A statewide shortage of emergency medical responders is putting the squeeze on smaller, rural ambulance services, and Nashville is feeling the pinch.
Castleton Maple Grove Nashville Emergency Medical Service Director Mel Oakley said he is losing staff to other agencies, and even other industries, and is struggling to fill shifts.
The service had four days last month in which they were unable to have minimum staff coverage of one emergency medical technician and one paramedic on a shift.
On Tuesday, one of Oakley's employees finished a 72-hour shift to help cover for the lost staff, while another closed out a 60-hour shift.
“We’re staying open right now on the backs of staff who are picking shifts that they really shouldn’t be picking up,” Oakley told the Castleton Maple Grove Nashville EMS Board during a meeting Monday night. “The sacrifice being put in to keep our service open right now is significant - and it will run out.
“That well will run dry – or one of them will get hurt.”
The service covers nearly 10,000 people across Castleton, Maple Grove and Woodland Townships, and half of Kalamo Township in Eaton County. The
coverage includes the villages of Nashville and Woodland.
Because of the cost, the CMGN does not have full-time employees. It instead relies on part-time employees, all of whom work at other services, to pick up shifts for Nashville in between their regular EMS jobs.
But Oakley said that employment model is no longer able to sustain a sufficient workforce. Personnel are leaving for other opportunities that offer higher pay and benefits.
Nashville's service offers $11 an hour to EMTs and $13.50 an hour to paramedics – no benefits.
“Nobody wants to come talk to us,” Oakley told the board.
In the past year, the service has lost six employees who, Oakley said, covered most of the shifts.
“We are bleeding a slow bleed, but it's bright red,” he said.
One employee took a job as a security guard for a hospital, where they work fewer hours, have benefits and make more money than Oakley. Another employee left for a service in Lansing, where union rules prevent them from picking up shifts to help out in Nashville.
“We’re competing with places that pay enough that they can tell you what to do with your time off,” Oakley said.
To address the crisis, he said, the board will need to raise the hourly wage, create six full-time positions and offer those employees health insurance and paid sick leave. Several current or former employees would work full time under those conditions, Oakley said.
Board member Mike Trahan replied that they do not have the money for full-time employees.
“Then shut down,” Oakley said.
Other board members said they would talk to their respective township boards to try to come up with funding to alleviate the crisis.
“We cannot get people in the door for what we’re paying, for me that's just a fact of life, and we need to do something to keep it in service,” board vice-chairman Jeff Butler said. “We’re so far out of the ballpark right now, we’re thankful for the people that do come to work.”
Butler said he believed the residents of Maple Grove Township would be willing to vote for a millage increase if they understood the situation.
“There’s no way to double our number of calls; we’re just a very small community,” Butler said. “But we have chosen to provide advanced life support, and we’re going to have to fit the bill for it.”
The current millage – of a half mill in both townships – is not set to be renewed until next year. But board chairwoman Cheryl Hartwell said they will look for opportunities to go to voters, possibly in November, with a request for an increase.
However, Butler said, even if the townships put a request on the ballot now, they could not start collecting the additional money until December 2022.
Hartwell replied that the members would see what their township boards would be willing to do to help the problem now.
Butler said the Maple Grove Township board is aware of the crisis and is ready to do what it can to help.
Residents may remember the service faced a staffing shortage in early 2018, which was part of the reason the Barry County Medical Control Authority revoked the service's license for two weeks in January that year.
But Oakley said the service is not in danger of having its license revoked a second time. In addition to staffing issues, the MCA also listed a lack of communication, incomplete paperwork and administrative issues with the previous director of the service as the reasons for decision to remove the license in 2018.
Oakley said those other issues have long been solved and he has regular communication with Barry County Medical Control Authority Coordinator Dana Yarger.
Yarger attended Monday night's meeting and told the board she appreciated the conversation.
