Emerson Posted April 16, 2012 Share Posted April 16, 2012 I had a conversation recently with a few of my attendings as it relates to the future of the PA in emergency medicine. My perspective is that there would be an increased presence and scope of the mid-level provider, but they shared a different perspective. They shared a similar opinion as the future of the ED is going to see significant decreases in volume with higher acuity patients. Insurance companies combined with triage screening for what is considered emergent (i.e. France) would direct patients that are non-emergent to local care clinics and urgent cares. With that, he feels the role of the PA will be obsolete in the next 5-8 years as the landscape changes. Physicians will manage less volume with higher acuity and suture techs ($15 /hr) will be trained in varying procedures. I thought i'd open this up for discussion. Link to comment Share on other sites More sharing options...
andersenpa Posted April 16, 2012 Share Posted April 16, 2012 if the docs are already seeing these high acuity pts in the current ED then the only change is a shift of PAs from EDs to UCs. Then these sites will have many PAs with a doc there for supervision. The only real change would be if there are PAs seeing the high acuity pts and they would then lose out after the switch. there is going to need to be a major change for EDs (serious real triage) to keep the fluff cases out though.... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 16, 2012 Moderator Share Posted April 16, 2012 UNLIKELY. Acep (american college of emergency physicians) is very interested in supporting pa's in emergency medicine and see an ongoing role for us. they helped develop the CAQ exam and are involved with developing emergency med pa postgrad programs(there are 16 now with several others in the works). em pa's are here to stay. their roles will vary depending on where they work with the full spectrum represented from triage to fast track to working in main to working solo in rural settings seeing everything. Link to comment Share on other sites More sharing options...
Emerson Posted April 16, 2012 Author Share Posted April 16, 2012 E - Do you have ACEP literature that supports this view? I'd really like to read it if you do. I definitely see the rural PA remaining very active, but the point was that in the future there would be no 'fast track' or patients with low acuity being allowed to be seen in the ED. Insurance companies are certainly going to play a heavy hand in this. We have fast track criteria that allows us to treat and street, but also get involved in higher acuity cases as well. I'd like to start doing some research and provide some ACEP data in order to create a bit of a shift in their current way of thinking if possible. Link to comment Share on other sites More sharing options...
Timon Posted April 16, 2012 Share Posted April 16, 2012 I know I am only a pre-PA but as a former business executive I do not see how this would in any way limit or remove the role of PA's in the next 5-8 years. If anything I can see the scope of practice for PA's expanding as PA's are cost efficient for hospitals. As someone managing a hospital why would I hire 2 Physicians to manage an ER making $210+, and let's say 4 people doing triage / suture tech at $15 an hour when I can hire 1 MD/DO and 4 PA's for the same price and have better quality of care? Current trends for PA's has indicated an increase of role and responsibility over the past 10 years.. based on that trend and the cost benefits of PAs I can only imagine that the roles and responsibilities of PA's only expanding and possibly dipping / decreasing the 20% extra work that physicians do that PAs currently do not perform. The supply of patients can only increase with the amount of baby boomers that will be needing treatment in addition to natural population increases. This would result in an increased demand of mid-level healthcare providers. Although we are all in healthcare to help people, the reality is that this is a business of helping people. From there, as a hospital, we would want to have increased traffic to increase revenue due to the principle of economy of scale. The more patients and services treated / rendered the more revenue a hospital will make especially with the number of patients that will be on medicare and obamacare. The legislation of public healthcare systems and managed care will then dictate elasticity (of how much one is willing to pay for a product or service). Due to this principal, insurance providers, government, and managed care systems will be more stringent on how much services are billed / costs due to hospital efficiency. Because of these reasons I suggest that PA's are really the way of the future with PA's doing most of the work and MD/DO's transitioning more into a supervisory role with PA's acting like middle management. If one were to make a SWOT analysis I would break it down like this from a hospital management perspective (keep in mind I'm doing this on the fly but I could put together a more comprehensive analysis with references if requested): Strength of PA's - Cost efficient - Able to perform 80% of a MD/DO's function - Increased patient services - Increase in patient capacity - Decrease in patient waiting times - Ability to write prescriptions (transcriptions) Weakness of PA's - Less in depth knowledge than a Physician - Relatively new field that some patients have no had exposure to yet - Some patients will demand to see a MD/DO and refuse treatment from PAs Threats - A/NP lobbying to extend into ED - Lobbyist pushing for limited scope of practice for PAs - MD/DO's who view PA's as a threat and will push to increase the amount of physicians - Nurse specialties and techs to divide the role of PA duties Opportunities - Helping managed care decreasing their delay of services rendered to patients - Possibly transitioning into a role similar to NPs of opening their own practice in rural areas with decreased charting from a MD/DO Link to comment Share on other sites More sharing options...
Emerson Posted April 16, 2012 Author Share Posted April 16, 2012 Timon - What percentage of PA's currently working in emergency medicine have the same ability as their attendings to manage ICU players? Your quote on "80%" is in reference to a primary care setting, not emergency medicine. I suspect this conversation will be group specific. If your group utilizes the PA concept to move low acuity patients and to manage fast track, I could see that level of care disappearing for the PA. On the other hand, if you have PA's that can intubate, place central lines, chest tubes, etc I could then see an expanded role - thus, the evolution of ED residencies. Link to comment Share on other sites More sharing options...
