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

2. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 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. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 3 Objectives and Methodology

4. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 4 Study Objectives Explore issues related to physicians roles and responsibilities within the states 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. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 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. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 6 Profile of Current and Former OMDs

7. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 7 4 Out of 10 of All Respondents (43%) Have OMD Experience Q13: Are you now or have you ever been an Operational Medical Director, generally referred to as an OMD? 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). 261 total respondents x 43% of all respondents as OMDs = 112.23 Respondents This translates into roughly a +/- 9% margin of error

8. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 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. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 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. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 10 Over a Third of Current OMDs Have Been Serving as an OMD for Over 10 Years Q14(Current) & Q39(Former): How long have you been serving/did you serve as an OMD? Former OMDs Generally Stopped their Service After 5 or Less Years… 76% served 5 years or less

11. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 11 Three-Quarters of OMDs Spend at Least 15 Hours a Month on OMD Duties 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)? 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).

12. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 12 Time is Divided Between Meetings, Teaching, Paperwork, and Personnel Issues Time On Paperwork 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. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 13 Almost Two-thirds (60%) of Current OMDs Serve 2 Agencies, While Two-Thirds (66%) of Former OMDs Served One Agency 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] 71% current OMDs serve 1- 3 agencies Research Note: Directional finding suggesting this conclusion

14. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 14 Number of Agencies Served Increased Over the Course of Respondents OMD Service 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? The average current OMD had 2.4 agencies when he/she started service and now has 3.1 agencies.

15. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 15 Time Spent Per Month Also Increased Over the Course of Respondents OMD Service 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)? The break-down of how these hours are spent does not differ between when OMDs started and the present/when they stopped.

16. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 16 Initial Motivation With Volunteer OMD Service

17. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 17 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: The differences between current and former OMDs do not reach statistical significance.

18. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 18 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] NOTE: Percentages total more than 100 because respondents were permitted to select more than one option.

19. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 19 Challenges to Volunteer OMD Service

20. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 20 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.

21. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 21 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.

22. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 22 Malpractice Liability And Reimbursement Issues - Are The Single Biggest Concerns in the Practice of Emergency Medicine Q2: What is the single biggest challenge facing physicians in the practice of emergency medicine today? 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. NOTE: Percentages shown are based on the responses of all respondents.

23. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 23 When Asked About the Challenges Facing OMDs, No Pay, Time Commitment, and Lack of Support & Training Lead the List Liability Issues Are Not Top Of the List Q28: Please rate the degree to which each of these is a challenge to you in your current OMD position? NOTE: Percentages indicate those who selected 4 or 5 Critical Challenge on a 1-5 scale. Not the major challenge

24. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 24 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 some respondents gave more than one answer.

25. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 25 No Pay and Time Commitment Were Also Significant Reasons Why Former OMDs Say They Ended Their OMD Service Q55: What were the reasons you ended your OMD service? NOTE: Percentages total more than 100 because respondents were permitted to select more than one option. 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.

26. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 26 Most Current OMDs Are Aware of OEMS Indemnification Requirements; Many Former OMDs Are/Were Not 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 OMDfor both medical malpractice and civil liability? This response was only an option for former OMDs.

27. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 27 About a Third Of Current OMDs Have Additional Liability Insurance to Cover Their OMD Duties Q30(Current) & Q57(Former): Do/did you have additional liability insurance to cover your OMD duties? This difference is not statistically significant.

28. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 28 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? 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.

29. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 29 OMDs Think that the EMS Regional Council Could be Doing More Across The Board 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). NOTE: Percentages indicate those who selected Very Good or Excellent.

30. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 30 Overall Satisfaction With OMD Service

31. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 31 Most OMDs (92%) Say The Work Is Satisfying 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?

32. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 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. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 33 OMDs Like Interacting with Medics Best, But Also Appreciate the Altruistic Parts of the Job Like 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] NOTE: Percentages total more than 100 because some respondents gave more than one answer.

34. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 34 Awareness & Perceptions of An OMD Short-fall

35. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 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. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 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. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 37 Awareness of OMD Coverage Issue Is Mostly Among OMDs 57% of Current OMDs & 31% of Non-OMDs Have Heard Theres An OMD Short-fall Q78: Which of the following best describes what you have heard regarding the extent of OMD coverage in your regionthat is, the number of OMDs relative to the number of agencies they oversee. Non-VACEP members were particularly likely to have not heard anything about this issue.

38. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 38 Just A Quarter of Those Who Have Heard Theres 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. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 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. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 40 Yet, Only 5% Feel as though the Quality of Emergency Care Delivered in the Pre-Hospital Setting Has Decreased. Almost Half Think It Has Increased 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? 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.

41. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 41 More Than This (14%) - Think the Quality of Emergency Care in the Hospital Setting Has Decreased in the Past Five Years Q7: Compared to five years ago, how would you rate the quality of emergency medical care delivered in the hospital setting in your community? 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.

42. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 42 What It Will Take To Convince Physicians There Is An OMD Short Fall

43. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 43 Question: what would it take to convince you there was a need for more volunteers? 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 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.

44. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 44 Potential Solutions For OMD Short-fall (if there is one now)

45. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 45 OMD Short-fall Solutions Immediate: recruitment Mid-term: programming Long-term: paid positions

46. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 46 Immediate Solution to Avoid OMD Short-fall: Have OMDs Recruit OMDs

47. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 47 There Appears to Be Some Opportunity to Convince Non-OMDs to Volunteer & Former OMDs To Sign Up Again 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] 43% of Non- OMDs say they are somewhat or very likely to volunteer in the future. 24% of Former OMDs say they are somewhat or very likely to volunteer in the future.

48. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 48 8 in 10 Non-OMDs Know Someone Who Is Serving as an OMD Q66: Do you personally know anyone who is serving as an OMD? Current members of VACEP were more likely to know someone who is serving as an OMD.

49. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 49 Yet, Familiarity with the OMD Position Among Non-OMDs is Low 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? 93% of all respondents were aware that every agency that delivers emergency care is required to have an OMD actively overseeing all activities. VACEP members are much more familiar with the OMD position than non-VACEP members.

50. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 50 Recall, Few Volunteer On Their Own 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: The differences between current and former OMDs do not reach statistical significance.

51. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 51 OMDs, Especially Current Ones, Say They Have Tried to Recruit Other OMDs Q36(Current OMDs) & Q63(Former OMDs): Have you ever tried to recruit other OMDs or talked to a colleague about becoming an OMD? 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.

52. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 52 Yet, Only 17% Of Non-OMDs Say They Have Ever Been Asked to Be An OMD Q69: Have you ever been asked to be a volunteer 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.

53. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 53 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?

54. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 54 The Right Recruitment Message For Non-OMDs & Former OMDs…

55. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 55 Non-OMDs Correctly Perceive the Biggest Issues Facing OMDs: Time Commitment and Lack of Pay Q68: What do you think are the biggest issues facing OMDs? NOTE: Percentages total more than 100 because respondents were permitted to select more than one option. Remember, these were also seen as the top 2 challenges by current OMDs.

56. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 56 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? NOTE: Percentages total more than 100 because respondents were permitted to select more than one option.

57. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 57 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 Q72: How much time per month and total length of service would be a reasonable expectation of volunteer physicians? Respondents also reported that 1-2 years would be the most appropriate total length of service.

58. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 58 Make An Impact: Non-OMDs Look at the Potential Benefits of Being an OMD Differently than the Motivations of Current & Former OMDs Q67: What do you think would be the biggest benefits of serving as an OMD? NOTE: Percentages total more than 100 because respondents were permitted to select more than one option. Messaging: Non OMDs: Make an impact on policies Former OMDs: Make an additional impact in your community

59. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 59 Mid-term Solution To Avoid OMD Short-fall: Programming Support

60. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 60 Potential OEMS Support Initiatives Hold Promise – OMD 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?

61. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 61 Former OMDs Show Even Greater Interest in Many Potential Support Initiatives NOTE: Percentages indicate those who selected 4 or 5Very Interested. Q61: How interested would you have been in the following OEMS support initiatives designed to make OMD service easier for OMDs?

62. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 62 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? NOTE: Percentages indicate those who selected 4 or 5 Highly Positive.

63. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 63 Long-term Solution To Avoid OMD Short-fall: Shift To Paid OMD Position

64. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 64 Half Believe that OEMS is Responsible for Shoring Up the Shortage; 40% Dont Know Q80: Who is responsible for shoring up the shortage? [ASKED ONLY OF THOSE WHO SAID THERE IS A SHORTAGE] NOTE: Percentages total more than 100 because respondents were permitted to select more than one option.

65. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 65 If 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 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? This position was described as an all-paid, statewide position reporting to OEMS.

66. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 66 Contribute $500 For Stipend 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.

67. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 67 Moving To Paid System Received 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.

68. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 68 7 Key Take-A-Ways

69. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 69 7 Key Take-A-Ways 1.Most were asked to serve and most signed on for OMD service to support the community. 2.No pay, time involvement, and support (from hospitals and partners), not insurance liability issues, are the greatest challenges facing OMDs today. 3.Current OMDs may be serving longer and serving more agencies than former OMDs. And, time involvement and number of agencies increases with tenure. 4.Most are satisfied, however, with OMD position and will stay on as OMD. 5.Fifty-seven percent of current OMDs and thirty-one percent of non-OMDs have heard theres an OMD short-fall. Yet most are not aware of its impact. In fact, most believe pre-hospital setting care has actually improved. 6.Physicians need data/ facts to believe theres 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.

70. Southeastern Institute of Research 2005 OEMS Virginia Emergency Physicians Survey 70 Thank You