Ambulance firm eyes employee ownership to attract and keep staff

One of the state’s biggest ambulance companies is considering an unusual tack to combat shortages of medical staff: giving workers a financial stake in the business.

“When the company’s profitable, the employees share in the profits,” said Justin Van Etten, executive chairman of Stewart’s Ambulance Service in Meredith. “It will create a lot more long-term financial security for all our EMTs and we hope will pull more people into the field.”

Stewart’s Ambulance Service is in the process of creating an Employee Stock Ownership Plan or ESOP, which gives shares of company stock to employees once they have become vested by working there long enough. An ESOP is similar to a retirement program with tax benefits for the company and workers.

The National Center for Employee Ownership said almost 6,300 companies in the country had an ESOP as of 2019, the most recent year for which data is available. That includes some 180 companies in the six New England states according to the ESOP Association, including Hypertherm in Lebanon, a nationally known maker of industrial cutting systems.

ESOPs are rare among ambulance companies nationally, Van Etten said. This would be the first ESOP for an ambulance service in the state.

Stewart’s Ambulance Service was founded in 1981 and has “just shy of 300 employees” in New Hampshire and Maine, Van Etten said. They provide 911 service in a number of communities, many in the Lakes Region; handle many hospitals, including the three in the Concord Hospital system; and carry patients in virtually the entire state. The company is owned by Transformative Healthcare of Massachusetts.

 Van Etten said the service, like many health care agencies, has been struggling with staffing issues throughout the pandemic. He described the situation as exacerbated by federal restrictions on Medicaid reimbursement that have contributed to industry problems. 

“There aren’t as many ambulance services (in New Hampshire) as there were five years ago. … Those that remain have really been reducing their offerings, everybody’s just so challenged for staff,” he said. 

Van Etten said the company hoped ESOP along with programs like “earn as you learn,” which can cover costs for training as an EMT, will increase staffing levels and reduce turnover.

Under an ESOP the senior management team stays in place with a “more robust” board of directors, Van Etten said, and a trustee to ensure that profits are properly distributed.

“We run just like any other for-profit business, except the profits are distributed to the employees,” Van Etten said.

Employees will have no direct say in the business operation, unlike a workers cooperative. 

The idea was announced informally to workers in March. The company and trustee have been doing internal due diligence and will hire an evaluation firm to work out vesting schedules and other details before the decision is made to go with the ESOP.

Employees will have to put up no money themselves to participate, Van Etten said.