There might simply be no quick fix to the EMS crisis, and we’re all at risk because of it.
We hear all the time about the shortage of EMS and other health care workers, and it’s a very real problem: the American Ambulance Association found that things are bad, and getting worse: EMS agencies report 30% of full-time paramedic positions, and 39% of part-time EMT positions open, while the National Center for Health Workforce Analysis projects that by 2025 there will be a shortage of 78,610 full-time RNs. This labor constraint was certainly exacerbated by Covid, but underlying demographic trends would have created a shortage with or without the pandemic.
According to the US Census bureau, the US population increased by 7.12% during the period 2010-2020, but the population over 65 shot up by 38%, from 40 million people to around 55 million. In the same decade, the population aged 18-49 barely budged, from 135 million to 139 million, or less than 3%. The economy’s worker to retiree ratio is rapidly and dramatically going out of balance, straining an insufficient labor supply, leading to understaffed industries everywhere.
Although all sectors of the economy feel the strain from a lack of available workers, the aging population presents challenges that are unique to EMS & healthcare: According to the US Labor Department, the average EMT age is 29.7, so the aforementioned under 50 cohort makes up the overwhelming majority of the EMS workforce, and also represents the future EMS labor supply. According to the National Center for Health Statistics, not only were there 43 ED visits per 100 persons in the over 60 age category, the percentage of visits by ambulance increases with age. Also, roughly 11% of those over 65 stayed at least 1 night in the hospital in the last year. This growing segment of the population has an outsized demand for EMS and healthcare services. Simply put, there just aren’t enough working-age people to keep up with the healthcare needs of a growing retirement-age population.
Moreover, worker shortages affect first responders beyond EMS and health care: For instance, Dallas police response times have increased due to officer shortages, a lack of available volunteers has forced the closure of fire stations in New Jersey and elsewhere, and according to the American Lifeguard Association, a third of the nation’s pools are impacted by a lifeguard shortage. As these other industries struggle to find personnel, they’ll be competing with EMS for a shrinking pool of talent, while EMS remains perhaps the first responder service most affected by the aging population.
This demographic issue is not unique to the United States: Great Britain’s health service has 111,000 open positions, according to a Kind’s Fund analysis of NHS data; Institut Montaigne reports that France is short 12,000 doctors and 50,000 nurses; and Australia will be short an estimated 100,000 nurses by 2025, according to Health Workforce Australia.
The proposed solutions to this crisis often focus on increasing pay and amplifying recruiting, but the root-cause demographic trends do not favor a quick resolution. Population forecasts for the next few decades show the trend continuing: According to the census bureau, the population over 65 is set to grow to 78 million by 2040. This represents a 42% increase for this age group over the 2020 figure.
Demographic trends affecting the supply (workers) and demand (consumers) for EMS services will not be changing – America will be getting older before it gets younger.
In the near term, employer-specific pay incentive and recruiting drives may strain resources without yielding net growth in the EMS workforce, given the unique physical and emotional demands put on first responders.
Long term, our society will have to recognize the challenge and instill values that encourage the workforce joining age population to see EMS careers as viable, respected, and fulfilling.
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