Recognition of EMS as a subspecialty serves as vivid evidence of the advancement of EMS in American medicine, particularly if one considers that medical direction was not even mentioned in the 1973 landmark Emergency Medical Services Act. 104 EMS subspecialty certification has standardized the optimal qualifications and training of EMS practitioners and provides tangible evidence of the expertise now sought for this increasingly vital role. 105
CHALLENGES TO INNOVATION DYSFUNCTIONAL JOB MARKET With the creation of the subspecialty of EMS, it is becoming increasingly recognized that medical direction requires a unique body of healthcare, public health, and public safety knowledge not typically within the normal educational scope of medicine. However, given the relatively low number of EMS fellows, an optimal number of credentialed EMS physicians is highly unlikely for the foreseeable future. Simultaneously, there is a maldistribution of currently qualified medical directors - while many agencies find it difficult to recruit a single qualified individual, EMS physicians tend to cluster in urban centers or at academic institutions and in those markets, may struggle to find available compensated positions. Indeed, the National EMS Assessment found that in 31 of 49 states, the majority of local EMS Medical Directors served in uncompensated roles. Further, only eight (16%) states required continuing medical education specific to local EMS medical directors. 106 The problem is compounded by the lack of reimbursement for either online or offline medical oversight. Several key barriers to effective, innovative EMS medical direction – lack of recognition, authority, independence, resources, compensation and responsibility - were repeatedly identified in surveys and focus groups conducted by the PIE project team. Unless these are addressed, the EMS
industry will continue to struggle to retain and benefit from the talent and experience of the many physicians who desire a career in EMS medicine. UNDERUTILIZED In as much as EMS interfaces with an enormous array of providers, programs and organizations, it is a logical nexus for effective community team-building. The EMS medical director is well- positioned to champion the new systems to address a broad spectrum of healthcare needs. Unfortunately, it is uncommon for the medical director to be adequately resourced and effectively integrated into the decision-making processes of the EMS agency. Healthcare and public safety systems lose valuable input by failing to incorporate EMS medical directors in conversations involving integration, modernization, and new models of care. TRANSFORMING EDUCATIONAL NEEDS While the American healthcare system increasingly emphasizes the importance of population health, current EMS physician education and practice remains predominantly limited to oversight of emergency care for a small segment of high acuity situations. Medical directors need to develop experience working with the full spectrum of acute and chronic care providers and solicit input from all relevant sources of expertise including primary care and mental health. Having a consistent method to incorporate the input and direction of non-EMS physicians in both direct and indirect medical oversight would be valuable.
104 Harvey, John C. “The emergency medical service systems act of 1973.” JAMA 230, no. 8 (1974): 1139-1140. 105 “EMS- Overview.” American Board of Emergency Medicine . Accessed June 28, 2017. https://www.abem.org/public/subspecialty-certification/emergency-medical-services/ems-overview 106 Ibid. 7
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MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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