Factors that affect Israeli paramedics’ decision to quit the profession: a mixed methods study

BACKGROUND: The rate of Israeli paramedics leaving the profession has been increasing in recent years: 50% leave the profession in three years, for the most part before retirement. While approximately 2500 paramedics have been trained, only about a third of them are still active. The number of paramedics per 100,000 in Israel is only 8, compared to around 66 in the US, and in light of the shortage of paramedics it is important to enhance retention rates. The purpose of the study was to examine the factors related to paramedics leaving the profession in Israel. METHODS: 1. An online survey was sent to 1000 paramedics via Email. 533 were recruited of whom 200 have left the profession. Questions included demographics, job satisfaction, and reasons for leaving or remaining in the profession. 2. In-depth interviews with 15 paramedics who left the profession. RESULTS: Out of 1000 emails sent, 533 Paramedics responded, of which 200 paramedics who left the profession responded (73% left five years after completing training and 93% after 10 years). Among these former paramedics, choosing the paramedic profession was based mainly on an idealistic sense of mission and eagerness to help others, yet leaving the paramedic profession was related to extrinsic factors: lack of career options, extensive and strenuous physical demands accompanied by unrewarding salaries, unusually long work hours, and shift work that negatively affected family and personal life. CONCLUSIONS: It seems that work conditions, including the lack of opportunities for promotion, lack of professional prospects, and inappropriate compensation for hard work are crucial factors in the decision to leave. RECOMMENDATIONS: A joint committee of the Ministries of Health, Justice, and Finance and MDA (Magen David Adom, the national EMS in Israel) should be established for the purpose of improving the conditions and modalities of employment of paramedics and providing appropriate emotional support for paramedics who are exposed daily to work under extreme conditions of stress and human suffering. A joint effort could greatly reduce rates of leaving, training costs, and costs incidental to turnover, as well as increase job satisfaction. Moreover, regulating the profession and expanding the scope of practice to new fields like community paramedicine as part of the EMS service and expanding the scope of physician assistants as an academic profession can create opportunities for advancement and diversity at work that will help retain paramedics in the profession.