Michigan EMS agencies are facing a continuing staffing crunch that has left rural communities without enough paramedics and emergency medical technicians, according to officials and advocates who described the problem as lingering since the start of the COVID-19 pandemic.
The crisis is taking shape as shrinking revenue pressures EMS agencies, with staffing costs identified as their top expense, even as the state has invested millions of dollars in grants to train workers. State Rep. Dave Prestin, R-Cedar River, who volunteers as a paramedic on a rescue squad covering 1,000 square miles in Michigan’s Upper Peninsula, said the persistence of volunteer help depends on public interest and willingness.
“The fact that they exist is only due to the need and the willingness of people to get involved in this line of work,” Prestin said, linking the current staffing reality to the continuing availability of volunteers in areas that cover large distances.
Prestin and other EMS advocates also pointed to how Michigan funds ambulance services. EMS is not treated as an “essential” service in Michigan—an approach described as common in most of the country by the National Conference of State Legislatures—so local governments can decide whether to fund their ambulances when money is discretionary.
At the same time, workforce data compiled by the Michigan Association of Ambulance Services indicates that the state has more than 29,000 EMS providers working across nearly 800 life support agencies, but the system still lacks capacity. Industry experts told reporters there are more than 500 vacancies for paramedics and EMTs.
The shortages are tied to recruitment and retention challenges, including compensation and burnout, according to the account. The field is described as notorious for burnout because paramedics and EMTs handle severe medical traumas and, in turn, face wages that are compared to fast-food workers. The Michigan Health Council also described the EMS workforce as among the most strained on labor-health measures, ranking EMTs as the “unhealthiest” medical technician profession in the state and citing low wages and high turnover.
In its assessment, the health council said paramedics—who receive more advanced training than EMTs—are the most paid medical technicians in Michigan, but it said they “barely” earn more than Michigan’s median hourly wage. The health council cited stress as a primary reason people leave both EMT and paramedic roles, and it said first responders face higher risk for suicide than the general population.
EMS training pipelines are also described as being affected by economic swings, with education investments rising when the “economy tumbles” and falling during booms. Angela Madden, executive director of the Michigan Association of Ambulance Services, said when job prospects with “decent pay” are readily available, potential recruits may choose jobs that start immediately rather than spending “money and time and energy” training as first responders.
In addition, EMS agency leaders described steady attrition as paramedics and EMTs quit for better pay, pursue nursing, move into other health care careers, or leave the field altogether. The Michigan Health Council workforce index showed the state had roughly 4,700 employed EMTs and 3,250 employed paramedics in 2024.
Some EMS agencies have started trying to address the shortages by building local training capacity, using state grant support and local funding measures. In St. Clair County, Tri-Hospital EMS has worked to recruit and retain first responders by integrating in-house training, with a scholarship program that covers tuition and provides a wage for enrollees while they take classes.
The training timeline and cost for EMTs and paramedics can also be major barriers for prospective recruits, and advocates said funding for education can determine whether people can pursue EMS roles. EMTs require several weeks of training, while paramedics can take anywhere from 10 to 14 months to get licensed. State lawmakers have also worked to lower the cost for accreditation exams, but courses can still cost thousands of dollars.
Cummings, who is cited in the account about Tri-Hospital EMS’s model, said people are not willing to pursue the training “just for the sake of going to school,” and he said recruits want clear outcomes. He said that if people take programs with the agency, they are “pretty much in line to be hired by us and work in the field and actually earn an income.”
Even where a recruitment model can be made to work in a county with more support, officials said the underlying shortages persist elsewhere. Cummings said other agencies across Michigan remain affected by ongoing staff vacancies that started 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.”