This year, Michigan state officials hope to improve the state’s paramedic shortage with new legislation that reduces barriers to accreditation. Senate Bill 249, signed by Governor Whitmer on May 22nd, will expand accreditation options for aspiring paramedics by expanding licensure requirements to accept scores from a new state-administered exam instead of only recognizing scores from the national exam.
Bill 249 follows an Emergency Medical Services (EMS) workforce crisis of too few paramedics and emergency medical technicians (EMTs) that began before and worsened during the COVID-19 pandemic. The reduction in EMS professionals has resulted in longer ambulance response times and wait times for transportation between healthcare facilities. The 2024 Michigan Healthcare Workforce Index, a report that measures the overall health of 36 healthcare occupations, estimates that, from 2023 to 2033, only 840 paramedics will graduate to fill a projected 2,000 job openings. The Index also projects that only 3,440 EMTs will graduate to fill 4,061 open positions over the same 10-year period. In total, Michigan will experience a shortage of 1,781 EMS professionals in 2033.
The EMS Workforce Shortage
The shortages of paramedics and EMTs can be partially explained by decreased training program availability, the use of EMS education as a launch pad for future healthcare career aspirations, and limited earning and reimbursement potential.
From 2014 to 2024, the number of schools offering EMS - EMT, and paramedic - education programs dropped from 20 to 17. Most of the remaining 17 programs are located in southeast and western Michigan. Michigan’s northern and rural communities either lack access to a nearby EMS school or rely on county fire or EMS services to create and oversee their own training programs. As a result, employers in these communities are often left competing for limited job seekers as many EMS professionals stay and serve in their communities instead of moving to underserved areas. A recent 2021 report found that 91 percent of rural EMS managers identified finding and hiring personnel as a major or moderate challenge.
Further reducing the available workforce are the students who use their EMS education as a stepping stone to become other higher-paying healthcare professionals, such as nurses or physician assistants (PAs). In 2022, paramedics and EMTs earned an average of $22.42 and $16.39 an hour, respectively. In comparison, PAs earned, on average, $55.55 an hour, and nurses earned an hourly wage of $38.04 (Registered Nurses) to $94.16 (Nurse Anesthetists) in 2022.
Lower compensation for EMS is part of the sector's larger problem of chronic underfunding. Michigan is one of the 37 states that does not recognize EMS as an “essential service.” Recognition as an “essential service” means local or state governments are responsible for providing and funding the service, often through taxpayer dollars. States without “essential” status rely more heavily on limited and insufficient reimbursements from Medicare and Medicaid to cover costs. While Michigan’s Medicaid EMS reimbursement rates have increased, funding remains insufficient to cover the costs of readiness, equipment, and non-reimbursable care delivered to uninsured patients.
Addressing the Shortages
Despite these workforce challenges, the paramedic and EMT professions are becoming “healthier.” Compared to the 2023 Michigan Healthcare Workforce Index, the latest report reveals paramedics jumped seven spots to the eighth overall healthiest profession due to relatively higher wages and the profession's expected growth. Similarly, EMTs’ health saw an increase, up nine spots to twenty-third, ranking in the middle of the 2024 Index due to lower wages in comparison to paramedics.
In addition to Bill 249, stakeholders are looking for unique opportunities to grow and support the EMS workforce. One such initiative is the Emergency Medical Services Workforce Grant for aspiring paramedics offered by MDHHS. Students can apply for funding through one of two tracks. One provides funding toward tuition payments and the other reimburses time spent during training. Preference is given to minority status applicants or those who desire to work in rural communities.
Other paramedic workforce initiatives include “grow-your-own” programs, where hospital systems, like Tri-Hospital, offer their own paramedicine training, and articulation and partnership agreements that facilitate EMTs' completion of paramedic training. Some stakeholders, like the UP Workforce Innovation Network, are working to support the EMS profession in the Upper Peninsula by providing a Community Paramedic program that focuses on delivering education through a hybrid model that includes satellite education and clinical rotations at sites throughout the UP.
MHC’s Insight’s Take
Paramedics and EMTs provide crucial, life-saving care essential to the healthcare system. However, EMS staffing shortages add minutes to emergency call responses where every second counts. The newly signed Bill 249 and other workforce recruitment and retention efforts are crucial steps to ensuring Michiganders receive care when they need it most.
For a list of current healthcare workforce initiatives, please visit mhc.org/hub.