Full time EMS medical directors are a rarity. GOOD full time EMS medical directors are probably even more so. Most medical directors are pretty much part time employees. Some do it in addition to their regular Emergency Medicine jobs. Some do it for little or no money because they think EMS is valuable to the public and the medical community. Some medical directors (one is too many) are little more than signatures on some forms in exchange for a check. They don’t know their medics on a personal basis and their medics wouldn’t know them if they tripped over them.
Good medical directors make an effort to know their medics, the system protocols, help develop new protocols, take part in rounds, and ensure quality of care. Their medics know them and have probably met them in person. The problem is that to do that effectively, especially in a bigger EMS system, is a full time job. Which many, if not most systems, can’t afford to pay for.
Complicating this is the bewildering variety of EMS system designs. I won’t go into the different kinds, but a friend of mine who’s studied the subject says that there are more than forty distinct models of EMS system in use in the US and Canada. The role of the medical director in those systems ranges from the fore mentioned signature/check model to full time medical director is who also the system CEO. And everything in between.
Which is why there are so few good medical directors around. It’s a specialty within a specialty. Not everyone in Emergency Medicine is involved in EMS and not everyone in EMS is qualified to or wants to be a medical director.
The medical director not only has to deal with the medical issues, often he has to deal with the inherent conflicts between the clinical side of EMS and the business side. Then there are the external conflicts between the EMS system and the hospitals that they transport to. EMS system protocols rarely match Emergency Department protocols, which causes some conflict. It just goes on and on from there. So, the medical director will have to be part doctor, part manager, and part politician. It’s the rare person who can do all three well.
I once had a medical director who wasn’t particularly good at any of the three and yet he hung in for almost seven years. It was the politics part that finally caused his demise. If not for his embarrassing a very powerful politician in public it’s likely that he’d be foisting his mediocrity upon us to this day. That probably happens more than we in EMS notice under normal circumstances.
If you need proof of that, look at the medical director for Washington DC Fire/EMS. They’ve had something like five in four years. There’s a job whose tenure is measured with a stop watch, not a calendar.
It seems that anyone smart enough to be an EMS medical director is also too smart to want to BE an EMS medical director. Which is probably why good EMS medical directors seem to be a rare breed.