Ambulance, EMT first responders face 'crippling workforce shortage'

The COVID-19 pandemic has dramatically worsened a nationwide staffing shortage for emergency medical technicians and paramedics bringing longstanding issues — including low federal reimbursement rates and salary constraints — to a head in an industry already dealing with extremely high turnover.

According to a survey conducted by the American Ambulance Association, the turnover among paramedics and EMTs ranges from 20 to 30 percent annually, resulting in an unsustainable 100 percent turnover every four years. 

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The survey of 258 EMS organizations across the country found that in 2020, nearly a third of the workforce left their ambulance company after less than a year. Eleven percent left within the first three months.

"I have not heard of any state that feels like they're not in a bit of a crisis mode for first responders, paramedics in particular," said Shawn Baird, the association's president.  

Baird said staffing shortages have been a "systemic" problem, but COVID-19 hit the pipeline of new recruits hard. Training programs paused or shut down entirely, and the National Registry of EMTs stopped its certification testing.

Another issue is the pandemic has opened up opportunities for paramedics to work in other health environments, Baird said. Hospitals that were short on nursing staff have hired paramedics to do the job at much higher wages.

"It's great to see the career path develop, but unfortunately ... we can't come close to competing with that in our traditional work environment in the ambulance," Baird said. "I don't blame the worker, but the system. The system is facing pressure from so many directions at once, that we really have to begin to try and address as many of the pieces as we can."

In a letter to congressional leaders, the American Ambulance Association along with the National Association of Emergency Medical Technicians called for a hearing on workforce shortages, and asked for more funding to increase wages.

"Our nation’s EMS system is facing a crippling workforce shortage, a long-term problem that has been building for more than a decade. It threatens to undermine our emergency 9-1-1 infrastructure and deserves urgent attention by the Congress," the groups wrote.

James Pierson, president of the California Ambulance Association, noted wages are at an all-time high, but companies can't charge insurers more because so many patients are on Medicare and Medicaid, which are reimbursed at a fixed rate. 

Agencies rely on payments from commercial insurance and patients to make up the difference.

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Stewart Eubanks, a paramedic for the private ambulance service American Medical Response (AMR) in Sumter County, Fla., said there have been "extensive" response time delays, which he blamed on a workforce shortage. The delays were so bad, the county opted not to renew the company's contract and will instead operate its own ambulance service.

"Unfortunately, they're going to find themselves faced with the same pitfalls that AMR was faced with over the last two years. Staffing is not going to magically be ready just because we change ownership of who provides the EMS service," Eubanks said.

AMR over the summer substantially raised wages for paramedics and EMTs, which Eubanks said should make recruiting easier, but until there's a more consistent flow of new recruits, there will just be a never-ending revolving door. 

"At this point, we're literally robbing Peter to pay Paul," Eubanks said. "We're recruiting people from neighboring agencies, and then those agencies become short. And then if they increase their wages, we'll see a shift of our folks crossing county lines again and going to work for a new agency, and we'll be short again."

And the pay is still not competitive with other industries. Even after the increase, Eubanks said entry-level EMTs are making $14 to $15 an hour. Paramedics can earn more, because they have more training, but the tuition for a paramedic certification can cost tens of thousands of dollars.   

Christopher Vandenberg, who owns an ambulance company in Illinois, said the schooling that's required to become a paramedic is only "marginally less" than nursing school. 

"But the earning potential for a nurse is so much higher than as a paramedic," he said. 

Angela Madden, executive director of the Michigan Association of Ambulance Services, whose members provide about 60 percent of ambulance transports in Michigan, said there are 1,000 open spots across the state.  

Madden said the primary cause of the shortages is federal reimbursements for ambulance service under Medicaid or Medicare that fall short of meeting expenses. 

According to Madden, Medicaid typically pays anywhere from 10 percent to 25 percent of response costs, while Medicare pays about 30 percent.

Michigan Gov. Gretchen WhitmerGretchen WhitmerMichigan prosecutor calls state gun laws 'woefully inadequate' 65M women could lose abortion rights in Supreme Court case Judge orders pro-Trump election lawyers to pay 5,000 in sanctions MORE (D) and the state legislature recently passed a budget that allocated $12.9 million to boost Medicaid reimbursements for EMS agencies. When combined with a federal match, nearly $50 million will benefit EMS in Michigan.

Madden said the funding will be a major help for current EMS personnel, but there's still "a very huge hole in our recruitment and training efforts" that needs to be filled.