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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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Prepared by

OEMS

Virginia Emergency Physicians

OMD Study

(Co-Sponsored with the Virginia College of Emergency Physicians)

November 18, 2005

Prepared By


Table of contents
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


Objectives

and

Methodology


Study objectives
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.


Methodology
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


Profile of

Current and

Former OMDs


4 out of 10 of all respondents 43 have omd experience
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?


Most omd respondents are serving rural areas
Most OMD Respondents Are Serving Rural Areas

Q17 (Current) & Q42 (Former): What kind of area do/did you primarily cover in your OMD role?


Most omds are part time volunteers
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?


Over a third of current omds have been serving as an omd for over 10 years
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?


Three quarters of omds spend at least 15 hours a month on omd duties
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)?


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?


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]


Number of agencies served increased over the course of respondents omd service
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?


Time spent per month also increased over the course of respondents omd service
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)?


Initial Respondents’ OMD Service

Motivation

With

Volunteer

OMD Service


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?


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]


Challenges were permitted to select more than one option.

to Volunteer

OMD Service


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?


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?


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?


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?


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]


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?


Most current omds are aware of oems indemnification requirements many former omds are were not
Most were permitted to select more than one option. 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?


About a third of current omds have additional liability insurance to cover their omd duties
About a Third Of Current OMDs were permitted to select more than one option. 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?


Of those with additional liability insurance very few pay for it themselves

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?


Omds think that the ems regional council could be doing more across the board
OMDs Think that the EMS Regional Council were permitted to select more than one option. Also, these percentages combine the responses of both current and former OMDs.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).


Overall were permitted to select more than one option. Also, these percentages combine the responses of both current and former OMDs.

Satisfaction

With OMD

Service


Most OMDs (92%) Say The Work Is Satisfying were permitted to select more than one option. Also, these percentages combine the responses of both current and former OMDs.Former 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?


Most 82 current omds are likely to continue to serve as an omd
Most (82%) Current OMDs Are Likely were permitted to select more than one option. Also, these percentages combine the responses of both current and former OMDs.to Continue to Serve as an OMD

Q38: How likely are you to be an OMD three years from now?


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]


Awareness & respondents gave more than one answer.

Perceptions of

An OMD

Short-fall


Availability of OMDs & Quality of respondents gave more than one answer.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?


Availability of Qualified Emergency Physicians respondents gave more than one answer.& 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?


Awareness of OMD Coverage respondents gave more than one answer.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.


Just A Quarter of Those Who Have Heard respondents gave more than one answer.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]


Is there a short fall crisis
Is There A Short-fall Crisis? respondents gave more than one answer.

% 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%


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?


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?


What It in the

Will Take To

Convince

Physicians There

Is An OMD

Short Fall


Question what would it take to convince you there was a need for more volunteers
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


Potential need for more volunteers?

Solutions For

OMD Short-fall

(if there is one now)


Omd short fall solutions
OMD Short-fall Solutions need for more volunteers?

Immediate: recruitment

Mid-term: programming

Long-term: paid positions


Immediate need for more volunteers?

Solution to Avoid

OMD Short-fall:

Have OMDs

Recruit

OMDs


There appears to be some opportunity to convince non omds to volunteer former omds to sign up again
There Appears to Be Some Opportunity to need for more volunteers?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]


8 in 10 non omds know someone who is serving as an omd
8 in 10 Non-OMDs Know Someone need for more volunteers?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?


Yet familiarity with the omd position among non omds is low

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?


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?


Omds especially current ones say they have tried to recruit other omds
OMDs, Especially reach statistical significance.Current Ones, Say They Have Tried to Recruit Other OMDs

While this difference can be looked at as a “trend,” due to the small sample size of former OMDs, the difference between current and former OMDs is not statistically significant.

Q36(Current OMDs) & Q63(Former OMDs): Have you ever tried to recruit other OMDs or talked to a colleague about becoming an OMD?


Yet only 17 of non omds say they have ever been asked to be an omd
Yet, reach statistical significance.Only 17% Of Non-OMDs Say They Have Ever Been Asked to Be An OMD

Current and former members of VACEP were more likely to have been asked to be an OMD.Men and those who are ABEM certified were also more likely.

Q69: Have you ever been asked to be a volunteer OMD?


If Provided with Training and a List of Candidates to Approach, Half of Current OMDs and a Quarter of Former OMDs Would Help Recruit Others

Q37(Current OMDs) & Q64(Former OMDs): Would you recruit others to be an OMD if OEMS and VACEP provided you with training and a list of candidates to approach?


The right recruitment message for non omds former omds
The Right Approach, Half of Current OMDs and a Quarter of Former OMDs Would Help Recruit OthersRecruitment MessageFor Non-OMDs & Former OMDs…


Non omds correctly perceive the biggest issues facing omds time commitment and lack of pay
Non-OMDs Approach, Half of Current OMDs and a Quarter of Former OMDs Would Help Recruit Others Correctly Perceive the Biggest Issues Facing OMDs: Time Commitment and Lack of Pay

Remember, these were also seen as the top 2 challenges by current OMDs.

NOTE: Percentages total more than 100 because respondents were permitted to select more than one option.

