Understanding Rural Michigan’s EMS Staff Shortages

Stories about EMS staff shortages are nothing new in America. However, a March 31, 2026, post on cbsnews.com told a particularly grim story about the staff situation in rural Michigan. Under the headline, “Providers face 'extreme shortage' of paramedics, EMTs in rural Michigan,” CBS News reported that, “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.”

In a bid to see the story behind the headlines, EMS World contacted Angela Madden. She is executive director of the Michigan Association of Ambulance Services.

EMS World: What is the current state of paramedic and EMT shortages in rural Michigan?

Angela Madden: Following the COVID-19 pandemic, Michigan faced a statewide shortage of approximately 500 paramedics. While state tuition grants have successfully trained hundreds of new paramedics over the last three years, retaining them in rural and "super rural" areas remains a severe struggle. The remote nature of the work, lower call volumes, and long transport times make rural EMS a difficult job that isn't for everyone.

EMS World: What specific factors are preventing people from entering the field or causing them to leave?

Angela Madden: There are two main hurdles:

• Lack of Educational Access: There is a severe shortage of licensed instructor coordinators in northern Michigan and the Upper Peninsula. Additionally, it isn't cost-effective to run a paramedic course for only one to three interested students, so classes are frequently canceled, leaving willing candidates untrained.
• Job Demands: The physical and mental toll of long-distance transports — spending lengthy periods in the back of an ambulance with a patient — can be a major deterrent.

EMS World: EMS isn’t classified as an "essential service" in Michigan. Does this hurt retention, and are there efforts in motion to change it?

Angela Madden: The association is taking "baby steps" and having conversations with legislative leaders about essential service designation. However, because of how the legislation is currently written, it wouldn't actually mandate rural municipalities to provide EMS anyway. While it might help slightly, it’s not viewed as the magic bullet that would solve the crisis.

EMS World: What do you believe is the most effective solution to help agencies attract and retain staff?

Angela Madden: The most critical need is an increase in state Medicaid reimbursement rates. Current rates are frozen at the 2023 Medicare base rates, failing to account for the rising costs of equipment, readiness, and gasoline. Rural agencies rely heavily on public payers. Furthermore, as commercial health insurance shifts toward high-deductible plans, an ambulance trip often hits a patient's deductible immediately, essentially turning a commercially insured trip into a private-pay burden.

EMS World: How likely is it that the state legislature will increase these reimbursement rates?

Angela Madden: There is optimism. Over the last 12 to 18 months, the association has built strong relationships with lawmakers who are beginning to understand the financial strain on agencies. The immediate goal for the upcoming FY27 budget (due June 30) is to at least unpeg Medicaid reimbursements from the 2023 rates and match current Medicare rates. This boost would ideally be passed down to EMS workers in the form of higher wages and better benefits.