EP monthly article by Greg Henry

[EMEDPA]

Boat, I agree, I think the CAQ will become a requirement before residency.

I think eventually it will be required to do a residency to be caq eligible....several of the current programs have their residents take it at the end of the program.

[GreatChecko]

what fast track only job isn't?

 

Where did the idea that this was a fast track only job come from? It's definitely not.

[Evolute]

One of my jobs gave me better privileges (equivalent to ED doc) based on having the caq. my newest job is the result of someone cold calling me because they saw my name on the caq recipients list.

E, glad to hear this, expanded scope/privileges can do nothing but move our profession foreword.

 

I had an interesting conversation the other day. Bare with me for the back story, its relevant....I think.

My experience is as an emt/paramedic x nearly 10 years. PA x 7+ years all in rural EM/hospitalist, where I have been the solo provider with mostly doc back up by phone only. So when I gave them a copy of my CAQ cert they literally said thanks, I'll put it in your file.

 

So anyway a few weeks ago I apply for a locum job in an urban ED about 200 miles form my house. I'm talking to the recruiter (on the phone) she tells me she is "looking at your CV" as we are talking. She then goes on to state multiple times that "we need to be sure" that the PA's are "qualified" to "work in the er". After the third or forth time she stated that, I pointed out the fact (it states on my CV) that I have a CAQ in EM (Im positive she was diligently reading my CV...lol). After which she completely changed her tone. She literally went from what makes  you think you are qualified to work in our er....to "oh you are more then qualified".

 

Anyway, that was an eye opener

[EMEDPA]

E, glad to hear this, expanded scope/privileges can do nothing but move our profession foreword.

 

I had an interesting conversation the other day. Bare with me for the back story, its relevant....I think.

My experience is as an emt/paramedic x nearly 10 years. PA x 7+ years all in rural EM/hospitalist, where I have been the solo provider with mostly doc back up by phone only. So when I gave them a copy of my CAQ cert they literally said thanks, I'll put it in your file.

 

So anyway a few weeks ago I apply for a locum job in an urban ED about 200 miles form my house. I'm talking to the recruiter (on the phone) she tells me she is "looking at your CV" as we are talking. She then goes on to state multiple times that "we need to be sure" that the PA's are "qualified" to "work in the er". After the third or forth time she stated that, I pointed out the fact (it states on my CV) that I have a CAQ in EM (Im positive she was diligently reading my CV...lol). After which she completely changed her tone. She literally went from what makes  you think you are qualified to work in our er....to "oh you are more then qualified".

 

Anyway, that was an eye opener

yup. although the caq is not a "board certification" in em, it is what docs understand as the closest thing available. if I was director of an ed I would look first for folks who had done a residency and had a few years of experience and next at folks with experience + caq and last everyone else....not to say that there are not experienced folks with neither, but as a marker for dedication to the field it's hard to beat a residency or caq.

[Simplify]

I think eventually it will be required to do a residency to be caq eligible....several of the current programs have their residents take it at the end of the program.

E-

 

Curious as to what programs these are?  My understanding is that  a residency doesn't meet the hours requirement for the CAQ because of the time spent on off-service rotations (even 18 month programs).  

[EMEDPA]

E-

 

Curious as to what programs these are?  My understanding is that  a residency doesn't meet the hours requirement for the CAQ because of the time spent on off-service rotations (even 18 month programs).  

many of the ny programs. 18 months spent in an EM residency does meet the requirement because the off-service rotations are part of an em curriculum.

[kargiver]

This puff piece by Dr. Henry is geared towards academic and large ERs with high volumes where attendings are aplenty.  ACEP is sticking its head in the sand, and so is SEMPA frankly, by not discussing and dealing with the reality that we have two healthcare systems in this country - the one in the cities and the one in the sticks.

 

"Incident to" billing has been the bailiwick of what ACEP has been using as its supervisory clause to see what monitor what all PAs do. Otherwise, hospitals cannot bill at 100% for our services.  This is redundant and a waste of time, particularly for truly ESI 4-5 patients.  3s are condition or patient specific, and 2/1s are required usually as MDs can admit, PAs cannot (most bylaws for hospitals).  Now, come to the country, or roughly 50 miles or so from any civilization.  I do not present to anyone, and do all my own consults with the medical mecca 50 miles away, stabilize and transport anything critical that comes through the door, and we bill appropriately for it.  And our outcomes are equal to or better than the other hospitals in our state.  This is a danger to ACEP as it shows, convincingly, that it can be done.  Here's the rub:

 

Most people don't want that level of responsibility.  If they did, they would have gone to med school.  I have heard it from FAR too many people coming through my shop who cannot last 6 months, even with intensive support.  That's the reality - they don't want it.  In my estimation, it is roughly 4-5 percent of EM PAs who want that degree of latitude and responsibility.  So the market is responding.  But it doesn't change the reality of rural medicine, where many PAs go - they now are lacking the experience necessary to even walk in the door. 

 

Ours is a tale of 2, possibly 3 professions woven into one.  If I had my druthers, I'd have a graduated system to autonomy so those who want to progress.  But we have covered this a million times on the board.

 

G
 

[ohiovolffemtp]

There are a couple of key points here:

1. ESI code or even patient's initial acuity is not completely correlated with the need for physician involvement in their care.  It really depends upon the complexity of the patient, their co-morbid conditions, etc.  An extreme example is a non-breathing opiate OD.  ESI 1 or 2 - until the narcan takes effect, then a 4 hour obs.  There are many PA who were or sometimes still are paramedics who have done this for years.  Even coding someone is pretty straight-forward.  Post resuscitation support - much more complicated.
2. The real issue is the decision on which PA needs to present which type of patient to the attending.  That must be decided at the practice level for the individual PA.  For example, I'm on the path to get independent intubation priviledges (just might have something to do with the fact that I've been intubating in trailer parks for years :) ).  Central lines on the other hand will be a much longer time coming.   I have a colleague, former CV PA - who has never intubated but is great at central lines.  Having a ceiling like they describe hurts PA's and significantly slows ED throughput.