It’s the economy, stupid!

In 1991, shortly after the U.S. ground campaign during the Gulf War, President George H. W. Bush’s approval ratings were at 90%. A year later, Bush’s approval rating had dropped by one-third, and he lost a re-election campaign to a then little-known Governor of Arkansas named Bill Clinton. How did that happen?

Good question.

Despite a flagging economy – along with an HIV/AIDS epidemic that was dominating primetime news – Bush’s spokespeople focused on framing their campaign by painting Clinton – and Democrats by extension – as nothing short of an existential threat to democracy. In direct response to their lackluster messaging, a campaign manager for Bill Clinton named James Carville hung a sign at campaign headquarters. It featured a bullet point that would be front-and-center at each press conference, townhall and debate stage until Election Day.

“It’s the economy, stupid!”

It was a rather poignant observation that, despite alarmists attempting to raise awareness about any number of problems, people will often care foremost about their pocketbooks.

History lesson aside, what can we – EMS – learn from Carville’s strategy?

Money talks

Money talks, plain and simple, and we should start speaking our employees’ language.

Right now, due to a variety of financial conditions, labor has become a seller’s market. The seller holds almost all the transactional power, due to laws of supply and demand. I’m sure that you’re already aware that unemployed prehospital providers are essentially nonexistent (low supply), and that everyone needs to hire them (high demand). When you have a commodity that everyone wants, but few people have: you can metaphorically “name your price” … and prehospital providers everywhere are doing just that.

For example: longer shift-types and mandatory overtime have transformed from being unpopular to deal-breaking.

Care to guess why?

Because there are literally millions of employers whose business models do not rely upon these necessities, and they are equally as desperate for new employees as you.

Far too many people are not talking about our non-traditional competitors. Why on Earth should we expect anyone to willingly spend time on an ambulance – an environment rife with stressors – when they can receive equal or more compensation doing something completely different with far less entry barriers and exponentially less responsibility? It’s not simply other public entities that are our competition anymore. It’s Amazon, Home Depot, UPS and many more.

Creating an employer value proposition

What if you’re paying an outlandish amount for prehospital providers, but still not getting anyone?

Don’t worry, I won’t make you guess why.

It may be that despite your best attempts at being top of your market and giving people more than an adequate wage: working for you at that rate still doesn’t equate to a valuable trade for prospective employees’ time. Much like beauty, we each have differing viewpoints on what’s valuable and what’s not; one man’s trash will be another man’s treasure.

Money does talk, but to speak that language with employees, you’ll need a shared lexicon: an employer value proposition, or a clearly defined and easily communicable set of benefits that employees will find valuable to them.

Now, I’m not going to provide you with a step-by-step guide to create a strong employer value proposition, because – spoiler alert – I don’t know how. If I did, I’d be too busy solving my own staffing problems to tell you. I can tell you how to start thinking about that process though with 5 questions.

1. Who are you hiring?

Begin by understanding who you’re hiring. If you’re anything like me, you have candidates with an average age of 27, and most often hire those aged 18. Considering that people can now retain their parent’s healthcare plans until age 26, your benefits are more than likely a non-starter for a vast percentage of your new hires. Why should they worry about something they get for free?

If you have a surplus of younger candidates, you may want to consider a revision of your full-time and part-time percentages to favor per-diem staff. In doing so, you cut down on unnecessary benefit costs – while still retaining them for existing full-time staff that need them – and can redirect those funds to compensation.

Meanwhile, those of you whose rosters trend more toward middle age may have employees shouldering prohibitively expensive benefits, which only seem to get more costly with each passing year. Consider a childcare subsidy for these more seasoned employees, many of whom undoubtedly have children. In doing so, you not only ease an oftentimes exorbitant cost, but can free up other members of the household to financially contribute while simultaneously lessening dependence on sick time when caregivers are unavailable.

2. What are you hiring employees to do?

Next, think about what you’re hiring employees to do. It’s common knowledge that working as a prehospital provider will be anything but fun. Employees work long hours, suffer sleep deprivation (clinically proven to cause diabetes, obesity and cardiovascular disease), face long-term traumatic stress (again proven to cause all the above), and miss out on key life events. Mix all of that with mostly sedentary work activity, and you have a recipe for overweight, unhealthy human beings and a largely unappealing workplace.

