EMS Medical Directors

[Ibuprofen]

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I'm curious....are there any medical directors for EMS agencies on this board.

I'm going through paramedic school with the intent to go to medical school as well. I'm thinking about possibly EM and serving as a MD for an agency.

I'm just curious....what do you guys do? Is it lots of administrative stuff? Paperwork? Do you give in house education? Are you there for questions? Can you go out on calls with the medics if you want to? If you don't mind me asking, what is the size of your service and do you get paid for administering medical control?

What is the nature of the beast?!

 

[docB]

I'm the asst. director for a large private EMS service. ~800 employees, ~200K calls per year.

Yes, lots of "administrative stuff" if by that you mean meetings, QA/QC, policy and protocol revisions, etc. Yes you can ride when you have time. Yes you can and should do in house education. You also supervise all the currencies, merit badges and have to sign all the recert apps.

The pay is negligible. You better love it 'cause you lose money doing it.

One thing to keep in mind. You get into this because you want to work closely with the highly motivated, studious, professional people who do great work and dazzle everyone. You wind up working primarily with the less motivated, marginally competent people who need more hand holding and direction. That's a minus. Then when things really come off the tracks you are involved in disciplining and firing them. That downright sucks. But that's a part (a big part, not the majority, but still a big part) of the job.

 

[southerndoc]

I'm medical director of a suburban county-based EMS service, a private paramedic program, and a state college paramedic program. It's lots of meetings, QA, training, and yes, I ride on the trucks frequently. Pay is pretty decent for me, but nowhere near EM clinical pay.

 

[OCDEMS]

For those of you who are former paramedics, when you operate in the field do you return to the paramedic level or continue to function with your full scope of practice?

I ask this because in my area we hear constantly from our EM physicians that it's impossible to function because of malpractice concerns. Basically, the argument is that society...ahem lawyers...will hold them to the standard of their education but that the hospital malpractice insurance doesn't cover them outside of the hospital environment. I've heard of physicians in our state who basically return to their paramedic scope of practice, complete with consultation, when they ride (if they ride in a system for which they are not the actual medical director).

What do you think of the EMS subspecialty? As a soon-to-be M1 and paramedic, EM will probably remain high on my list of specialities as I navigate medical school. Echoing docB's comments, several EM docs have told me that being a medical director is generally a hobby; an expensive hobby that often takes more than is given back.

How many positions have shared clinical arrangements as part of a full-time position or is this pretty rare?

 

[Ibuprofen]

I'm the asst. director for a large private EMS service. ~800 employees, ~200K calls per year.

Yes, lots of "administrative stuff" if by that you mean meetings, QA/QC, policy and protocol revisions, etc. Yes you can ride when you have time. Yes you can and should do in house education. You also supervise all the currencies, merit badges and have to sign all the recert apps.

The pay is negligible. You better love it 'cause you lose money doing it.

One thing to keep in mind. You get into this because you want to work closely with the highly motivated, studious, professional people who do great work and dazzle everyone. You wind up working primarily with the less motivated, marginally competent people who need more hand holding and direction. That's a minus. Then when things really come off the tracks you are involved in disciplining and firing them. That downright sucks. But that's a part (a big part, not the majority, but still a big part) of the job.

I generally expected that, I can't really see EMS being able to support a nice physicians pay haha.

But I was thinking that it could be something I do maybe a few days a week along with my regular ER gig (if I ever get that far).

I'm just curious as how it all goes.

 

[southerndoc]

I have my own EMS malpractice insurance as my employer's insurance will not cover any EMS medical direction (since the agencies are not contracted with my employer; they are contracted with me directly).

I function as a physician, but I don't carry any additional equipment. So in essence I function as a paramedic. I don't have a scapel that I carry around to do a cric. I've thought of carrying succinylcholine when I'm on the trucks, but the need to use it would be few and far between considering I only ride on the ambulance once/month (lately not in the past few months thanks to work schedule and personal schedule).

 

[DrMom]

I'm a director for a small, rural city-owned EMS service. I definitely lose money on the deal (annual pay is basically what I make in 1.5 shifts in the ED) but I enjoy it. I do plenty of paperwork and do in-house training. I, too, have a separate liability policy provided by the city. In theory I'm available to the service 24-7 if there's an urgent problem, but it hasn't been an issue so far.

