Hospital-at-home and other home-based care programs have turned paramedics into hot commodities for health systems and ignited competition for their skills.
Hospitals systems including Geisinger Health System, Allina Health and Sanford Health, in addition to home-based care providers WellBe Senior Medical, DispatchHealth and myLaurel are deploying paramedics into patients' homes to provide certain medical services that would otherwise be provided by registered nurses. Paramedics have skills similar to nurses and are less costly. But increased demand for their services from fire departments, emergency medical systems and healthcare providers is exacerbating a national shortage.
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Paramedics typically start as emergency medical technicians who receive additional training that allows them to perform care beyond basic lifesaving and transportation services. For example, they can administer oral and intravenous medications, as well as clear and open patient airways. Community paramedics receive even more training that allows them to provide services such as primary care, chronic disease management and post-hospital follow-ups.
Their training and experience with patients in the community make both paramedics and community paramedics ideal for hospital-at-home and other home-based medical services, according to Susan Jarvis, chief operating officer of Sanford Fargo and Health Network North.
Jarvis said the Sioux Falls, South Dakota-based health system uses community paramedics and nurses to provide twice daily visits to patients enrolled in the hospital-at-home program it launched in December based at a medical center in Fargo, North Dakota.
Sanford tapped four community paramedics from the emergency medical service the health system owns and operates in Fargo to work in the hospital-at-home program, Jarvis said. The service employs more than 200 EMTs, paramedics and community paramedics who provide emergency services, transportation and community healthcare in eastern North Dakota.
Jarvis said paramedics were a lynchpin for the hospital-at-home program, which operates in a rural area where registered nurses are scarce.
“I don’t know if we would have been able to start [hospital-at-home] when we did without using paramedics,” she said. “Getting staffed up was the thing that took us the longest with launching hospital-at-home.”
WellBe Senior Medical is also using paramedics to provide urgent care in most of the nine states where it offers home-based health services to older adults through partnerships with health plans, Chief Medical Officer Dr. Iyad Houshan said.
Chicago-based WellBe uses registered nurses for scheduled health assessments and wellness visits, while community paramedics respond to unscheduled urgent calls. The company provides urgent care through a joint venture with emergency care provider QuikMedic, which employs the paramedics, Houshan said.
“With the community paramedics, we can care for patients 24/7, with a turnaround time as short as 30 minutes,” he said.
Demand for community paramedics has been on the rise over the past decade as the pool of registered nurses has gotten tighter, said Lori Burns, vice president of learning for Global Medical Response. The Greenwood Village, Colorado-based company employs about 35,000 EMTs, paramedics and nurses who provide services to health systems, fire departments and emergency medical systems across the country.
Paramedics are also in high demand because they cost less than nurses. They make a median annual salary of approximately $53,000 compared with registered nurses who make an annual median salary of about $86,000, according to the most recent Labor Department data.
But demand for paramedics is starting to strain the supply, creating competition for those workers.
The Labor Department estimates there are approximately 270,000 paramedics and EMTs compared with about 3 million registered nurses. But the National Registry of Emergency Medical Technicians, which certifies EMTs and paramedics, puts their numbers at more than 500,000. A spokesperson for the organization said the government might not be counting all of the workers employed outside of emergency medical services.
Either way, the shortage of paramedics is real, said Andy Gienapp, executive director of the National Association of State EMS Officials. He thinks the problem is getting worse as more employers want to hire them.
“Anecdotally, there are enough employers who are reporting that they are having a lot of trouble recruiting and retaining folks,” Gienapp said. "Where there is smoke, there is fire.”
Training more paramedics is part of the answer, but it can exacerbate worker shortages when EMTs go back to school to become paramedics.
Geisinger Health System is recruiting paramedics for its hospital-at-home and longitudinal care program from an emergency medical service, or EMS, system it operates in parts of Pennsylvania, said Dr. Douglas Kupas, medical director for Geisinger Mobile Integrated Healthcare.
Kupas said the Danville, Pennsylvania-based health system typically trains EMTs to become community paramedics, but the training can take time and robs the EMS system of staff.
“We put those EMTs out of service for about a year to become a paramedic,” Kupas said. “In the long run that will help us, but in the short run we have to work through promoting people to become an EMT and take them offline for a year.”
Global Medical Response is stepping up recruitment and training efforts as the paramedic shortage grows, said James Menar, recruitment director at Global Medical Response. The company operates its own training program and Menar said he has been pounding the pavement trying to recruit people to become EMTs and paramedics.
“We are meeting with local colleges, even high school students who are in emergency medical response programs that are gearing them up to be first responders,” Menar said. “We connect with them at the junior or senior level to let them know about opportunities and help push them through our own program as well.”
Sanford Health is also visiting high schools and community colleges to recruit students for its EMT and paramedic training programs, Jarvis said. She said beefing up the paramedic pipeline is crucial as the health system looks to grow its hospital-at-home and community health programs.
Legislation introduced in the House of Representatives last month could help increase the pool of paramedics, but industry observers said it might not be enough. The Preserve Access to Rapid Ambulance Emergency Medical Treatment Act would establish a pilot program to award grants to EMS agencies to recruit and train EMTs and paramedics.
Gienapp thinks grants to fund training are a good idea. But he compared them to putting a bandage on a massive hemorrage as the shortage of EMTs and paramedics is so severe.
