There’s a problem in healthcare that most of us have quietly accepted: the “butts in seats” approach to staffing.
It sounds simple enough: Fill the openings, ease the overtime, stop the constant scheduling headaches. But over the past decade, I’ve noticed that this mindset has quietly hollowed out the profession from the inside, especially in EMS.
When the goal becomes staffing the schedule instead of building the team, the cracks spread fast. The wrong hire doesn’t just bring down morale; they can dilute the skill and standard of everyone around them. Competence and attitude both matter, but lately it feels like one has taken a back seat to the other.
The other day, I was doom-scrolling (as any good millennial does) and stumbled across a post from @prep_medic (HERE) where he said something that stuck with me:
“Being nice is no longer enough to get hired, competence should come first.”
And he’s right. Somewhere along the way, we started hiring for personality over performance, assuming we could train clinical judgment into someone who was just “a really nice person.” The problem is that competence isn’t something you can always teach after the fact — at least not at the level critical care demands.
I once asked a member of executive leadership why a chronically unreliable employee — someone who had missed mandatory trainings and repeatedly no-call, no-showed — was still employed. The answer?
“We need them more than they need us.”
That’s when it clicked for me: We’ve built a system where desperation drives hiring decisions. We’ve convinced ourselves that an empty seat is worse than a bad fit. But in practice, the cost of keeping the wrong person is always higher– it drains morale, creates friction, and lowers the bar for what “acceptable” looks like.
We all say we want to elevate the profession, yet we still fall into this cycle of quick fixes and low standards because the alternative feels inconvenient. But real progress takes discomfort. It means slowing down the hiring process. It means standing firm when someone doesn’t meet expectations, even when it means another night of overtime.
Filling a shift is easy. Building a culture isn’t.
If we want to fix the “butts in seats” problem, we need to stop measuring success by how many people we put on the roster, and start measuring it by how many of them we’re proud to stand beside.
Thankfully, there are signs of change. At my current employer, our leadership has chosen to do something that’s becoming rare in this field: wait. They’re willing to hold out for the right candidate rather than rush to fill a spot. It’s a refreshing approach, and one that reminds me that progress doesn’t always mean moving faster. Sometimes it means slowing down just enough to get it right.
After all, slow is smooth, and smooth is fast.