Q68: What do you think are the biggest issues facing OMDs?


In fact non omds say that the time commitment is the biggest barrier to volunteering as an omd

NOTE: Percentages total more than 100 because respondents were permitted to select more than one option.

In fact, Non-OMDs Say that the Time Commitment is the Biggest Barrier to Volunteering as an OMD

Q70: What are the biggest barriers to volunteering as an OMD?


Between 6 10 hours per month seems to be the right amount of time
Between 6-10 Hours per Month Seems to Be the Right Amount of Time

Three-Quarters of Current OMDs Spend at Least 15 Hours a Month on OMD Duties

Respondents also reported that 1-2 years would be the most appropriate total length of service.

Q72: How much time per month and total length of service would be a reasonable expectation of volunteer physicians?


NOTE: Percentages total more than 100 because respondents were permitted to select more than one option.

Make An Impact:Non-OMDs Look at the Potential Benefits of Being an OMD Differently than the Motivations of Current & Former OMDs

Messaging:

Non OMDs: Make an impact on policies

Former OMDs: Make an additional impact in your community

Q67: What do you think would be the biggest benefits of serving as an OMD?


Mid-term were permitted to select more than one option.

Solution

To Avoid

OMD Short-fall:

Programming

Support


Potential oems support initiatives hold promise omd training related ideas have most appeal
Potential OEMS Support Initiatives Hold Promise – OMD were permitted to select more than one option.Training–Related Ideas Have Most Appeal

Q34: How interested would you be in the following OEMS support initiatives designed to make OMD service easier for OMDs like you?


Former omds show even greater interest in many potential support initiatives

NOTE: Percentages indicate those who selected “4” or “5—Very Interested.”

Former OMDs Show Even Greater Interest in Many Potential Support Initiatives

Q61: How interested would you have been in the following OEMS support initiatives designed to make OMD service easier for OMDs?


NOTE: Percentages indicate those who selected “4” or “5—Highly Positive.”

State Tax Credit & Sovereign Immunity Would Make the Position More Appealing Across All OMD Audiences – Former, Current, and Potential

Q35(Current OMDs), Q62(Former OMDs), & Q76(Non OMDs): What impact do you think each of the following potential OMD-support initiatives would have on making the OMD position more appealing?


Long-term “5—Highly Positive.”

Solution To Avoid

OMD Short-fall:

Shift To Paid

OMD Position


Half believe that oems is responsible for shoring up the shortage 40 don t know

NOTE: Percentages total more than 100 because respondents were permitted to select more than one option.

Half Believe that OEMS is Responsible for Shoring Up the Shortage; 40% Don’t Know

Q80: Who is responsible for shoring up the shortage? [ASKED ONLY OF THOSE WHO SAID THERE IS A SHORTAGE]


If were permitted to select more than one option.the Facts Show there is a Shortfall of OMDs that is Compromising Pre-Hospital Care, Over Half of the Respondents Would Support Transitioning OMDs into a Paid Position

This position was described as an “all-paid, statewide position reporting to OEMS.”

Q81: If the facts clearly support that there is a shortfall of OMDs, and that this shortfall will eventually compromise the quality of pre-hospital emergency care, which of the following solutions will you favor?


Contribute 500 for stipend generated comments
Contribute $500 For Stipend were permitted to select more than one option. Generated Comments

“Asking physicians to pay another annual fee to support this position is an insult.”

“Asking physicians to support an OMD program with a special assessment (like the injured infant fund) is an ABSURD solution to the problem.”

“I have no intention of paying $500 to supplement any OMD.”


Moving to paid system received many positive comments
Moving To Paid System Received were permitted to select more than one option.Many Positive Comments

“There is too much needed to be done (as an OMD) for it to be volunteer.”

“It would ensure that the person chosen would be 100% dedicated and committed to the task.”

“If the people I am working with are compensated, then I should be compensated.”

“A full time paid position would be more accountable and lead to less conflicts with time and partners.”

“There has to be a stop to the expectation that physicians will continue to provide time and services without some basic level of compensation. We are being squeezed by insurance agencies, EMS rules, etc.”


7 were permitted to select more than one option.

Key Take-A-Ways


7 key take a ways
7 Key Take-A-Ways were permitted to select more than one option.

  • Most were asked to serve and most signed on for OMD service to support the community.

  • No pay, time involvement, and support (from hospitals and partners), not insurance liability issues, are the greatest challenges facing OMDs today.

  • Current OMDs may be serving longer and serving more agencies than former OMDs. And, time involvement and number of agencies increases with tenure.

  • Most are satisfied, however,with OMD position and will stay on as OMD.

  • Fifty-seven percent of current OMDs and thirty-one percent of non-OMDs have heard there’s an OMD short-fall. Yet most are not aware of its impact. In fact, most believe pre-hospital setting care has actually improved.

  • Physicians need data/ facts to believe there’s a short fall.

    7. Solution to OMD short-fall issue can work on a number of levels: aggressive recruitment of OMDs by OMDs; programming training support services; and moving the whole system to a paid model. All three options will work from a demand standpoint.


Thank You were permitted to select more than one option.


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