As a result, people aren’t often being swayed by sign-on or retention bonuses – not only because they are merely band-aids that fail to address key, systemic deficiencies with your employer value proposition, but also because your payment schedule and/or contractual terms are unappealing. Even larger sign-on bonuses that are distributed through each paycheck are a waste of time. If your salary requires pen-and-paper and at least a sixth-grade math level to understand: you’re not going to be successful. People want more money, not more gimmicks.

Instead, consider how you can adapt workplace conditions to be more appealing, or at least minimize those facets of prehospital medicine that are most tiresome to your staff. Even die-hard aficionados must logically admit that when stacked-up against other employers, EMS work expectations, coupled with existing compensation plans, appear laughably absurd by comparison.

3. When are you hiring?

Next, consider when employees are being hired. Consumers have less and less purchasing power with every passing day. Owning a home – a longtime hallmark of a way to build wealth for Americans – gets further and further out of reach for Millennials and Gen Z alike. In response, rental costs have risen by 15% nationally over a single year, and around half of all Americans live paycheck to paycheck.

Due to these factors, your offered retirement plans are also similarly defunct. I don’t know about you, but I wasn’t planning for my future when I couldn’t afford housing. Your employees – especially your younger employees who are fresh out of high school – don’t find your retirement plans valuable either. While you can’t simply reallocate funds you spend on these plans (and you shouldn’t), you can stop your age old practice of messaging about them and take a hard look at your shift structure.

Most of our staff are forced to have multiple employers to make ends meet, especially during these difficult times, and our historically rigid shift structures make working multiple positions harder and harder. When some say they literally cannot financially survive on what we pay alone, anything other than a flexible schedule will not be valuable (the moral ambiguity of that statement being a discussion for another day).

4. Where are you hiring?

Next, be mindful of where employees are being hired. Cost of living, especially during today’s day-and-age, has become nothing short of an existential threat to our employee’s financial security. You also must understand that cost of living can differ wildly sometimes over very short distances.

For example: Small Town, USA, can have comparatively cheaper purchasable goods than Resort Town, USA, that’s only 30 miles away. If you’re hiring prehospital providers for both locations, you need to be aware that one group could have different financial requirements than the other.

In addition, consider your employee’s commutes. Rising gas prices are hitting employees hard, especially those who may be working shifts of a shorter duration, simply because they must commute more often. Today, costs of owning, leasing or straight-up operating a vehicle can be a dealbreaker for some. The problem becomes compounded when you consider that many cities lack a robust mass-transit system as well.

Consider a shuttle service from large population areas (neighborhoods, suburbs, etc.) that act as silos for staffing, and help offset these transportation costs. If you have a mostly rural area, consider a gas stipend and have employees submit receipts, or simply pay them more. Your choice.

5. Why should employees work for you?

Finally – and luckily enough – you can control a lot about why your employees should work for you.

A lot of business professionals might shower you with flowery advice here, but I’ll be blunt: you must wage war on anything that makes your employees’ lives more difficult.

• Do you have a toxic work environment? Then you must do everything within your power to cleanse that stain. Your employees already have duties that are above-and-beyond what normal, everyday people must deal with at work. Why would you tolerate additional unnecessary strain on those whom you rely upon so acutely? Drop everything else that you’re working on. You are not losing your businesses through fire and fury, but rather through death by a thousand cuts. If you do not staunch these small wounds that you previously would’ve turned a blind eye to because you had bigger fish to fry, you’re going to fail.
• Do you have supervisors who consistently cause problems? Then you should re-educate them or terminate them posthaste. Supervisors are your bridge between management and clinicians, and – as a rule – should be your most respected providers and your best paid employees. If even one prehospital provider resigns due to poor supervision, you’ve lost countless opportunities to generate additional revenue, and simultaneously generated negative publicity amidst an ever-dwindling workforce.
• Do your policies, procedures or practices hobble your employees and make things harder for them? Then rewrite them, modify them or scrap them entirely. They are living documents, and should you want your business to continue living, you should change them accordingly!

Look, figuring out your employer value proposition will take time, but doing so will pay dividends. Don’t delude yourself and think that there are still undiscovered caches of prehospital providers somewhere out there – forgotten like sunken treasure – waiting to be unearthed. Instead, make every attempt to understand who you’re hiring; what you expect them to do; when you’re hiring them; where you expect them to work, and chiefly why they should work for you.

I promise that both current and future staff will trade those efforts for a commodity worth more than solid gold: their time … but you’ll still probably need to pay them more. If you want loyalty: get a dog.

It’s the economy, stupid!