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OEMS Virginia Emergency Physicians OMD Study (Co-Sponsored with the Virginia College of Emergency Physicians) November 18, 2005. Prepared By. Table of Contents. Objectives and Methodology Profile of Current and Former OMDs Initial Motivation with Volunteer OMD Service

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  1. OEMS Virginia Emergency Physicians OMD Study (Co-Sponsored with the Virginia College of Emergency Physicians) November 18, 2005 Prepared By

  2. Table of Contents • Objectives and Methodology • Profile of Current and Former OMDs • Initial Motivation with Volunteer OMD Service • Challenges to Volunteer OMD Service • Overall Satisfaction with OMD Service • Awareness & Perceptions of an OMD Shortfall • What it Will Take to Convince Physicians there is an OMD Shortfall • Potential Solutions for OMD Shortfall • 7 Key Take-A-Ways

  3. Objectives and Methodology

  4. Study Objectives • Explore issues related to physician’s roles and responsibilities within the state’s Emergency Medical Services (EMS) system. • Investigate the Operational Medical Director (OMD) short-fall and how to encourage more emergency physicians to become OMDs. • Part of longer survey which also investigated VACEP membership issues.

  5. Methodology • Study was conducted Sept. 20 - Oct. 19, 2005 • 1,208 survey links were sent out to emergency physicians across Virginia • 888 were emailed • 320 were sent in the regular mail • 261 physicians completed the survey • No incentives were offered • Response rate for the study is 22% • Study results contain a margin of error of +/- 5.4% at the 95% confidence level

  6. Profile of Current and Former OMDs

  7. 4 Out of 10 of All Respondents (43%)Have OMD Experience 261 total respondents x 43% of all respondents as OMDs = 112.23 Respondents This translates into roughly a +/- 9% margin of error “An OMD is a physician currently licensed to practice medicine in the Commonwealth, who is formally recognized by OEMS and responsible for providing medical direction, oversight, and quality improvement to a licensed EMS agency, such as volunteer, career, commercial, or government rescue squad(s).” Q13: Are you now or have you ever been an Operational Medical Director, generally referred to as an OMD?

  8. Most OMD Respondents Are Serving Rural Areas Q17 (Current) & Q42 (Former): What kind of area do/did you primarily cover in your OMD role?

  9. Most OMDs Are Part-Time Volunteers Q22(Current) & Q47(Former): Which of the following best describes your [current] OMD position? Q23(Current) & Q48(Former): Is/was your [current] OMD position full or part-time?

  10. Over a Third of Current OMDs Have Been Serving as an OMD for Over 10 Years Former OMDs Generally Stopped their Service After 5 or Less Years… 76% served 5 years or less Q14(Current) & Q39(Former): How long have you been serving/did you serve as an OMD?

  11. Three-Quarters of OMDs Spend at Least 15 Hours a Month on OMD Duties Paid OMDs reported spending much more time on their OMD duties than did volunteers (however, due to the small sample size, this was not statistically significant and should just be viewed as a trend). Q18(Current OMDs) & Q43(Former OMDs): How many hours per month do you currently spend on OMD duties (or when you stopped serving as an OMD)?

  12. Time is Divided Between Meetings, Teaching, Paperwork, and Personnel IssuesTime OnPaperwork May Be Increasing Q19(Current OMDs) & Q44(Former OMDs): What percentage of this time do (did) you spend on each of the following in your role as OMD?

  13. Almost Two-thirds (60%) of Current OMDs Serve 2 Agencies, While Two-Thirds (66%) of Former OMDs Served One Agency Research Note: Directional finding suggesting this conclusion 71% current OMDs serve 1-3 agencies Q15: How many agencies do you serve as an OMD today? [CURRENT OMDs] Q40: How many agencies were you serving as an OMD when you stopped? [ASKED OF FORMER OMDs]

  14. Number of Agencies Served Increased Over the Course of Respondents’ OMD Service The average current OMD had 2.4 agencies when he/she started service and now has 3.1 agencies. Q16(Current OMDs) & Q41(Former OMDs): Thinking back to when you first started your OMD service, how many agencies did you serve when you first became an OMD?

  15. Time Spent Per Month Also Increased Over the Course of Respondents’ OMD Service The break-down of how these hours are spent does not differ between when OMDs started and the present/when they stopped. Q18(Current OMDs) & Q43(Former OMDs): How many hours per month do you currently spend on OMD duties (or when you stopped serving as an OMD)?

  16. Initial Motivation With Volunteer OMD Service

  17. NOTE: The differences between current and former OMDs do not reach statistical significance. Most OMDs Were First Introduced to “OMD Service” When they Were Approached by an Agency that Needed Help Q24(Current OMDs) & Q49(Fomer OMDs): What event first introduced you to OMD service?