 

[DoctorMedic]

I'm not a medical director but I am a former (technically current) medic and starting PGY-1 with intentions to go into EMS Medical Direction and EM. Can't comment on pay but after spending a month doing an EMS rotation with an EMS Fellowship you would need your own insurance. There are quite a few places that offer EMS medical insurance now. Also some places (where I rotated) they have EMS Physician response vehicles. All the Director kept was some o2, monitor, glucose, narcan, and succs/etomidate/rok. He basically only used what the medics carried and every Friday he would just do calls with them. Never uses his lights unless it's an arrest or something he really wants to see his crews work. He very much sits back and just observes, lends a hand if needed and chats w the crews. Overall something I would definitely want to emulate in my practice. The rest of the week is usually administrative, meetings, training, and SOP stuff. Hope this fills you in.

 

[joeDO2]

every Friday he would just do calls with them. Never uses his lights unless it's an arrest or something he really wants to see his crews work. He very much sits back and just observes, lends a hand if needed and chats w the crews. Overall something I would definitely want to emulate in my practice. The rest of the week is usually administrative, meetings, training, and SOP stuff. Hope this fills you in.

outstanding. we need more like him. too many just sign paperwork without any real involvement.

 

[CraftyMed]

We have an EMS division at my hospital where the agencies can contract with the hospital. As a result, our malpractice is covered thru the hospital. We'll hop calls when it sounds like something fun, interesting, or that they might need an extra hand. Otherwise, it's administrative: QI/QA, training, chart review, annual skills testing, discipline, etc. Each agency contracts a specific minimum of hours/month. Some require 32hrs/month of onsite time, others only want 1hr/month (i.e. basic transport companies that need AED sign off).

 

[Ibuprofen]

So for most of you guys is it primarily a part time gig, maybe 10-20 hrs/week? So if you wanted to you could hold down a full time clinical job and then work EMS on the side?

 

[EM_Rebuilder]

So for most of you guys is it primarily a part time gig, maybe 10-20 hrs/week? So if you wanted to you could hold down a full time clinical job and then work EMS on the side?

I am the director of a 41K/year call volume service. My 'contract' says I should spend 24 hours/month with the service. In reality, I spend 60-80+ hours/month. I have taken a significant pay cut to do this. I decreased my shifts by 3-4 12 hours shifts, but do not make that up in 'admin pay'.

Some EMS directors get paid well/fairly for their work, others have a VERY hard time convincing administration or their city that the pay should be more.

It is fun and exciting; medics are a good group to work with and I have found other EMS directors to be VERY helpful as far as open to being contacted for any questions I have since I am new to this. 80% of the job is politics; there are hospital politics, within the department politics, and municipal politics. The medicine is actually a small part of what we (at least I) do...

 

[Ibuprofen]

I am the director of a 41K/year call volume service. My 'contract' says I should spend 24 hours/month with the service. In reality, I spend 60-80+ hours/month. I have taken a significant pay cut to do this. I decreased my shifts by 3-4 12 hours shifts, but do not make that up in 'admin pay'.

Some EMS directors get paid well/fairly for their work, others have a VERY hard time convincing administration or their city that the pay should be more.

It is fun and exciting; medics are a good group to work with and I have found other EMS directors to be VERY helpful as far as open to being contacted for any questions I have since I am new to this. 80% of the job is politics; there are hospital politics, within the department politics, and municipal politics. The medicine is actually a small part of what we (at least I) do...

Well that's promising...but kinda expected. 😀 Thanks for the input!

 

[docB]

So for most of you guys is it primarily a part time gig, maybe 10-20 hrs/week? So if you wanted to you could hold down a full time clinical job and then work EMS on the side?

Pretty much everyone has to work clinical shifts, either part or full time. You have to do that to keep your board cert.

I get paid about the same as DrMom. I make what I could make doing 3 or 4 clinical shifts in a year. I think the main purpose of the pay in many cases is to establish a legal relationship more than anything else.

 

[southerndoc]

Pretty much everyone has to work clinical shifts, either part or full time. You have to do that to keep your board cert.

I get paid about the same as DrMom. I make what I could make doing 3 or 4 clinical shifts in a year. I think the main purpose of the pay in many cases is to establish a legal relationship more than anything else.

In Georgia, if you aren't paid you are protected by the state as a Good Samaritan for medical direction. I often times wonder if it would be better to do the work pro bono, but the EMS agency also pays for my malpractice insurance.

 

[docB]

In Georgia, if you aren't paid you are protected by the state as a Good Samaritan for medical direction. I often times wonder if it would be better to do the work pro bono, but the EMS agency also pays for my malpractice insurance.

Interesting. Here, you are considered to have The Duty paid or not. The pay just firms up your role in the event of labor allegations, ability to go onto hospital property when you're not privileged there, etc.