This presentation introduces a model for operational medical direction tailored to the challenges of large-scale, multidomain combat operations. It emphasizes the critical need for enhanced medical skills and increased autonomy among medics, facilitated through comprehensive medical direction. The model encompasses oversight of care, adherence to standards, credentialing, training, skill sustainment, competency assessment, and quality improvement. Central to this approach is the establishment of a standardized entry-level scope of practice and interoperability across military and federal healthcare systems. The presentation explores the unique partnership between privileged providers and medics, advocating for standardized competency assessments like those used for providers. It discusses adapting civilian emergency medical services standards to military environments and outlines ongoing U.S. Army initiatives to expand medic roles, including the development of permanent and advanced practice paramedics. The model addresses challenges in skill maintenance, reviews protocol-based medical screening and treatment, and highlights efforts to fill identified gaps in Army Medicine. Future developments in Army Combat Medic roles and physician military education are examined, along with an analysis of policies and practices across sister Services and the VA. The presentation emphasizes the role of operational Senior NCOs in implementing clinical safety concepts and adapting aviation medicine principles to enhance combat survivability. It concludes by stressing that while physician supervision is crucial, it doesn't replace individual medic certification, competency, and responsibility, underscoring the need for medical directors to continually assess and adjust medic skills and scope of practice.