# Why is Physican Medical Director Salary so low?



## usalsfyre (Dec 1, 2010)

Currently in the US physician medical directors are an important part of system design. Yet, medical director salaries are stunningly low compared to other opportunities for emergency physicians. Is it any wonder we get absentee medical directors who foist underpreapared, dangerous medics with "mother may I" protocols on the world? Why do ya'll think the average medical director gets paid less than the average EMS service manager?


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## Veneficus (Dec 1, 2010)

usalsfyre said:


> Currently in the US physician medical directors are an important part of system design.



I respectfully disagree. While some are important to their systems, in all of my US travels most of them are like absentee landlords you only see when there is trouble. 

Additionally any authority they commanded their neglect has totally eroded away. They are almost a dime a dozen and if one gives your service trouble, he/she can be replaced over night.

Most medical directors I have worked under had little if any interest or time devoted to EMS.



usalsfyre said:


> Yet, medical director salaries are stunningly low compared to other opportunities for emergency physicians. Is it any wonder we get absentee medical directors who foist underpreapared, dangerous medics with "mother may I" protocols on the world? Why do ya'll think the average medical director gets paid less than the average EMS service manager?



Because they do nothing to earn anymore. I have seen a handful at services I have been at that devoted about 10 hours a month to their EMS duties. If they could get away with less I am sure they would.

Even their professional organizations don't set demands or make recommendations. 

Though lately they are advocating EMS fellowships, I can't say I am impressed with what I have seen. 

If the laws were changed and they could be eliminated, I doubt EMS would miss them.


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## EMSLaw (Dec 1, 2010)

I think Vene hit the nail more or less on the head.  Being a medical director isn't their primary job.  It's not even a part-time job.  It's something they do a few hours a month and collect a check for.  

I was told, by the way, that medical control physicians, who are full-time ER docs who answer paramedic's phone calls as a sideline, make about $250 per call, in addition to what they bill their ER patients for.


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## lightsandsirens5 (Dec 1, 2010)

Veneficus said:


> I respectfully disagree. While some are important to their systems, in all of my US travels most of them are like absentee landlords you only see when there is trouble.



This unfortunately is so true. Ours has an office in our stations admin hall and he has not been in that place for years I bet.


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## Simusid (Dec 1, 2010)

My medical director certainly is not an absentee landlord.  He talks to our Operations Manager every single day (probably more).  He holds M&M rounds at least twice per month and he said he is on scene at calls on average of 20 calls per month.  

YMMV of course.  I'm just glad I got a good one !


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## Veneficus (Dec 1, 2010)

Simusid said:


> My medical director certainly is not an absentee landlord.  He talks to our Operations Manager every single day (probably more).  He holds M&M rounds at least twice per month and he said he is on scene at calls on average of 20 calls per month.
> 
> YMMV of course.  I'm just glad I got a good one !



Make sure you keep him, because you are very unlikely to find another like that.

One medical director I had told us during our orientation that he hates paramedics and the best paramedics he has are the ones he never hears from or about.


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## JPINFV (Dec 1, 2010)

Veneficus said:


> One medical director I had told us during our orientation that he hates paramedics and the best paramedics he has are the ones he never hears from or about.



To be fair about the last part of this statement, the majority of time that anyone in management, including medical directors, hears about a provider's actions, it's normally because either something went wrong, or something amazing happened. Stuff going wrong is much more common.


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## abckidsmom (Dec 1, 2010)

JPINFV said:


> To be fair about the last part of this statement, the majority of time that anyone in management, including medical directors, hears about a provider's actions, it's normally because either something went wrong, or something amazing happened. Stuff going wrong is much more common.



Amazing is a lot about luck of the draw on the calls, too.  

We once had a medical director, Vene, you're familiar with her...she came out and taught CME, ran calls, and called people on the carpet when she encountered their patients, good or bad.  Getting called in to talk with her was ALWAYS intimidating, but she always handled issues fairly.  If you did something great, she was going to shout it from the rooftops.  If you did something reckless, she was going to educate you to the point that you didn't want to make that mistake again.

My partner made a bad call once and a patient ended up dying from her injuries that could possibly have been better addressed.  This information wasn't made public in the department, but he taught a class on that particular kind of trauma, index of suspicion based on the patient's presentation, and used a few case studies that our medical director provided him with to present his class.

She was involved, serious, and didn't take any crap.  After she fired the third medic for incompetence and failure to learn from mistakes, the department found a new medical director.  

He's cheaper, and they don't have to pay as much in OT for meetings with him and classes, and they are all happier.  

Ask the patients how they feel about that.

Medical directors that are at-will employees of the system managers are a joke unless the system managers are bold enough to stick by clinical decision making being the driving force in the department.

Sadly, that is SO not the case in most of the departments I've had the opportunity to look into.


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## Veneficus (Dec 1, 2010)

JPINFV said:


> To be fair about the last part of this statement, the majority of time that anyone in management, including medical directors, hears about a provider's actions, it's normally because either something went wrong, or something amazing happened. Stuff going wrong is much more common.



That is very true.

I think though when the medical director is actually involved with his EMS people more than the absolute minimum that he has to be, the ratio of amazing to wrong shifts more towards amazing or at the very least more away from wrong.

But like I said originally since medical directors decided a more hands off approach was going to be the norm rather than the exception, you see what EMS has done to itself and the direction (or lack of) it has taken. 

Now it is easier to replace a med director than even a field provider in many cases (especially where unions are involved) and if your "medical director" is giving direction more than taking it or keeping head down and mouth shut, you get things like Naples Florida, or simply a more amiable medical director. 

Where is the highly touted FACEP to issue a stand on this? How about a professional medical director organization or accrediting body? Maybe even a gentlemans agreement between EMs and those involved as physicians in EMS to not accept or apply for a position where the medical director is removed for not playing ball?

Physicians are just as responsible for the state of EMS as the EMS providers. It's about time they start owning up to that and putting forth some effort as a body to fix it.


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## zmedic (Dec 1, 2010)

Err, I'm not sure the argument of "start working more and we'll pay you more" makes a lot of sense. I think basic economics say it's the other ways around. Fire departments and ambulance services are going to pay medical directors the minimum that they can get away with and still get the services they want.  Most emergency physicians make somewhere between $180-300k a year. So if you want a full time medical director you are going to have to pay that much.  

Otherwise you are going to have to put up with medical directors who are basically volunteering their time.


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## Phlipper (Dec 1, 2010)

What's a "Medical Director"?  Do I have one of those?  I'll have to ask tomorrow.  :lol:


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