The ITIJ team have been reporting live from ITIC Global in Barcelona this week (November 2023) sharing the discussions that took place at the conference. Read all reports
The Air Ambulance Forum was introduced by Ian Cameron, ITIC Chairman and ITIJ Editor-in-Chief. He emphasised that the issue of recruitment and retention of staff has become even more relevant post-Covid-19, especially for the air ambulance sector.
Rory O'Gara, Chief Operating Officer at Servisource
O’Gara started by indicating the challenges facing international recruitment, citing candidate availability; immigration and visa issues; language and cultural barriers; compliance with local and international labour laws; medical credentialling and conversion processes that are particularly relevant for air ambulance companies; verifying international credentials; relocation difficulties including finding and the cost of accommodation; costs and fees; staff retention; and political instability as a motivator for relocation.
O’Gara then discussed ways to address and solve these problems. He started by identifying that a competitive salary and employment package in line with market rates will help; stating that you will increase the risk of hiring the wrong person if you offer a lower rate and poor package who then consequently leaves for a better position, causing you to end up paying for recruitment again as the process will have to be repeated. O’Gara emphasised this point: “Get the benchmark, do your homework.”
O’Gara mentioned that promoting a good work–life balance by offering flexible scheduling options and reasonable workloads will reduce burnout and improve employee satisfaction.
He said that employee recognition and rewarding individuals for their achievements makes the employee feel noticed and valuable, and therefore much more likely to remain.
He also stated how a good corporate image is important to show values, and that the organisation should inhabit their good corporate values so that the projected image is a true reflection of the company. He also expressed that the ‘job description needs to be upended’ so that, when recruiting, employers can engage potential employees in how their future contribution will lead towards a common meaningful goal.
Open communications, and keeping staff informed of organisational strategy and business road maps shows employees the value behind their work, helping them be engaged with the company as a whole.
O’Gara concluded with the importance of a robust hiring process, identifying key areas to ensure that companies hire and retain the right people, by focusing on seven core aspects of recruitment to avoid: an inadequate or lengthy hiring process; a lack of diversity and inclusion; bias and discrimination; a poor candidate experience; an inadequate skills assessment; high turnover rates; and an inadequate background check.
Cameron asked about retention if air ambulance companies paid more money and whether this would solve that problem. O’Gara said that money isn’t always a big factor, that employees currently value career progression and work–life balance more, and the generation that had preferred monetary remuneration over other values is retiring.
An audience member asked how the panel were preparing for Gen Z, and Treadwell said that they were moving to more digital training, and alternative ways of working – including a different working environment and wider staffing pools to account for larger unscheduled absences – to mitigate the differences in expectations.
Denise Treadwell, President, Airmed International
Treadwell provided a perspective on the North American situation. She outlined the shortfall in pilot availability, and the projected shortfall in the next couple of years of up to 4,505 US airline pilots and the possible total deficit of 30,000 pilots by 2025.
In order to retain pilots, airlines have been increasing pay by large amounts, and air ambulances have to compete against this. Treadwell broke down the average pay of pilots by aircraft type, highlighting an annual increase in wages by 8.2 per cent over the last few years.
As well as pilots, another skilled aviation position that has seen a worrying decrease in numbers, are the qualified aircraft maintenance technicians, and Treadwell identified that they are also receiving an average increase in salary over the last couple of years by 9.4 per cent. She stated that much needed to be done to retain this portion of the workforce as well as pilots and flight crew.
Treadwell dissected the clinical staff market data, showing that across the USA, the base salary increased by 15 per cent in the last year.
In addition to salary considerations, Treadwell discussed further factors impacting recruitment and retention, including better hours, and reaching out to schools, and helping trainee pilots with their progression towards their licences through real-life training and simulation; bridge programmes to convert medical specialties; the effect of Covid-19 on clinical staff such as the increase in travel nursing and burnout; mandatory retirements for Part 121 operators; European Union Aviation Safety Agency (EASA) age restrictions; and the set reimbursement from commercial payors forcing a renegotiation of contracts.
In order to lessen the challenges facing recruitment and retention of employees in the sector in the USA, Treadwell determined four core areas to focus upon: attracting staff by being aware of the economic environment and establishing appropriate pay programmes; retaining staff by valuing employee contributions with financial rewards and development opportunities; motivating staff by rewarding behaviours and achievements that enhance business performance; and communicating with staff proactively and transparently. Treadwell said that businesses can also enhance their crew recruitment and retention policies by having regular reviews and market analyses to ensure that their compensation is appropriate and sufficient.