“I’m encouraged by the discussion, that makes me very happy,” Yarger said. “You’ve got an excellent ambulance service here.”
After the staffing crisis in 2018, the Castleton and Maple Grove Township boards agreed to pay $4,000 a year to help pay for hourly wage increases. The Village of Nashville also paid $4,000 over the course of a year toward the increases.
At the time, the service was paying EMTs $9.50 an hour and paramedics $12.
“That was the Band-Aid we applied at that point to get people to stick around, but it's not holding,” Oakley said, expressing skepticism that another hourly raise, without any benefits, would have much of an impact.
“That’s going to do nothing?” Trahan asked.
“Probably,” Oakley replied.
While CMGN EMS is the hardest hit service right now, other people in the industry say staffing shortages are all too familiar.
“It is a challenge – and it is not just Barry County. It's all over,” Thornapple Township Emergency Services Chief Randy Eaton said. “It's a smaller and smaller pool of candidates to pick from.”
Thornapple offers full-time positions with benefits and higher wages than Nashville, but still faces staffing issues.
“We struggle from time to time,” Eaton said. “Right now, we seem to be OK, but that could change in two weeks if we have a couple people say, 'Look, I've had enough.'”
When there are jobs in other fields available that require less education and provide higher starting wages, the competition becomes fierce.
EMS directors also find that some personnel frequently hop between different services, looking for better wages, benefits and hours.
According to the Michigan Department of Health and Human Services, the average EMT makes $30,000 a year, after six months of training, which costs about $2,250 to obtain. The average paramedic makes $39,000 a year after 21 months of training, which costs about $8,200.
Oakley said the staffing situation at Nashville has always been “tenuous,” but it has worsened in the past year, which may have been partly due to the pandemic. The extra stress of coming into contact with possible COVID-19 patients, and the added workload of preparing personal protective equipment and constant sanitization. may have made the job less appealing.
“EMS is a harder job today than it was two years ago,” he said.
But, even before the COVID-19 pandemic, the number of people interested in the industry has been dropping.
The Michigan Bureau of EMS, Trauma and Preparedness reported the number of students graduating from paramedic programs in the state fell from 1,200 people in 2016 to 250 in 2019.
“The pool of candidates is dropping, but the need is still there,” Eaton said.
“The state has to do something to make it easier to attract new EMTs and paramedics,” President and CEO of Mercy Ambulance Service Dennis Palmer said. Mercy serves multiple townships in Barry County, including the Hastings area.
Despite offering competitive wage packages, ranging from $42,000 to $62,000 a year along with benefits, for paramedics, Palmer said he's still short on staff.
At a certain point, Palmer said, it's no longer about the money – the personnel just aren't there.
Increased rules and regulations on staff have made the job more difficult, he said.
Plus, additional educational requirements have put the role of EMS in direct competition with other fields.
For example, when people see the requirements to become a paramedic, they may decide it doesn't take that much more work to become a registered nurse, Palmer said.
While Michigan previously had its own EMS personnel examination and licensing process, it is now part of the national registry, which Palmer said has been a setback for many people trying to enter the field.
“It's quite a hurdle to get over,” Joe Huebner agreed.
The human resources and continuous quality improvement director for Mercy Ambulance Service, Huebner has been a Barry County paramedic since 1988 and also serves an instructor with Kellogg Community College.
“I predicted a few years ago that we were going to see the staffing shortage. But the depth of it – I don't think anybody could see it coming,” Huebner said.
Many people only stay in the EMS business for five years before moving on to something else, he noted. The job can be a great way for people to explore the larger medical industry to find a field that suits them best.
But the people who have been in the industry for decades, like Huebner, are starting to age out, and there are fewer people to replace them.
“We just don't have the volume of students, and we're not seeing the applicants,” he said.
Even so, it's an immediate employment opportunity for people with the right training, offering plenty of open positions and room for advancement.
“To be able to make a difference right away, EMS is a great career,” Huebner said.