  18. NOTE: Percentages total more than 100 because respondents were permitted to select more than one option. Wanting to Support the Community Was the #1 Motivation for Serving as an OMD; Former OMDs Were More Likely to Say that It Was Part of Their Job Responsibility Than Current OMDs Q25(Current OMDs) & Q50(Former OMDs): What motivated you to serve as an OMD? [QUESTION NOT ASKED OF THOSE WHO SAID THEY WERE REQUESTED BY PEOPLE IN THEIR PRACTICE]

  19. Challenges to Volunteer OMD Service

  20. NOTE: Percentages shown are based on the responses of all respondents. When Asked About the Challenges Facing Physicians in the Practice of Emergency Medicine, Malpractice Issues Top the List Q1: To what extent do you believe that each of the following issues is a challenge facing physicians in the practice of emergency medicine today?

  21. NOTE: Percentages shown are based on the responses of all respondents. Availability of Qualified Emergency Physicians & OMDs, and Quality of Pre-Hospital Care Are Not Seen As Major Challenges Q1: To what extent do you believe that each of the following issues is a challenge facing physicians in the practice of emergency medicine today?

  22. NOTE: Percentages shown are based on the responses of all respondents. Malpractice Liability And Reimbursement Issues - Are The Single Biggest Concerns in the Practice of Emergency Medicine Current OMDs were less likely to say that malpractice insurance is the biggest concern and more likely to say that inability of patients to afford health insurance is the biggest concern. Q2: What is the single biggest challenge facing physicians in the practice of emergency medicine today?

  23. NOTE: Percentages indicate those who selected “4” or “5—Critical Challenge” on a 1-5 scale. When Asked About the Challenges Facing OMDs, No Pay, Time Commitment, and Lack of Support & Training Lead the ListLiability Issues Are Not Top Of the List Not the major challenge Q28: Please rate the degree to which each of these is a challenge to you in your current OMD position?

  24. NOTE: Percentages total more than 100 because some respondents gave more than one answer. Likewise, when Current OMDs Were Asked What they Like Least About Being an OMD, Liability Issues Were Not at the Top of the List Q29(Current) & Q54(Former): What do/did you like least about being an OMD? [OPEN-END]

  25. NOTE: Percentages total more than 100 because respondents were permitted to select more than one option. No Pay and Time Commitment Were Also Significant Reasons Why Former OMDs Say They Ended Their OMD Service After moving/changing jobs, these were the top reasons that former OMDs gave when asked in an open-ended question what the single biggest reason for ending their OMD service was. Q55: What were the reasons you ended your OMD service?

  26. Most Current OMDs Are Aware of OEMS Indemnification Requirements; Many Former OMDs Are/Were Not This response was only an option for former OMDs. Q32(Current OMD) & Q59(Former OMD): Are/were you aware that the OEMS regulations call for a written agreement between an agency and OMD that ensures adequate indemnification exists for the OMD—for both medical malpractice and civil liability?

  27. About a Third Of Current OMDs Have Additional Liability Insurance to Cover Their OMD Duties This difference is not statistically significant. Q30(Current) & Q57(Former): Do/did you have additional liability insurance to cover your OMD duties?

  28. NOTE: Percentages total more than 100 because respondents were permitted to select more than one option. Also, these percentages combine the responses of both current and former OMDs. Of Those with Additional Liability Insurance, Very Few Pay for It Themselves Q31(Current) & Q58(Former): What additional insurance coverage do/did you have for your OMD duties?

  29. OMDs Think that the EMS Regional Council Could be Doing More Across The Board NOTE: Percentages indicate those who selected Very Good or Excellent. Q33(Current OMD) & Q60(Former OMD): Please rate your EMS Regional Council in terms of their ongoing support of you in your OMD positions (when you were serving in an OMD position).

  30. Overall Satisfaction With OMD Service

  31. Most OMDs (92%) Say The Work Is SatisfyingFormer OMDs Were Slightly More Likely to Say that Being an OMD Was Not Satisfying Q27(Current) & Q52(Former): How personally satisfying has it been/was it to serve as an OMD?

  32. Most (82%) Current OMDs Are Likely to Continue to Serve as an OMD Q38: How likely are you to be an OMD three years from now?

