The longitudinal study of turnover and the cost of turnover in EMS

Purpose—Few studies have examined employee turnover and associated costs in emergency medical services (EMS). The purpose of this study was to quantify the mean annual rate of turnover, total median cost of turnover, and median cost per termination in a diverse sample of EMS agencies. Methods—A convenience sample of 40 EMS agencies was followed over a 6 month period. Internet, telephone, and on-site data collection methods were used to document terminations, new hires, open positions, and costs associated with turnover. The cost associated with turnover was calculated based on a modified version of the Nursing Turnover Cost Calculation Methodology (NTCCM). The NTCCM identified direct and indirect costs through a series of questions that agency administrators answered monthly during the study period. A previously tested measure of turnover to calculate the mean annual rate of turnover was used. All calculations were weighted by the size of the EMS agency roster. The mean annual rate of turnover, total median cost of turnover, and median cost per termination were determined for 3 categories of agency staff mix: all paid staff, mix of paid and volunteer (mixed), and all-volunteer. Results—The overall weighted mean annual rate of turnover was 10.7%. This rate varied slightly across agency staffing mix: (all-paid=10.2%, mixed=12.3%, all-volunteer=12.4%). Among agencies that experienced turnover (n=25), the weighted median cost of turnover was $71,613.75, which varied across agency staffing mix: (all-paid=$86,452.05, mixed=$9,766.65, and all-volunteer=$0). The weighted median cost per termination was $6,871.51 and varied across agency staffing mix: (allpaid=$7,161.38, mixed=$1,409.64, and all-volunteer=$0). Conclusions—Annual rates of turnover and costs associated with turnover vary widely across types of EMS agencies. The study’s mean annual rate of turnover was lower than expected based on information appearing in the news media and EMS trade magazines. Findings provide estimates of two key workforce measures – turnover rates and costs – where previously none have existed. Local EMS directors and policymakers at all levels of government may find the results and study methodology useful towards designing and evaluating programs targeting the EMS workforce. Address correspondence and requests for reprints to: P. Daniel Patterson, PhD, Department of Emergency Medicine, University of Pittsburgh School of Medicine, 3600 Forbes Avenue, Iroquois Bldg. , Suite 400A, Pittsburgh, PA 15261, (T) 412-647-3183, (F) 412-647-6999, pattersond@upmc.edu. PDP, CBJ, NC, MWH, and JE conceived the study and developed the methodology. PDP, MC and MDW executed the study and conducted data collection and analyses. PDP, CBJ, NC, JE, MC, MWH, and MDW developed and revised the manuscript. Presentations: Portions of these data/results have been previously presented at the National Association of EMS Physicians (NAEMSP) Annual Meeting, January 2009, Jacksonville, FL, and are scheduled to be presented at the 2010 NAEMSP Annual Meeting in Phoenix, AZ. NIH Public Access Author Manuscript Prehosp Emerg Care. Author manuscript; available in PMC 2010 June 11. Published in final edited form as: Prehosp Emerg Care. 2010 April 6; 14(2): 209–221. doi:10.3109/10903120903564514. N IH PA Athor M anscript N IH PA Athor M anscript N IH PA Athor M anscript