dr-exmedic.com

When’s the last time you saw your medical director?

This isn’t an idle question.  According to a recent survey of Nationally Registered EMTs at all levels, two-thirds reported having “recent” contact with their medical director.  In this case, “recent” contact means that the provider had seen their medical director at a continuing education class, on a call, or in private about an EMS issue at least once in the last six months.  This means that over a third of responders hadn’t seen their medical director in at least 6 months, and of the other two-thirds, we can’t know how many saw their director only once.

This has been an issue of interest to me for some time:  I typically see my current medical director about once a year.  I say “about” because my command is with one hospital of a 2-hospital system, and to achieve even that number, I’m counting contact with the other hospital’s medical director–all fifteen minutes of it, running a megacode scenario for groups of 4 at the annual skills review.  To be honest, I couldn’t even tell you who my medical director properly is, thereby failing the Busko-Margolis-Politis test for professional medical direction:

Part 1: At your next in-service or crew meeting, show your providers pictures of four different physicians who practice emergency medicine in your community. Ask your providers to identify their medical director both by face and name. You should expect a greater than 75% correct response.

Part 2: Show your medical director pictures of your EMS providers and a separate, unmatched list of all of their names. Your medical director should be able to correctly match more than 50% of the names to the faces. If you’re not comfortable trying part two, this should tell you something about your medical director.

From JEMS 2006. 31(3):92-9.

Having little contact between EMS providers and medical directors is problematic for a couple of reasons.  First, medical directors are nominally on the line for care provided by the EMS types under them in most places, and really ought to know what they’re getting into.  Second, frequent contact with docs is probably healthy for a workforce filled with 110-hour wonders, who really don’t have enough education to know what they don’t know.

There are plenty of factors working against true professional medical direction everywhere, one of the biggest being the issue of paid time to devote to EMS issues.  Heck, even I may find it difficult to put as much time as I’d like to into medical direction, when I get to that point.  That’s why change, as much as I hate to admit it, is probably going to have to come from the top down–in the form of state EMS laws that encourage professional medical direction, rather than encouraging all but the largest EMS services to find the cheapest solution available.