Cameron asked about the factors influencing the recent rise in the pilot shortage. Treadwell said that Covid-19 meant that many airlines shut down and that allowed an increase in the pool of available pilots, but mostly the reason for the current loss of pilots is the large generation that have and are retiring, while a smaller upcoming generation include fewer getting trained.
Jérôme Pin, Deputy CEO–General Secretary at European Air Ambulance
Pin introduced the factors affecting recruitment in the air ambulance market and the European employment sector generally. He listed staff shortages (where the healthcare and aviation sectors are heavily affected with fewer people going into training), long working hours, heavy regulation, long training, relatively low salaries, poor investment into aircraft and equipment, sustainability of aviation, and being a less attractive sector to potential employees.
The European employment is also suffering from diverse influences affecting the ability of air ambulance companies from recruiting. Pin identified economic and geopolitical crises, climate change, inflation, post-Covid burnout, mental health issues, an aging population, the expectations of work–life balance especially for Generation Z, digitalisation and the working from home model, and tension in the labour market, all affecting the ability to recruit in Europe.
Pin added that, to combat the difficulties in the sector and region, there are some ways to reduce their negative effects, including having human resources central to the organisational strategy, a strong corporate culture and values, a distinct career and personal development plan, flexible working, a focus on training, mentorship and knowledge management programmes, and competitive compensation and working conditions. Pin said: “We want our staff to be in the best condition to perform their missions.” He added: “We are committed to investing in our staff, our fleet, our facilities and our equipment.”
Pin also identified that the approach shouldn’t just be internal, but outward looking as well, with staff being active ambassadors for their organisation. How an organisation is perceived by its reputation can be an influence on bringing in staff to work for it, including current and former staff providing recommendations for working there. Furthermore, ensuring the work is meaningful and stable can have an effect, he said outreach through social media can enhance digital recruitment avenues, but also participation in innovative programmes, job fairs, school visits and offering summer jobs and engaging with the potential and future workforce, as well as encouraging people that are interested in the industry with apprenticeships and robust onboarding.
A question was posed by a member of the audience about more reasonable duty times for medical crews. Pin said that European Air Ambulance have introduced flight time restrictions for crew as well as those regulated for pilots to ensure safer flight limitations and, in the long term, it will help the medical crew get fairer and better working hours. Rodenburg concurred and said they have the same standards for pilots as crew, but also that they encourage crew to alert management when fatigue and tiredness becomes a concern.
Anne Rodenburg, Commercial Director at AirLink Ambulance
Rodenburg began her presentation by outlining that different countries often have differing approaches to air ambulance staffing and recruitment, particularly around training. She highlighted that the difference in the supply pool of staff is often what necessitates these different approaches, stating that although the access to pilots is fairly similar across countries within the Americas, there do exist large differences in the availability of medical crew that can be recruited. Rodenburg explained that in Latin America (LatAm) and Mexico, there are many more qualified medical professionals free to work than found in the USA, and that this is mostly due to the high cost of medical services and competition of high salaries in the USA restricting availability.
Rodenburg identified that the progression of many air ambulance pilots who then leave to go to the larger airlines. She described the processes of training pilots, indicating that initial and continuous training is expensive. She said that it was more cost effective to have their own aviation school to mitigate these expenses, but also allowed the opportunity for cross training with the medical crew – allowing the trainees to work in teams in real-world scenarios, especially the live training events. She also noted that the challenge and experience of flying for an air ambulance company is an attractive proposition for pilots to progress in their early careers, and stressed the importance of employing pilots who have personal characteristics and personalities suited to the role with the experience and flexibility to fly into areas that are unknown, and be able to make command decisions in emergencies that may be more complex than often experienced with a large commercial airline. She said: “A lot of pilots come back from commercial airlines because they find it boring, and instead want to be a part of saving lives.”
Rodenburg added that training medical crew has aspects similar to pilots, such as the requirement for initial and continuous training, but that there is a difference where the cost of continued medical training is concerned, stating that in Mexico, the cost is more affordable than equivalent medical staff in the USA. In this regard, she stated that the training of their medical colleagues can be done both externally and in house. On top of the work and training, the medical staff also continued to perform shifts at local hospitals, which helps maintain their day-to-day skills and experience.
Cameron asked the panel if things have changed so that the aviation industry is no longer attractive when people can work in IT and have the same salary, work from home, and then travel their spare time. Treadwell said that diversity is also an issue in this regard and that the upfront cost of training is a hurdle. O’Gara agreed that IT has opportunities that are not open to air ambulance staff and doesn’t require the same rigorous and regulated training needed in aviation. Rodenburg said that she could see that in areas of the world that have lower costs of living and training, recruitment is moving towards getting qualified staff from these zones to work in countries where it is harder to get the right staff.