If you call for an ambulance in northern Michigan, chances are it will show up within ten minutes. But lately, sending out ambulances has become a balancing act.
Benzie County paramedic Kent Adams worries about when there are multiple emergencies at once.
“Call 911, everyone expects an ambulance is going to come,” he says. “They don’t realize that we’re at crisis right now.”
There is a big shortage of EMS workers across the state and country. The Michigan Association of Ambulance Services estimates there’s more than 500 open positions for EMTs and paramedics, who have more training.
Adams says staffing has been a problem for years, but he’s never seen it so bad.
“[In Manistee County] we had 13 full-time paramedics, plus our part time staff as well as our EMTs. I just talked to a medic a couple days ago who was working there. They have four [paramedics].”
To deal with the shortage of workers, ambulances often only send one paramedic instead of two, according to Jason MacDonald of Mobile Medical Response, a hospital-based EMS provider in northern Michigan.
Still, service has been impacted. According to Manistee County 911, the average time it took for an ambulance to show up in March this year was about nine and a half minutes. Ten years ago it was seven minutes.
MacDonald says while they’re managing, the company needs more EMTs and paramedics.
“At some point if we can’t find the people or the people simply don’t exist, coverage could be impacted, there’s no question,” he says.
But there are a number of obstacles in recruiting new paramedics, primarily low salaries.
Emergency medical services make money by billing insurance companies for hospital runs. But, Medicare and Medicaid reimbursement rates have barely increased in 20 years, while equipment costs have skyrocketed.
Today, the average rate for both EMTs and paramedics in northern Michigan is about $15.50 an hour, according to Northwest Michigan Works!, a social services agency.
“EMTs doing this for 10 plus years have been maxed out making less money than what McDonalds and Burger King were advertising,” Adams says.
He often tells young people to pursue a career in nursing instead. It’s roughly the same time in school but almost double the starting salary.
Angela Madden, the director of the Michigan Association of Ambulance Services, says a recent provision in the Affordable Care Act has made it harder to compete against hospitals’ salaries.
“When you think about working in an emergency department versus working along the highway in a truck in an ambulance,” she says. “I mean the working conditions are dramatically different. The hospitals — thanks to that incentive from the ACA — can pay more. They have more regular hours.”
Burnout is another problem. Many paramedics work additional full-time jobs or take several extra shifts to pay the bills.
For most of his career, Adams has worked 96-hour weeks for EMS.
He says it used to be a competitive field, where you had to build a reputation to get a job with the crew you wanted.
“It’s kind of gotten to a point because of the shortage where, ‘do you have a license and a pulse? Welcome aboard,’” he says.
Recruiting medics is especially difficult in northern Michigan. Experts call the region a training desert.
Right now, Munson Healthcare is about the only place in the region that offers courses. Adams says last year they had a paramedic certification which educated already working EMTs.
“It was a net gain of nothing,” he says.
Madden, from the Michigan Association of Ambulance Services, says in rural areas you have to recruit in the community. In many places that means driving two or more hours for a class.
It’s definitely limited their hiring pool, MacDonald says.
His company, Mobile Medical Response, wants to start an education program in northwest lower Michigan, but he says it’s been hard to invest since recent changes to EMS certification in Michigan increased costs.
Right now, the Michigan Association of Ambulance Services and the Michigan Association of Fire Chiefs are asking the state for help.
They want $5 million to boost training programs and $10 million annually to increase EMS salaries and purchase equipment upgrades.
Madden says she’s heard positive feedback from legislators.
But Adams isn’t holding his breath.
“The only thing that they’re going to do to improve this is they’re going to pull medics out of Benzie County or Kalkaska,” he says. “All we are going to do is shuffle pieces on the board. We’re not going to change anything.”
Adams and other EMS workers say because they aren’t visible to the public like firefighters and police officers, they’ll continue to be overlooked until ambulances stop showing up.
