Why EMS Providers Walk Away, And How Tennessee Is Responding
Editor’s Note: This article is the second in a three-part series on how Tennessee is tackling retention in EMS. Read part one here. Part three will be available in the coming weeks.
The Cracks in the System
Long before Tennessee launched new leadership courses and statewide mentoring networks, EMS agencies were already showing signs of strain. Providers were leaving faster than agencies could replace them. New EMTs burned out within months. Veteran paramedics retired early. The calls were getting harder, the stress heavier, and the support systems that once held the workforce together were beginning to fail. When COVID‑19 arrived, it didn’t create the problem, it magnified it.
EMS providers were on the front lines every day, walking into homes, nursing facilities, and chaotic scenes with no idea what they were about to face. The public cheered for doctors and nurses, but EMS often felt invisible. Hospitals appreciated us, and the medical professionals we worked alongside treated us with the respect we afford one another. But outside those walls, many providers felt used, abused, and taken for granted. The emotional toll was immense, and the people responsible for supporting the workforce — supervisors, field training officers, administrators — were often unprepared for the leadership demands placed on them.
The Tennessee EMS Board recognized the urgency and asked what was being done to strengthen the workforce. That question prompted Director Brandon Ward to convene two groups to understand the problem directly from the people living it.
What the Workforce Told Us
Ward brought together two distinct groups: the Young Guns — new EMTs and paramedics under 30 — and the Rusty Rifles, seasoned veterans with decades of experience. Despite their differences, both groups said the same thing: Leadership was failing. Supervisors had never been trained to lead. Administrators had never been taught to manage people. FTOs were expected to mentor without ever being shown how. Many shift leaders had been promoted because they were clinically strong, not because they were prepared for leadership.
The consequences were real. One EMT student told their instructor they weren’t sure EMS was for them after their first shift. Their preceptor had asked whether they were “sure they wanted to do this,” calling EMS a dead‑end job and “just a fancy cab.” That kind of message, delivered on Day One, can derail a career before it begins.
Another supervisor once told me he was promoted because he was “the best paramedic they had.” His partner later confided that he simply wrote better reports and was sloppy in the field. “We were glad he was off the ambulance,” the partner said. “Now management would have to deal with him.” These stories weren’t outliers. They were symptoms of a system that promoted people without preparing them.
The workforce wasn’t leaving EMS leadership. The workforce wasn’t being led at all.
People were leaving because they didn’t feel heard, appreciated, or valued. They were exhausted from the pandemic, frustrated by stagnant wages, and tired of being bossed around instead of being supported. Leadership wasn’t the only problem, but it was the problem that touched everything else.
This confirmed what educators and leaders at the Tennessee EMS Education Association (TEMSEA) — including Shannon Morphis, Jason Fox, Phil Sanderson, Eric Clauss, Greg Johnson, and others — had been seeing for years. The pandemic simply exposed the problem more clearly. Providers needed support, and supervisors needed training.
Strengthening the Foundation
Before Tennessee could fix leadership, it had to strengthen the foundation. Part I of this series explored the state’s decision to integrate mental‑health curriculum into every level of EMS education. Combined with statewide Mental Health First Aid training, Tennessee created a baseline of emotional support that had been missing for years.
Recruitment began to improve. Salaries increased — finally catching up to where they should have been years ago. EMT and AEMT enrollment grew. The legislature expanded training capacity by allowing ambulance services to teach entry‑level courses. Community colleges worried these classes would siphon off students, but the opposite happened; both pipelines grew. The workforce expanded, not shifted.
Grass‑Roots Collaboration Becomes Formal Policy
As Tennessee addressed leadership gaps, structural change followed. The EMS Board underwent a major restructure in 2023. Although the legislation only dictated the physical seats of the 13‑member board, the newly seated members immediately recognized the leadership crisis and took decisive action.
What began as an informal partnership, where the State EMS Director leaned on TEMSEA to innovate leadership training, was formally adopted by the board. They created the Leadership and Advancement Committee, giving the initiative permanent institutional backing. Leadership development was no longer optional. It became part of Tennessee’s EMS governance.
