EMS Medical Direction

[EM Junkie]

I have a few questions for those who have EMS experience or experience with EMS Medical Direction.

I had about 5 years of EMS experience prior to medical school, and a friend of mine is starting a private EMS service and has asked me to serve as his medical director. The service would be mainly emergent and nonemergent transfers, special events, and dialysis. No 911 at first.

1. What salary should I ask for? I know of some docs doing public 911 EMS Medical Direction, but none doing private EMS. I assume that the salary should start low and increase as the service grows.

2. I have been offered the option to be part owner, and my ownership share would be my salary. The more money the service makes, the more I make. This sounds risky to me, and may increase my legal exposure. Any thoughts? Would you choose a straight salary or an ownership interest?

3. Any other thoughts or personal experiences would be appreciated! I can't moonlight just yet, so I have some time to research the issues.

Thanks in advance!

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[Apollyon]

I have a few questions for those who have EMS experience or experience with EMS Medical Direction.

I had about 5 years of EMS experience prior to medical school, and a friend of mine is starting a private EMS service and has asked me to serve as his medical director. The service would be mainly emergent and nonemergent transfers, special events, and dialysis. No 911 at first.

1. What salary should I ask for? I know of some docs doing public 911 EMS Medical Direction, but none doing private EMS. I assume that the salary should start low and increase as the service grows.

2. I have been offered the option to be part owner, and my ownership share would be my salary. The more money the service makes, the more I make. This sounds risky to me, and may increase my legal exposure. Any thoughts? Would you choose a straight salary or an ownership interest?

3. Any other thoughts or personal experiences would be appreciated! I can't moonlight just yet, so I have some time to research the issues.

Thanks in advance!

Good questions, and I don't have a lot of answers. One thing is the business end - talk to a business attorney, to see what you need to do to make it legal to own the business and be medical director. It may be nothing at all - there are hundreds (or thousands) of doctor's offices that have x-ray and lab in them, and the office owns the equipment and bills for all of it, and those multispecialty groups that have IM, cards, GI, gen surg, and vascular surg all in them, and refer between themselves, but also there's the question of kickbacks and collusion. So, as I say, not for the EMS/MD end of it, but for the strictly business, talk with a business/finance attorney.

As for the EMS end, check out http://www.naemsp.org/ - they have MORE than enough resources available.

Also, there are a large number of former EMS people here (docB - firefighter, Jeff698, southerndoc, me, others I've omitted simply by my error), and I am confident that they will sound off with much better advice than I've proffered.

edit: what I forgot was that the President of NAEMSP is one of the attendings where southerndoc is a resident, and one of the at-large members of the board is a woman that I worked with when we were paramedics!

 

[Haemr Head]

There are all sort of models and amounts out there. A lot depends on the work which in turn is often driven by specific state rules.

First thing to estimate is how many hours/week you will need to devote to teaching, QI, writing and reviewing protocols, and online medical direction.
Each of these will be driven by state regs, the vision of the company, and your own vision of the role of the medical director. Once you know the number of hours/week, figure out how much your time is worth for this sort of work and that is the best estimate.

Now if you go for ownership, you should expect to make less initially as you are getting the business started. It is riskier but the gain is much greater if the company succeeds. I don't think there is a conflict as you should be able to work for the EMS company that you own as medical director, but I agree that you want to confirm this with an outside opinion. As an owner, however, you cannot participate in hospital administration where the decision of which EMS providers will get the EMS contracts or even who the unit coordinator in the ED should call for the transfer. The interfacility transfers are where the $$s are made more than the 911 work in most places. If you are going for ownership, it is best to understand the market and why this company is going to be able to take business away from existing providers.

 

[southerndoc]

Keep in mind one thing: if you do this as a volunteer, you may have release of liability from lawsuits. This varies by state, and you should contact your state EMS coordinator for more information.

If you are paid, you will need malpractice insurance for sure. It might be that the increase in your malpractice premiums, if not paid for directly by the EMS agency, may be more than your salary and might be a reason to do this as a volunteer basis.

The NAEMSP was working on an insurance policy specifically for medical directors. I believe, although not 100%, that I read in a recent NAEMSP newsletter that they have secured an insurance company that will give policies to medical directors. I would check their website at www.naemsp.org for more information. Unfortunately, I do not have easy access to Dave Cone (NAEMSP president) right now (except email) to ask because I am out of the country.

 

[Jeff698]

If you choose not to become an owner, I'd offer an additional payment option. You can negotiate a specific amount per call. This helps the business as it starts out.

There are many start up costs for any small businesses. An EMS firm is very capital intensive and the company is likely to be stretched at first. They will also, if successful, find themselves with the challenge of how to up-size to meet a, hopefully, increasing demand.

Once the company reaches a growth plateau, you can switch to a more stable salary. The benefit to the company is obvious. The benefit to you is that you helps the company grow into something that can offer you a nice salary.

