Thoughts on EMS Fellowship/Medical Direction?

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Apr 25, 2023
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Hello all,

Just posting out of curiosity since I haven't seen much discussion about this subsection of EM. What are some of your thoughts on going down the EMS/Medical Director route? Is it something you see as only viable at academic centers? Is focusing on that even viable based on the job market trends or do you think it will be just an additional set of responsibilities with little extra benefit?

Your insight is appreciated by this pre-med applicant :)

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There are relatively few EMS medical directors open at any point in time. You could find some here/there in community programs. Academic /city positions are almost never available.

It pays very little to do this. You should do it if this an interest for you that would make you feel fulfilled in doing it. Otherwise it does not add much
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Depends why you want to do it. You'll make more money doing regular old shift work. If you want to be a medical director of a large system then you'll likely need the fellowship in this day and age. If you're more interested in a smaller or rural system then you likely won't need the fellowship.
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I have no experience on this topic beyond chiding an old residency buddy of mine who wanted to do this.

I would say: "Bro, just admit that you wanna 'play fire truck' and get on with it."

I have no valid criticisms, but it was a good joke.
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I'm a current medical director for a rural agency and negotiating with another one. The best way I can answer is: it depends.

I was a medic for 15+ years before going to medical school and worked on the truck, and as an EMS candidate examiner for the state while in medical school. EMS medical direction was something I was always going to do. Since I was a non-traditional student and needed to work straight out of residency, I didn't do a fellowship, plus, I figured it would have little benefit to me.

The overwhelming majority of medical director spots are part-time, additional responsibility with little benefit. Every now and then, big agencies like LAFD, Washington DC, Seattle, Las Vegas, etc. will have openings, those are full time spots with the commensurate pay, but there is a narrow candidate pool of "big name" EMS docs they're likely looking at. They'll definitely need someone fellowship trained.

Community jobs are usually word-of-mouth. The crews get to know you and if one opens up, they'll ask you. I found mine on an EMS physicians facebook group. I get paid decently, enough to pay my EMS malpractice, and my gas money to and from the station. I'm in the office a couple of times a month, QA/QI certain runs, jump on the ambulance/run a chase truck, and available by phone or radio. I'm working on new protocols right now.

Ultimately; Community jobs are there, they're more for if you enjoy EMS and want to make a difference in the quality of prehospital care in your community. Big city/academic area-you'll need fellowship. Feel free to PM me for further info
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Fwiw I think this community overstates the difficulty of getting desirable jobs after EM fellowships. The few people I know who did EMS are directors or director adjacent at EMS agencies in major desirable cities. Same for the tox people I know - all got jobs with poison control or cush academic tox gigs. And this wasn’t from a powerhouse residency.
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EMS fellowship can open doors. You may have difficulty getting an academic position at a residency program (there's competition for them), but there are plenty of opportunities in the community as a full-time medical director. These positions are starting to open up more. I am aware of one EMS physician who works full-time for a fire department making $285k/year and another at a fire department making $335k/year. Both work 4 days/week and are on call 24/7, but rarely get called. It's a desk job. The benefit of doing a fellowship is if you get burned out or tired of working in the ER when you get older, there is always something non-clinical that you can pursue.

I have given a verbal commitment to go to work full-time for my department if the position is approved (they are pushing it for next budget year, but it has to be formally approved by the Board of Commissioners since it's a full-time position with benefits including retirement benefits).
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