TEMSEA’s Early Leadership Initiatives
As the pandemic eased, TEMSEA focused on reconnecting the statewide EMS community. The first effort was the TEMSEA Leadership Podcast, hosted by Eric Clauss, which offered candid conversations about leadership challenges, agency culture, and professional growth.
Soon after, TEMSEA launched the monthly Mentoring and Leadership Call, hosted by Phil Sanderson. Held on the first Friday of each month, the call brought together EMS professionals from across Tennessee for open discussion, shared experiences, and guidance from seasoned leaders. These early initiatives laid the groundwork for the leadership ladder that followed.
Leadership I: Building the Foundation
Leadership I became the first major step in rebuilding EMS leadership. TEMSEA designed an eight‑hour workshop built around discussion, interaction, and practical application. Participants worked through real‑world leadership problems, reflected on communication breakdowns, and examined how conflict had been handled in the past.
Each participant received a comprehensive workbook to build a personalized leadership plan tailored to their strengths and goals. Leadership I quickly became more than a class. It became a cultural reset.
Leadership II: Elevating the Trainer
Leadership II turned foundational principles into practice. TEMSEA understood that field training officers (FTOs) and preceptors shape agency culture more than anyone else. Historically, these roles were filled by clinicians who had never been taught how to teach, coach, or mentor.
Leadership II debuted at the TASA Mid‑Winter EMS Conference last February. Built as an eight‑hour interactive workshop, it immersed participants in discussions, hands‑on activities, and real‑world scenarios. The course emphasized self‑development, communication, feedback, and the crucial conversations that define the early months of a provider’s career.
The difference a good preceptor can make is profound. Early in my career, I worked with a colleague named Jeff. He was an EMT instructor part‑time and went out of his way to teach and encourage students when he precepted. He explained the “why” behind decisions, shared his enthusiasm for the profession, and treated every shift as a chance to build someone up. He was a thorn in management’s side — anti‑establishment and outspoken — but he was dedicated, and his students felt it. Leadership II was built to create more leaders like Jeff.
Leadership II didn’t just prepare FTOs and preceptors. It elevated them.
Leadership III: Preparing the Next Generation of EMS Administrators
Leadership III became the summit, the moment where Tennessee began shaping the next generation of EMS administrators. The course was beta‑tested this week at the TEMSEA conference, as an invitation‑only session. Each region was asked to send directors and supervisors, ensuring statewide representation.
Held at the Embassy Suites in Murfreesboro, the two‑day course immersed supervisors in the realities of modern EMS administration. They explored staffing pressures, personnel support, communication with elected officials, and long‑term planning. Because this was a beta course, feedback was essential. Leadership III will now be refined before its formal statewide rollout.
Eliminating the Accidental Leader
Accidental leaders, those promoted for clinical skill rather than leadership readiness, had long struggled with conflict resolution, strategic planning, supervising peers, and navigating administrative expectations. Tennessee’s leadership ladder was designed to eliminate accidental leadership entirely. Leadership I prepared providers. Leadership II prepared supervisors. Leadership III prepared administrators. Mental‑health curriculum supported every level. The podcast and mentoring call connected leaders statewide. The EMS Board’s Leadership and Advancement Committee ensured leadership development was formally embedded in governance.
Together, these efforts stabilized the workforce by stabilizing the people who lead it.
A New Direction for Tennessee
Tennessee discovered something profound: The workforce wasn’t leaving EMS because they disliked the work. They were leaving because they weren’t being led. They were leaving because they didn’t feel heard, appreciated, or valued. They were leaving because the pandemic left them emotionally exhausted and professionally invisible.
By building a structured leadership ladder — and pairing it with mental‑health support, legislative expansion, improved training pipelines, and a restructured EMS Board — Tennessee is addressing the root cause of workforce instability, not the symptoms. Leadership only matters if it changes what people do, how systems function, and whether a profession feels worth staying in. In Tennessee, those shifts are already visible in the way agencies are stabilizing and the profession is regaining momentum.
Part III will explore the systems that support leaders once they’re trained: CORE, financial first aid, operational resilience, and statewide consistency. Tennessee isn’t just training leaders. It’s rebuilding its emergency medical systems from the inside out.
