Paramedics and emergency medical technicians, or EMTs, face a harsh reality in Michigan — shrinking revenue has left emergency medical service agencies grappling with multiple financial issues at once, with staffing being their top expense.

Despite the state investing millions of dollars in grants to train workers, staff shortages that began at the onset of the COVID-19 pandemic continue to strain EMS agencies, especially in rural communities.

“The fact that they exist is only due to the need and the willingness of people to get involved in this line of work,” said state Rep. Dave Prestin, R-Cedar River, who volunteers as a paramedic on a rescue squad that covers 1,000 square miles of the Upper Peninsula.

EMS is not considered an “essential” service in Michigan, just like most of the country, according to the National Conference of State Legislatures. Without the designation, funding becomes discretionary — local governments have the option whether or not they want to fund their ambulances.

The state has more than 29,000 EMS providers working across nearly 800 life support agencies statewide, according to the Michigan Association of Ambulance Services. Industry experts say there are more than 500 vacancies for paramedics and EMTs.

Low wages, high turnover

The field is notorious for burnout. Paramedics and EMTs regularly handle the state’s worst medical traumas and receive wages similar to fast-food workers.

EMTs are considered to be in the “unhealthiest” medical technician profession in the state, by the Michigan Health Council, a health care research nonprofit — below dental hygienists, surgical technologists and occupational therapy assistants. The ranking reflects the profession’s low wages and high turnover rate.

The health council said paramedics, who receive more advanced training than EMTs and are ranked as the most paid medical technician, “barely” earn more than Michigan’s median hourly wage.

Stress is cited as a primary reason for leaving the profession for both EMTs and paramedics. First responders are at higher risk than the general population for suicide.

Time and energy

The training of EMTs and paramedics is tied to the boom and bust cycle of the economy, according to Angela Madden, executive director of the Michigan Association of Ambulance Services.

Investment in education goes up when the “economy tumbles,” she said, but in a boon, people are more likely to take an hourly job with decent pay that forgoes the extra effort — factory and restaurant workers can begin working immediately without spending “money and time and energy” training to be a first responder.

EMS agency leaders describe a steady attrition rate of paramedics and EMTs quitting for better pay, pursuing careers in nursing or as other health care professionals, if not leaving the field altogether.

The state had roughly 4,700 employed EMTs and 3,250 employed paramedics in 2024, according to a Michigan Health Council workforce index.

Going to work

Tri-Hospital EMS in St. Clair County has worked to address a lack of first responders in its communities by integrating its own in-house training through the support of state grants and local millages. The scholarship program covers tuition and provides a wage for enrollees to come to class.

Without outside support, those seeking careers in EMS are on their own to fund their education and find jobs.

EMTs require several weeks of training. Paramedics can take anywhere from 10 to 14 months to get licensed and state lawmakers have recently worked to lower the cost for accreditation exams. Courses can cost thousands of dollars.

Cummings said he learned that people are not willing to go through that first responder training “just for the sake of going to school” — they want clear outcomes.

“If you take one of our programs, you’re pretty much in line to be hired by us and work in the field and actually earn an income,” he said.

While Tri-Hospital EMS has developed a sustainable model of recruitment and retention in St. Clair County, Cummings said other agencies elsewhere in the state are still reeling from the ongoing staff vacancies that began in the years after the pandemic.

“There’s still a pretty extreme shortage of paramedics across the state of Michigan, in particular in the rural areas,” he said. “Those areas lack sufficient training programs in which to produce those paramedics. That’s one of the reasons why there’s such a shortage in the rural market.”

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This story was originally published by Bridge Michigan and distributed through a partnership with The Associated Press.