This certainly isn't the only option, but I just wanted to toss one more approach out there.

Take care,
Jeff

 

[docB]

Everyone has made some really good points. I echo the concern about liability. You need to know exactly what your insurance policy will cost and cover, does it have a tail? etc. All the same stuff for your regular med mal insurance. I've never been involved in buying, negoiating insurance for a new agency. I've just taken over existing positions so I can't offer a lot on that process.

For me the thing that consumes most of my time is administrative, bureaucratic stuff at least some of which will fall to you as the medical director. You have to know what agency certifies your personnel, your agency, your rigs, your equipment. You'll need to have a plan to deal with QA/QC issues, medication supply, recertifications, disciplinary actions against your medics and so on. These issues vary by state and municipality.

Your friend should be getting the agency set up for billing, HR, leases and so on but if your are part owner you may wind up dealing with some of that as well.

 

[Haemr Head]

Emergency Medicine - Saving the world from seeing its primary care doctor.

Personally I like
Emergency Medicine - Thriving through the work aversion of other specialties

 

[corpsmanUP]

Hey Junkie, aren't you still an intern? I have been the medical director of one of our local county EMS agencies now for a few months. It is a lot more work than I thought it would be simply because as a former paramedic, I knew what kind of director I wanted to be. I spend about 5-10 hours a week almost reviewing run reports and making comments. I want the medics to know what I think they could have done better or differently, and I also let them know when they do well. I spend one day a month with them at lunch having a staff meeting and doing a lecture. Because I only have a temporary resident license right now, one of my faculty docs does all the state paperwork for me to keep me legit. But in a couple of months I will have my permanent license and that will all change. The cool part is I think my department is still going to cover me for the malpractice end. I thought you were in Houston Junkie, right? Is there where the friend is opening a business? I have seen more services come and go in Houston and I don't recall one of them ever succeeding and not going belly up or being bought out. Just be careful! I would recommend straight salary per hour.

 

[Jeff698]

Personally I like
Emergency Medicine - Thriving through the work aversion of other specialties

Perfect! A new classic is born!

There is an amazing correlation between 4:45 and the explosion in our waiting room. I'm sure it's all just a coincidence and all the patients who say "my doctor told me to go to the ER because he couldn't see me" was pure artifact.

Take care,
Jeff

 

[Hallm_7]

2. I have been offered the option to be part owner, and my ownership share would be my salary. The more money the service makes, the more I make. This sounds risky to me, and may increase my legal exposure. Any thoughts? Would you choose a straight salary or an ownership interest?

You won't personally be held liable if you setup the correct business model. For example, corporations don't have personal liability although there is still corporate liability. There are several types of corporations that can be setup that will accomplish this for you and you will enjoy certain tax benefits as well. One type is called the Limited Liability Corporation (LLC) which is very common.

Before you decide anything you need to find an experienced corporate lawyer or accountant to guide you through this.

 

[Wackie]

Just my $.02...

All of the EMS med directors (grand total of three) I've known either don't get paid much for it or do it as a volunteer gig.

 

[EM Junkie]

Hey Junkie, aren't you still an intern? I have been the medical director of one of our local county EMS agencies now for a few months. It is a lot more work than I thought it would be simply because as a former paramedic, I knew what kind of director I wanted to be. I spend about 5-10 hours a week almost reviewing run reports and making comments. I want the medics to know what I think they could have done better or differently, and I also let them know when they do well. I spend one day a month with them at lunch having a staff meeting and doing a lecture. Because I only have a temporary resident license right now, one of my faculty docs does all the state paperwork for me to keep me legit. But in a couple of months I will have my permanent license and that will all change. The cool part is I think my department is still going to cover me for the malpractice end. I thought you were in Houston Junkie, right? Is there where the friend is opening a business? I have seen more services come and go in Houston and I don't recall one of them ever succeeding and not going belly up or being bought out. Just be careful! I would recommend straight salary per hour.

Yep, this would be once I was eligible to moonlight next year.

The proliferation of EMS services is why I am leaning towards a straight salary or a per call fee, not an ownership position.

 

[EM Junkie]

Just my $.02...

All of the EMS med directors (grand total of three) I've known either don't get paid much for it or do it as a volunteer gig.

I think that goes more for volunteer services or municipal 911 services. No way I'm doing it for free if they're making a profit on it. I would defnitely volunteer if the service was a volunteer 911 service, though!

 

[Wackie]

I think that goes more for volunteer services or municipal 911 services. No way I'm doing it for free if they're making a profit on it. I would defnitely volunteer if the service was a volunteer 911 service, though!

One of the EMS med directors I spoke of above works a big non-volunteer area including several cities. I asked him if he got paid much. He told they pay him so little, he considers it a community service he does and anything he gets from it is just a bonus. He still works full time in an ED.