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Human resources (HR) deal with the hiring, training, compensating, managing, and unfortunately, at times the disciplining or terminating of employees. Human resources managers are expected to have expansive knowledge of these fields. However, all individuals in supervisory roles must have a basic understanding of the agency’s HR framework. Physician medical directors bring extensive medical knowledge to an organization, but often have minimal business training or experience. Unlike their counterparts in dentistry or chiropractic medicine, physicians are given little, if any, education in the business world. While all of these functions do not fall directly under the purview of medical direction, an astute medical director should have an understanding of their role within an organization’s human resources structure.

Emergency medical services is a unique profession, straddling the worlds of public safety and allied health. Like other public safety professionals, prehospital care providers respond to emergency calls from the community 24 hours a day, 7 days a week. Providers often feel a special kinship with the firefighters and police officers alongside whom they work. However, the medical education they must possess distinguishes them from these colleagues and aligns them more closely with nurses and other health care professionals. Limited resources exist for dealing specifically with human resources issues in emergency medical services. By examining allied health and public safety references, one can better navigate these minimally charted waters.


  • Define the role of the medical director as a part of the EMS or fire agency administration.

  • Contrast the HR/ER roles of the medical director against those of the agency director or fire chief.

  • Contrast the terms remediation and discipline as they relate to a response to EMS provider performance issues.

  • Describe the proper method for instituting remediation, probation, and suspension of privileges.

  • Describe liability issues for medical directors related to labor laws.

  • Give examples of pitfalls related to the handling of HR/ER issues.


There are various models for the relationship between medical directors and the agencies they oversee. These models may alter the expectations, functions, and protection of the medical director. In an employee relationship, the medical director serves as a member of the agency's management team. He or she, like any other manager, may be hired or fired based on relevant employment law. The medical director's status as an employee may afford him or her a degree of liability protection. As independent contractors, however, medical directors may not have these same protections. The scope of their authority, protection, and subsequent liability will vary greatly based on their contracts.

A medical director may also provide oversight for an agency as an employee of a third party. Hospitals, physician groups, or academic programs may contract with outside organizations to provide medical direction. In these cases, the medical director has some degree of employee protection, but ...

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