By Thomas Moore
“Too often we hold fast to the clichés of our forbearers. We enjoy the comfort of opinion without the discomfort of thought.”
That is what President John F. Kennedy said to a group of graduates in his Commencement Address at Yale University on June 11, 1962. When applying that logic to the prehospital care sector, ask yourself the question “How often do I really think about my agency’s relationship with our medical director?”
In the fast-paced, ever-evolving environment that is prehospital care, engagement can get lost in the day-to-day operations of an EMS system. Particularly, the level of engagement with one of the most pivotal positions in our industry – the EMS medical director – is negligible.
The role of the EMS medical director in a modern EMS system is defined by the American Board of Emergency Medicine thusly:
As part of their clinical practice, EMS physicians are responsible for medical oversight of the whole EMS team. EMS physician practice combines direct patient care in the field with supervisory and other functions that ensure an effectively functioning response system. This includes daily direct medical decision-making and control of care provided by EMS personnel. Some examples of this include verbal medical treatment orders based on clinical information provided by allied health personnel, transport modality and destination appropriate patient care decisions, developing and deploying written patient treatment guidelines for the EMS team, and ensuring procedural competency training of allied health personnel. EMS physicians also lead quality management activities relating to medical care delivered by the entire EMS system.
An EMS leader’s role is to engage the medical director in all facets of the EMS agency, not just in areas that involve EMS provider clinical competency or protocol development. Research indicates that highly engaged employees tend to be more productive; the same goes for EMS physicians. Investing in the medical director allows agencies to create a more engaged and aligned workforce. Here are seven ways to engage physician oversight in an EMS system.
1. Compensate as you would any other position
Ensuring the financial stability of providers is a hallmark of well-designed EMS systems, and one of those providers is the medical director. Many EMS agencies want to pay physicians for their physical time; however, most EMS medical directors make themselves available 24 hours a day, seven days a week, 365 days a year because of the number of patients being assessed and treated under their medical license. Further, most full-time medical director salaries are half of what a full-time emergency department physician would make in the same service area.
The bottom line: compensate the medical director the same you would other members of the staff. Conduct salary surveys, determine what the market value is for physicians in your area and pay accordingly.
2. Involve the medical director in strategic planning
Include the medical director in strategic planning sessions, capital and operational budgeting, and any administrative position changes. Encourage the medical director to develop and implement goals related to improving quality outcomes, maximizing financial strength, enhancing operational performance and improving patient satisfaction.
3. Involve the medical director in securing talent
Ask for input and actively involve the medical director when field training officer, line supervisor, communications supervisor, clinical education coordinator or other management positions become available. The medical director should be actively involved in human capital revisions of the EMS system.
4. Communicate early and often
When issues arise, the medical director should not be the last one to know about them. When an incident does occur, notify the medical director immediately. Establish a relationship that allows for regularly scheduled meetings to review progress in achieving goals; unresolved issues; and current operational, fiscal and clinical performance.
5. Involve the medical director in community outreach initiatives
Hands-Only CPR, FAST stroke recognition and Stop the Bleed training are just a few opportunities for medical directors to get involved in local community outreach initiatives. Every EMS leader should meet with the medical director and determine what opportunities are available for EMS system participants to work closely together to increase public education and awareness. Once determined, the leader needs to identify available resources, develop a program and implement focused outreach efforts.
6. Encourage growth and development
If not already involved, encourage and pay for the medical director to attend and participate in local, regional, state and national EMS meetings and conferences. These conferences offer the unique opportunity for medical directors to meet direct colleagues and collaborate on solutions and key areas of improvement in the industry.
Also, encourage (and pay for) the medical director to complete the medical director’s course offered by the National Association of EMS Physicians.
7. Make it fun
Being a medical director should involve more than signing off on new equipment and procedures, and protocol development. Ideas for other areas of medical director involvement include:
- Provide the medical director with a uniform and encourage him or her to ride along and respond to calls with EMS field crews.
- Host monthly case reviews where the medical director discusses a recent interesting case with the workforce.
- Dedicate a section of the monthly newsletter for the medical director and have him or her provide an article on relevant current events.
- Schedule a “breakfast with the doc” or similarly themed event monthly or quarterly, where staff can sit down, and share a meal and fellowship with the medical director.
Each of these examples provides an avenue for the medical director to interact with staff in a manner that doesn’t involve a lecture or a discipline-related discussion about medical care. Physicians are normal people too. When staff feel comfortable with the medical director, he or she feels comfortable with staff. Medical directors would much rather be a part of the team than the doctor in the corner.
About the author
Thomas Moore is an Associate with public safety consulting firm, Fitch & Associates. His current assignment is as EMS Director for the University Medical Center’s EMS program in Lubbock, Texas that is managed by the firm. He holds a Bachelor of Science Degree in Management from the University of Alabama at Birmingham and will complete his MBA at UAB in 2018. Contact him at tmoore@fitchassoc.com.
