The position of an emergency medical services (EMS) agency medical director allows the opportunity for a physician to become engaged in the unique and ever-evolving realm of out-of-hospital care, a clinical practice offering a distinct set of challenges, and rewarding impacts in improving a community's emergency medical care abilities. For most, the driving force behind the desire to become an EMS agency medical director stems from a deep passion for helping patients in times of marked acute medical need whenever and wherever the need appears. Yet, understanding the nuances involved in the oversight and direction of an EMS agency requires specialized knowledge, skills, and abilities beyond the typical curriculum of emergency medicine or alternative acute care medical practices. It is for this precise reason that EMS has been recently recognized by the American Board of Medical Specialties as a formal physician subspecialty.