Workforce in Flux: Plunging Numbers Raise Alarm in Minn.

Star Tribune

Many Minnesota ambulance services are struggling to respond to emergency calls as workers leave the field in pursuit of better pay and working conditions.

The exodus comes as demand for emergency medical services is increasing statewide, not only from heart attacks, strokes and car accidents but also patient transfers from hospital to hospital because of crowded conditions caused by COVID-19.

"I've never seen so many workers leave the EMS field," said Buck McAlpin a lobbyist for the Minnesota Ambulance Association. "It is alarming."

Nearly 60% of the state's 10,465 certified emergency medical technicians did not provide patient care in 2021, suggesting they left the workforce altogether, according to state data.

Minnesota also has 3,730 paramedics, who require more training and tend to earn higher wages, but 15% of them show no record of working in the EMS field last year.

And more than 1,500 emergency professionals have given up their certification altogether, a quit rate that is higher than before the pandemic.

The industry and the Emergency Medical Services Regulatory Board are asking the Minnesota Legislature to temporarily waive some regulations — such as requiring certified professionals to drive ambulances or allowing some equipment to be used past expiration dates — to free up some staff time. The board would need to be review and approve each change.

Demanding Work, Little Pay

EMS staffing shortages are common throughout the nation, and rural ambulance services have faced challenges for years. But the COVID-19 pandemic has made the job more difficult, while the changing economy means low-paid emergency workers can earn more in other jobs.

"People are saying, 'I'd like to do this, but I can't do this and pay my bills,'" said Virginia Fire Chief Allen Lewis, who oversees the ambulance service in Virginia, Minn. "They will no longer be satisfied to work for what are essentially fast-food wages."

The job is also demanding, requiring long shifts, night work, on-call work and shifts on holidays.

Perham Area EMS has two paramedic positions open but hasn't received any applications, director Jim Rieber said.

"We've seen a huge decline of people even going into the field right now," Rieber said. "The training costs for some are unbearable."

Perham has offered to pay the $18,000 training costs for new paramedics, but only one person has taken advantage of the program. Another is considering it.

Two of the service's employees are studying for nursing school instead.

"There's a pretty big pay disparity between paramedics and nursing," he said. "They will walk out of the door after being in the field 10 years and get a $15-an-hour pay increase, at a minimum."

COVID-19 has worn down the resilience of many health care workers, including EMS providers, who on nearly every shift interact with people who might be unvaccinated or not wearing masks in homes, businesses and other settings.

"People are stressed at all levels of caregivers," said Jeff Czyson, director of workforce for Allina Health EMS. "We've been in this for two years. There is so much fatigue."

Allina has been trying to support its 716 workers with therapy dogs, chaplains and an employee assistance program. Although it hired a record 149 new employees last year, 150 left.

"We set records with our hiring to basically break even," he said. Although Allina has 300 paramedics, it would like 350 to make scheduling easier.

"If we have a reduced workforce, you start to see some delays in response time," Czyson said. "We are not getting as quickly to some places that we should."

Some ambulance services are facing financial problems, especially in rural Minnesota, which relies on volunteers. Several have closed in the past few years, and some are considering it.

"We are starting to see communities make choices, and there's communities right now taking a good look at their services to try to figure out what to do," said Mark Jones, executive director of the Minnesota Rural Health Association.

"When 9-1-1 is called, I am very confident that at some point an ambulance will get there," he said. "The concern is whether the rural ambulance services are able to answer the call in a timely manner."

Volunteers Are Harder to Find

Apart from not having the money to pay salaries that would attract new EMS workers, many small ambulance services are losing volunteers, who traditionally have been the backbone of emergency response in rural Minnesota.

"We are asking people to do this on top of their real jobs for minimal to no pay," said Ann Jenson, executive director of the Southwest Minnesota EMS Corp., which provides support services to first responder agencies in 18 counties.

"We are at a point where people don't volunteer anymore," she said. "Nobody is going to sit around their house for $2 a hour in case their pager goes off."

Still, some do, including Jenson, who volunteers for the Dawson Ambulance Services.

In the past eight years, five ambulance services have shut down in her region, and two more are considering it. When that happens, the territories are assigned to other agencies, which might also be stretched. Sometimes only emergency medical responders, who receive a minimal amount of training, are available.

Many emergency medical responders arrive on the scene in personal vehicles with a defibrillator and some bandaging. They can assess the situation and call an ambulance, but the wait is typically longer for an ambulance to arrive.

"They really are just grasping at straws to keep going," Jenson said. "They have done great things to hold on and keep ambulance services open, so it is not for a lack of trying, but it is just that you have to have people."