  33. NOTE: Percentages total more than 100 because some respondents gave more than one answer. OMDs Like Interacting with Medics Best, But Also Appreciate the Altruistic Parts of the JobLike Improving Quality of Care and Making A Difference in the Community Q26(Current) & Q51(Former): What do/did you like best about being an OMD? [OPEN-END]

  34. Awareness & Perceptions of An OMD Short-fall

  35. Availability of OMDs & Quality of Pre-Hospital Care Is Way Down On The List of Challenges Facing Physicians in Emergency Medicine Q1: To what extent do you believe that each of the following issues is a challenge facing physicians in the practice of emergency medicine today?

  36. Availability of Qualified Emergency Physicians & OMDs, and Quality of Pre-Hospital Care Are Not Seen As Major Challenges Q1: To what extent do you believe that each of the following issues is a challenge facing physicians in the practice of emergency medicine today?

  37. Awareness of OMD Coverage Issue Is Mostly Among OMDs57% of Current OMDs & 31% of Non-OMDs Have Heard There’s An OMD Short-fall Non-VACEP members were particularly likely to have not heard anything about this issue. Q78: Which of the following best describes what you have heard regarding the extent of OMD coverage in your region—that is, the number of OMDs relative to the number of agencies they oversee.

  38. Just A Quarter of Those Who Have Heard There’s a Short-fall Think it Has Already Negatively Affected Quality of Care; But Another 60% Believe it Could in the Future Q79: How do you feel the OMD shortfall in Virginia is affecting the quality of patient care? [ASKED ONLY OF THOSE WHO SAID THERE IS A SHORTAGE]

  39. Is There A Short-fall Crisis? % Aware % Say Short-fall Percent of short-fall Has Already of Group Had Impact who say already Had impact All emergency physicians: 40% 24% 9.6% Current OMDs: 57% 30% 17.1%

  40. Yet, Only 5% Feel as though the Quality of Emergency Care Delivered in the Pre-HospitalSetting Has Decreased.Almost Half Think It Has Increased Again, those who said their training was in something other than emergency medicine were more likely to say the quality of pre-hospital emergency care had improved. Current OMDs were also more likely to say that it had improved. NOTE: Less than 1% said that it had decreased significantly. Q9: Compared to five years ago, how would you rate the quality of emergency medical care delivered in the pre-hospital setting (medical care leading up to the hospital setting) in your community?

  41. More Than This (14%) - Think the Quality of Emergency Care in the Hospital Setting Has Decreased in the Past Five Years Those who said their training was in something other than emergency medicine were more likely to say the quality of emergency care in hospitals had improved. Q7: Compared to five years ago, how would you rate the quality of emergency medical care delivered in the hospital setting in your community?

  42. What It Will Take To Convince Physicians There Is An OMD Short Fall

  43. Question: what would it take to convince you there was a need for more volunteers? This question was only asked of those who said that lack of awareness of need was a barrier in not volunteering as an OMD. This amounts to only 27 people and was therefore not coded into categories. SHOW ME! • Statistics • Statewide listing of OMD positions not filled • Delay in response to EMS calls • Numbers and facts • Hearing it from a local squad or local OMD • Receiving regular notices of open positions in the area and across the state • Data

  44. Potential Solutions For OMD Short-fall (if there is one now)

  45. OMD Short-fall Solutions Immediate: recruitment Mid-term: programming Long-term: paid positions

  46. Immediate Solution to Avoid OMD Short-fall: Have OMDs Recruit OMDs

  47. There Appears to Be Some Opportunity to Convince Non-OMDs to Volunteer & Former OMDs To Sign Up Again 24% of Former OMDs say they are somewhat or very likely to volunteer in the future. 43% of Non-OMDs say they are somewhat or very likely to volunteer in the future. Q38: How likely are you to be an OMD three years from now? [CURRENT OMDs] Q65: How likely are you to become an OMD again? [FORMER OMDs] Q77: How likely are you to ever volunteer for an OMD position in your community? [NON OMDs]

  48. 8 in 10 Non-OMDs Know Someone Who Is Serving as an OMD Current members of VACEP were more likely to know someone who is serving as an OMD. Q66: Do you personally know anyone who is serving as an OMD?

  49. 93% of all respondents were aware that every agency that delivers emergency care is required to have an OMD actively overseeing all activities. Yet, Familiarity with the OMD Position Among Non-OMDs is Low VACEP members are much more familiar with the OMD position than non-VACEP members. Q12: How familiar would you say you are with the Office of Emergency Medical Services’ (OEMS) Operational Medical Director position, generally referred to as an OMD?

  50. NOTE: The differences between current and former OMDs do not reach statistical significance. Recall, Few Volunteer On Their OwnMost OMDs Were First Introduced to OMD Service When they Were Approached by an Agency that Needed Help Q24(Current OMDs) & Q49(Fomer OMDs): What event first introduced you to OMD service?

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