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The Shortage of Paramedics

The Shortage of Paramedics

For many years, whenever someone talked about a “shortage” of paramedics, I would have a snarky reply.

“There is no shortage of paramedic. What there is a shortage of is paramedics that are willing to work for horrible wages, crappy benefits, and sit on street corners for hours between calls while having to ask for permission to drive half a block to use a convenience store rest room.”

For years, that was a true statement for EMTs and paramedics who worked for most private and some government operated EMS systems.

Lately though, there is indeed a shortage of paramedics and to a lesser extent EMTs.

Some of my clients are so short of paramedics that they will hire EMTs and pay for them to go to paramedic school. Others are hiring paramedics with no field experience, none, to work in busy 9-1-1 systems.

All of my client agencies are fire based. That means good pay, great benefits, a pension when you retire, and actual stations that the crews go back to between calls. Oh, did I mention that they are all union? Which means that providers have protection if they are accused of wrong doing.

Even if an applicant is already a paramedic, they still have to go to the fire academy. Which means that they get paid to go to school.

Despite that, agencies just can’t find enough qualified applicants to fill openings.

We can debate, and many have, whether or not fire departments should be providing ambulance transport and ALS services. That’s not today’s topic and the reality is that fire departments do provide those things.

I should mention that inexperienced paramedics are actually good for me and the work I do. The problem is, that I don’t know that it’s good for patient care.

Anyone who has spent any time in EMS knows that much of what we learn as providers comes after we’ve taken the course and passed the certification exams. You really only get good at EMSĀ  by doing calls. Lots of calls.

The problem also exists as the BLS level. One local service has applied to the state regulatory agency for authorization to staff some ambulances with one EMT and one First Responder. The First Responder would have first aid training and be restricted to driving. So, in reality, it would be an EMT and an Ambulance Driver.

I know that some states, particularly those that work in rural areas staff that way. This service is not one of them. They also pledge that they will only do this for transfers of non acute patients.

Being the cynical guy I am, I can only think that this is a foot in the door towards lowering staffing standards.

An a guess, and it’s just that, part of the problem is the economy. It’s roaring along right now and there are more jobs than people to fill them. Everywhere I go, I see “Help Wanted” signs. Some are for good jobs, some are for entry level jobs. No matter, those jobs compete with jobs in EMS for people to fill them.

Think about that for a minute. If you were job hunting and there were two jobs open One job involved working with sick or injured people, being away from home for long hours, including holidays and weekends, with not so great pay and benefits, and often having to work late. The other has the same pay, fixed hours, minimal or no weekend or holiday hours, and having a comfortable place to work. Which would you choose.

Back when EMS was new and exciting, many people went into the field out of a desire to help. Back then, we thought that EMS would get better, become a profession, and be respected by the public.

That doesn’t seem to be the case these days. More and more, EMS is a stepping stone to a “real” career. Some of those are in medicine, but many aren’t.

I don’t have any answers to this, but someone has to figure it out. If not, we’re going to end up back in the pre EMS days of minimally trained and experienced providers whose main job is to drive people to the hospital.

Without a solid base of trained and experienced providers, all the fancy and expensive equipment in the world is useless.

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After a long career as a field EMS provider, I'm now doing all that back office stuff I used to laugh at. Life is full of ironies, isn't it? I still live in the Northeast corner of the United States, although I hope to change that to another part of the country more in tune with my values and beliefs. I still write about EMS, but I'm adding more and more non EMS subject matter. Thanks for visiting.


  1. FWIW, my experience with this was that back in the 80’s it was reasonably easy to get started out, by signing up for EMT cert courses at a whim, without being employed. Once certified basic, you could then seek a position, and they would pay for further training.

    All that started to change in the 90’s, not only did the courses become much more expensive, but you needed either a job or an offer of employment just to sign up for the class. So by the time I was ready to begin my training there were just too many darn hoops to jump through.

    Thus, I ended up going in another direction. What a shame. From what I’ve heard, the situation has only gotten worse since then.

    • My guess is that might have been particular to your location. Around here, some companies have long offered EMT courses with an offer of employment at the end. No one yet, does that for paramedic programs, but I know of one fire department that hires people at the EMT level and then sends them to paramedic school.

      In my state, you do need to be employed by a police or fire department to go to the academy. I know that in other states, it’s the other way around. You can go through the academy and then look for a job as a fire fighter or police officer.

      I can’t say that one way or the other is better.

      Oh, there are also shortages of police officers and fire fighters, separate from the paramedic shortage.

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