There are more than 20,000 openings nationwide for paramedics and emergency medical technicians (EMTs) as fire departments and emergency medical services agencies struggle to hire and retain workers.
And that’s just the tip of the iceberg.
The U.S. Bureau of Labor Statistics projects 20,000 openings annually for paramedics and EMTs nationally over the next decade to keep up with retirement and turnover.
Nationally, the median pay is $46,770 for paramedics and $35,470 for EMTs, according to BLS.
Some volunteer and entry-level EMTs and paramedics get paid even lower wages — akin to retail jobs in some places. Some agencies also report a significant contemporary and post-coronavirus pandemic drop in volunteer recruitment and retention for firefighters and paramedics.
The problem is pronounced in rural areas and small towns where communities rely on staffing-strained volunteer agencies or career departments whose wages can lag behind those of suburban and urban jurisdictions.
The staffing situation is prompting some potential solutions across the country to help ease a shortage that threatens emergency response times.
Housing challenges, administrative needs
“I need at least four more people. The challenge is I don’t have the funding,” said Greg Tryon, fire chief for the Central Valley Fire District in Belgrade, Montana.
Tryon’s fire department has 32 firefighter paramedics, and the agency is funded via voter-approved property taxes (i.e. mill levies in Montana).
He said pay, and expensive and sometimes limited housing options, work against hiring and keeping employees. Central Valley firefighters have a starting salary of $50,000 with benefits (for a 56-hour weekly shift).
Tryon said lower pay levels at EMS agencies and fire departments are a top challenge across the state and country.
“They could go and really earn more an hour working at McDonald’s, Wendy’s or Target,” he said.
Housing is expensive in the Belgrade and Bozeman areas, with rents surpassing or exceeding $2,000 per month for two bedrooms and $2,500 per month for a three-bedroom residence.
“We have very high cost of living, at least for housing, due to the growth rate,” Tyron said.
Montana — and the Bozeman and Belgrade area — have seen significant population gains, with a 12.4% growth since 2010, according to U.S. Census Bureau data and World Population Review.
Popular areas of Montana have seen influxes — including during and after the coronavirus pandemic — of new residents, including wealthier retirees and remote professional workers. That has put upward pressure on demand for housing, as well as prices.
Tryon said paramedics and firefighters are also overburdened, and worker burnout could be alleviated by boosting administrative staffing at smaller departments. He said his Montana department gets 2,500 emergency calls a year and has been seeing 10% increases in annual call volumes.
“They’re responsible for everything — patient care, transportation, paperwork, equipment,” Tryon said. “We have added this administrative burden to them, as well.”
Tryon said if agencies could upgrade their administrative side of the operations, then paramedics and EMTs can focus on emergency responses and patient care. “They can focus on the day to day,” he said.
Hospitals, consolidations filling the void?
In Wyoming, some hospital systems have taken over ambulance services as volunteer and career agencies deal with staffing shortages.
“We do see the most difficulties on the volunteer side. We are seeing less and less volunteers as the years go by,” said Luke Sypherd, president of the Wyoming Emergency Medical Services Association. “We do see shortages on the career side, as well.”
Like other states and regions, low pay and a drop in new volunteer firefighters and paramedics challenge recruitment and retention efforts.
“Pay is a critical issue,” Sypherd said, noting some volunteer and entry-level EMTs and paramedics make entry-level wages, such as $15 per hour.
Some volunteer EMTs get paid even less for their shifts. “We have some areas that start EMTs off at minimum wage,” he said.
Sypherd said a bill that made its way through the Wyoming Legislature will hopefully make it easier to create special taxing districts to help fund EMS operations. Gov. Mark Gordon signed it into law Thursday.
There are pushes in other states — including Wisconsin — to help better fund EMS agencies.“There needs to be changes on how people view EMS,” Sypherd said.
Some smaller volunteer EMS agencies and fire departments in Wyoming, Wisconsin and other states have consolidated to pool resources, staffing and coverage areas. “We have seen the consolidation efforts,” Sypherd said.
A number of smaller agencies in rural and small-town areas of Wisconsin have been consolidating operations to help alleviate limited staffing that can make for longer response times.
Fire and EMS chiefs in Wisconsin and other states report a significant decline in volunteer firefighters, paramedics and EMTs during and after the job losses of the coronavirus pandemic.
Other volunteer agencies have converted to pay departments, and hospital systems have taken the helm of ambulance and EMS operations.
In addition to his association duties, Sypherd is a quality supervisor for the Cody Regional Health EMS. The hospital launched its EMS efforts in 2017, has expanded into other local areas and is launching a new EMS air service in the spring. The emergency medical response and ambulance service covers 4,500 square miles in Wyoming’s Big Horn Basin region.
Sypherd said the hospital approach has seen successes in Wyoming, and other communities and regional medical systems are eyeing the approach.
“We’ve seen great success with local hospitals taking up the burden,” he said. Sypherd said hospitals can offer employee benefits (including health insurance) and other resources that help with the recruitment and retention.
They can also offer higher pay.
In southern Oregon, Matt Hitchcock is division chief of operations for the Klamath Falls Fire District. He said the agency is staffed for “75 total positions” with 63 firefighters/paramedics and 12 administrative staff.
The Oregon fire department currently has no openings. “Zero,” Hitchcock said.
Hitchcock said the EMT and paramedic staffing are problematic with other Oregon agencies, but he said the Klamath Falls district has focused staffing on dual-role workers who can serve as both firefighters and paramedics.
“Those single-role people were so hard to recruit and retain. They generally make less money than dual roles,” Hitchcock said. “We trimmed single-role (positions).”
Hitchcock said dual-role firefighters make $5,464 per month versus $4,751 per month for single-role paramedics. Pay levels for the dual-role positions helped the Oregon department with staffing.
But the situation statewide mirrors challenges seen in other states. That includes an aging workforce. Hitchcock there are currently 1,500 firefighters through Oregon who are eligible for retirement. “They could just drop papers today,” he said.
He sees the potential for apprenticeship programs statewide, and EMT and paramedic training programs launched by community and technical colleges.
Regionally, Klamath Community College and Rogue Community College launched EMT and paramedic programs in 2021. KCC also has fire science programs that can help with workforce pipelines, Hitchcock said.
That can help improve applicant pools which have dwindled.
“The days of departments having 500 applicants are gone,” Hitchcock said.
