Hospitals too busy to train Minnesota paramedic students, exacerbating shortage

Rob Simonson lives minutes from a dozen Twin Cities emergency rooms that could provide the real-life experiences he needs to graduate from Anoka Technical College as a licensed paramedic, but few hospitals are opening their doors to him or his classmates.

Instead, the 27-year-old recently missed work and drove an hour north to Welia Health in Mora to observe overnight shifts at the rural hospital. He is lucky. Four classmates need 16 ER shifts to graduate this spring, but local hospitals have offered only six.

"How the heck are we going to get all that done?" he said. "The math isn't mathing."

Since the COVID-19 pandemic, Twin Cities hospitals have cut training opportunities for paramedic students, delaying their education because they can't graduate without observing medical situations such as childbirths, strokes, drug overdoses and asthma attacks. Hospital leaders said they have lost the manpower to supervise these students on a voluntary basis, but college instructors countered that they are contributing to Minnesota's worsening shortage of ambulance crews.

"It seems like paramedic students have been pushed to the side," said Benjamin Feldkamp, an emergency medical services instructor at Inver Hills Community College. "Places that were open to us no longer wanted to make room for us."

Paramedics are a step beyond emergency medical technicians (EMTs), capable of intubating patients who are struggling to breathe, administering emergency medications and interpreting heart monitors at emergency scenes. To reach that level, students must take courses at accredited programs such as Anoka and Inver Hills, and gain first-hand exposure to a checklist of pediatric, adult and geriatric medical emergencies.

Some requirements are almost impossible to meet without access to hospitals, because students can't count on observing certain medical events just by tagging along on ambulances, Feldkamp said. "Some medics spend an entire career without seeing a live childbirth."

Hospitals helped paramedic students in the past, even though they weren't paid for it and were busy training their own nurses and caregivers and making sure they were ready to treat patients. Turnover and staffing shortages increased during the pandemic, though, leaving hospitals with more new workers to train in and fewer veteran workers to do the training.

"In the past, the hospital systems have been good players," said Jeff Morgan, associate director of Anoka's paramedic program. But he said he hasn't been able to send any students since the pandemic into the trauma centers at North Memorial in Robbinsdale or Regions Hospital in St. Paul. Students also must observe pediatric care, making the lack of hours at Children's Minnesota problematic, he added.

Morgan said he asked Allina Health for 10 students to receive 800 hours of training in the ER at United Hospital in St. Paul this summer. The request would have attached a student to a nurse for 1% of the ER's shifts, but Allina declined. Hours at Abbott Northwestern Hospital in Minneapolis and Mercy Hospital in Coon Rapids have been scarce as well.

Observation of real-life emergency medicine is vital for new first responders, said Jeff Czyson, workforce director for Allina's EMS department. National training standards loosened during the pandemic, allowing medics to graduate after observing simulated situations such as childbirths rather than real ones, and the difference in their readiness was noticeable, he said.

"There's a little more urgency when it's something real," he said.

Allina responded last year by adding two weeks of pre-training so that its newly hired EMTs could acclimate to the stress of emergency scenes if they hadn't faced it already. New paramedics don't receive that additional exposure because most already worked as EMTs, but Czyson said they still benefit from real-life training opportunities during college. He hoped Allina and others would be able to let more paramedic students back into their hospitals soon.

Allina is confronting its own shortage of ambulance crews by offering stipends to EMTs so they can afford to work part-time while pursuing paramedic education.

"All of us are short," he said. "Ask any ambulance service."

North Memorial in a statement said it remains "committed to supporting as many students as possible," but that staffing shortages have limited the paramedic students from 21 training programs that it rotates through its ER and operating rooms.

Burnout is causing paramedics to quit in their prime. More than half who allowed their certifications to expire last year were younger than 40, according to Minnesota's EMS licensing agency. Only 2,857 first-responders at all levels were newly certified last year, compared to 4,213 who let their state certifications lapse.

Lawmakers responded last year with $3 million to fund $5,000 scholarships for up to 600 paramedic students. That could increase enrollment at local colleges, starting this fall, but instructors said they won't be able to turn students out into the profession any faster unless hospitals increase their training opportunities.

Simonson was selling furniture when he sought a change and trained to become an EMT in 2022. The loosened standards during the pandemic made it easy, but he quickly realized he wanted to become a paramedic. Being an EMT "drives you insane," he said, on occasions when you know what patients need but don't have the licensed authority to provide it.

Simonson said he has been in enough metro emergency rooms to believe they could take more paramedic students. Many like him are EMTs, he said, and could help nurses rather than slow them down.

"I get that they're busy," he said of local ERs. "But the more hands you have to do things, the more it frees up your nurses."