely on emergency medical services (EMS) practitioners to provide immediate assistance in medical emergencies and disasters as well as augment primary care and public health services. But these clinicians are leaving their jobs at higher rates every year. A new study in the Journal of Public Health Management and Practice “Who is Leaving the Emergency Medical Services Workforce?” looks at trends in leaving jobs (turnover) and which workers are more likely to leave jobs.
The study, by Dr. Kyla F. Woodward and colleagues at the University of Washington’s Center for Health Workforce Studies and the TMF Health Quality Institute, analyzed data from the US Current Population Survey from 2018 to 2023. They found that the annual rate of EMS clinicians leaving their jobs rose from 16% in 2018 to 23% in 2023. That’s nearly one in four EMS professionals exiting the field each year. While the EMS workforce grew in size during this time period, the increased departure rates are cause for concern about the sustainability of the workforce.
One concerning finding is that EMS clinicians from racially and ethnically diverse backgrounds are leaving at disproportionately high rates compared to white EMS clinicians. Immigration status also played a role, as workers who were not US-born citizens were more likely to leave jobs than naturalized or US-born citizens.
Where do these professionals go? The study found a post-pandemic shift away from other hospital and public sector jobs, such as nonclinical roles in fire departments or public health, toward other health sector jobs. An increasing percentage left the workforce entirely. More EMS clinicians have been retiring, becoming unemployed, or leaving to pursue education. This suggests that many may be seeking better pay, career advancement, or relief from the intense stress of EMS work.
Another concerning trend is the growing number of EMS clinicians leaving their jobs in rural areas. Given that rural EMS systems often rely heavily on volunteers and already face staffing shortages, this trend could jeopardize emergency care access in underserved communities.
The reasons behind EMS turnover are complex, but recent studies point to several key drivers:1-4
- Burnout and stress: EMS clinicians face high workloads, exposure to trauma, and even workplace violence. These pressures intensified during the pandemic.
- Lack of career pathways: Many EMS professionals leave to pursue further education in other fields, often because there are limited opportunities for advancement within EMS itself.
- Low pay: EMS wages lag behind those of other healthcare professionals with similar training, especially for entry-level roles like emergency medical technicians.
- Organizational challenges: Poor team dynamics, inadequate resources, and lack of support contribute to dissatisfaction and attrition.
Read the Article in JPHMP
This study offers several policy recommendations for EMS agencies and other policy makers to stem the tide of EMS departures. First, EMS agencies will need to invest in a representative workforce by recruiting clinicians from all backgrounds and ensuring a supportive work environment, including appropriate responses to the violence and stress faced by EMS clinicians. Second, creating career ladders within the profession to management roles or expansion of programs in community paramedicine or mobile integrated healthcare can provide the advancement opportunities sought by EMS clinicians. Finally, reforming policy to support paid models in rural areas and allow EMS agencies to be reimbursed for community and preventive services could improve job satisfaction and financial sustainability in EMS.
EMS clinicians are more than just first responders—they are a critical part of our public health infrastructure. They provide care during pandemics, respond to the opioid crisis, and serve as a safety net in communities with limited healthcare access. If we don’t act now to support and retain this workforce, we risk weakening our entire emergency response system. This study “Who Is Leaving the Emergency Medical Services Workforce?” is a wake-up call. It’s time to listen to the voices of EMS professionals, understand why they’re leaving, and take meaningful steps to keep them in the field. Because when EMS clinicians leave, it’s not just a workforce issue—it’s a public health emergency.
References:
- Blau G, Chapman SA. Why do emergency medical services (EMS) professionals leave EMS? Prehospital Disaster Med. 2016;31(S1): S105–S111. doi:10.1017/S1049023X16001114.
- Gage CB, Cooke CB, Powell JR, et al. Factors associated with emergency medical clinicians leaving EMS. Prehospital Emergency Care. 2024;28:1-7. doi:10.1080/10903127.2024.2436047.
- Powell JR, Gage CB, Crowe RP, et al. National evaluation of emergency medical services clinician burnout and workforce-reducing factors. JACEP Open. 2025;6(1):100024. doi:10.1016/j.acepjo.2024.100024.
- Rivard MK, Cash RE, Woodyard KC, Crowe RP, Panchal AR. Intentions and motivations for exiting the emergency medical services profession differ between emergency medical technicians and paramedics. Journal of Allied Health. 2020;49(1):53-59. https://www.jstor.org/stable/10.2307/48722864. Accessed April 15, 2024.
Funding acknowledgement:
This work was supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) as part of an award totaling $450,000 with zero percentage financed with non-governmental sources (U81HP27844-11-00) and by the National Institute for Health National Institute of Nursing Research (T32 NR019761). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by NIH, HRSA, HHS, or the US Government. For more information, please visit HRSA.gov.
Kyla Woodward, PhD, RN, is an assistant professor at the University of Washington (UW). She partners with the UW Center for Health Workforce Studies to conduct research examining career pathways, job experiences, wellbeing and job outcomes for clinicians and other members of the health workforce across the US.
.
Bianca Frogner, PhD, is interim department chair and director of the Center for Health Workforce Studies at the UW Department of Family Medicine.
Davis Patterson, PhD, is a sociologist and research professor in the Center for Health Workforce Studies at the UW Department of Family Medicine.
You must be logged in to post a comment.