Timon Posted April 16, 2012 Share Posted April 16, 2012 I understand that our knowledge is limited in pathophysiology which limits us in most ED. I was under the impression it was at the discresion of that ER in accordance to state laws. That being said I am aware of one ED where PAs have acuity which is in Corona, CA. This is why I was under the belief that the roles and responsibilities of a PA could possibly expand in the future with additional training. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 16, 2012 Moderator Share Posted April 16, 2012 E - Do you have ACEP literature that supports this view? . sent you a pm Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 16, 2012 Moderator Share Posted April 16, 2012 another postgrad program announced today: http://www.carilionclinic.org/Carilion/EM_Fellowship The one-year fellowship program was developed to help meet a growing need for specially trained mid-level providers to treat emergency department patients, said Kim Roe, senior director of the Department of Emergency Medicine at Carilion Clinic. The need for the training is also indicative of the trend toward hiring nurse practitioners and physician assistants to help meet patient need without relying on doctors. In recent years health policy experts have said physician assistants and nurse practitioners will play an increasing role in treating people, especially in rural and underserved regions of the country. Link to comment Share on other sites More sharing options...
primadonna22274 Posted April 16, 2012 Share Posted April 16, 2012 That's interesting E...I have their IM residency on my radar. ;) Link to comment Share on other sites More sharing options...
RetNavyPAC Posted May 15, 2012 Share Posted May 15, 2012 Thanks for the plug :-) We're working on our website right now. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 15, 2012 Moderator Share Posted May 15, 2012 my brain says it makes sense to have PAs in the ER, but after seeing what im seeing here, i actually dont see the kind of future for PA's and NP's there that id like to have. I think you are seeing a regional issue. almost everywhere else is adding pa's/np's. at my last job we stopped using moonlighting residents and replaced them all with pa's. the RESIDENTS were having to staff all their cases WITH THE PA'S anyway so it just made sense to give them the boot. they made more money/hr than the pa's and were about 1/4 as productive. Link to comment Share on other sites More sharing options...
med218 Posted May 15, 2012 Share Posted May 15, 2012 Which area do you live in PAMAC? Link to comment Share on other sites More sharing options...
med218 Posted May 15, 2012 Share Posted May 15, 2012 Well that covers a rather large area. Here in the Atlanta area lots of hospitals employ PAs in their Emergency Departments (Grady, Emory, Emory Midtown, Dekalb - Decatur and Hillandale, Wellstar, Northside, etc...) and there have been recent advertisements for openings as well. I just finished my Emergency Medicine rotation yesterday down in Macon, GA and the ED there has lots of PAs and NPs working there rotating through the various areas and based upon my interaction with the attendings they love having them around. Where I'm from back in Northern New England you'll find many hospitals staffed MDs/PAs during the daytime with PA overnight coverage. It must be a regional thing where you're located. Link to comment Share on other sites More sharing options...
Joelseff Posted May 15, 2012 Share Posted May 15, 2012 Well that covers a rather large area. Here in the Atlanta area lots of hospitals employ PAs in their Emergency Departments (Grady, Emory, Emory Midtown, Dekalb - Decatur and Hillandale, Wellstar, Northside, etc...) and there have been recent advertisements for openings as well. I just finished my Emergency Medicine rotation yesterday down in Macon, GA and the ED there has lots of PAs and NPs working there rotating through the various areas and based upon my interaction with the attendings they love having them around. Where I'm from back in Northern New England you'll find many hospitals staffed MDs/PAs during the daytime with PA overnight coverage. It must be a regional thing where you're located. Well here in California (a pretty big and populous state if u haven't heard) CEP holds most of the ED contracts and hires PAs all year. In fact a good chunk of my graduating class was hired by them so I'm not too worried about pas not staffing EDs. As far as the indy practice thing with NPs, although they are able to in 16 states, IIRC, ONLY 4% of the entire profession do so. BUT THEY CAN SAY "we practice independently in 16 states..." So instead of looking at all the "good" things NPs have and all the "bad" things we have, I guess we should focus on all the positive things going on in PAdom and grow it from there like in Washington, PAs can practice without the "supervision" of a Physician, or that PAs CAN own their own practice (jmj and contrarian and a couple others on here do) and recently Massachussets has recognized PAs as Primary Care Providers etc. It's all on how we spin things. The nursing machine are great spin doctors (err nurses lol) I think we need to take a page from their playbook and start promoting all the good things that are PA! To quote Ella Fitzgerald: "You got-ta AC-Cen-Tchu-Ate the Positive, eliminate the negative....":cool: Sent from my myTouch_4G_Slide using Tapatalk Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 15, 2012 Moderator Share Posted May 15, 2012 Well here in California (a pretty big and populous state if u haven't heard) CEP holds most of the ED contracts and hires PAs all year. In fact a good chunk of my graduating class was hired by them so I'm not too worried about pas not staffing EDs. problem is the cep philosophy is pa's in triage and fast track for the most part, ditto emcare... Link to comment Share on other sites More sharing options...
Timon Posted May 16, 2012 Share Posted May 16, 2012 Just spoke to the CEO of my hospital in So Cal during our orientation and asked him his thoughts of utilizing PAs in the ED at our hospital in the future (we currently staff 0 PAs & NPs with 500 patients a day). He stated that mid level providers are the future for the ED and they are currently working on utilizing them in the near future. Currently there are only1-3 MD/DOs on staff at any given time. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted May 16, 2012 Moderator Share Posted May 16, 2012 Just spoke to the CEO of my hospital in So Cal during our orientation and asked him his thoughts of utilizing PAs in the ED at our hospital in the future (we currently staff 0 PAs & NPs with 500 patients a day). He stated that mid level providers are the future for the ED and they are currently working on utilizing them in the near future. Currently there are only1-3 MD/DOs on staff at any given time. 500 a day in ONE ER?? Jeez Link to comment Share on other sites More sharing options...
coloradopa Posted May 16, 2012 Share Posted May 16, 2012 Just spoke to the CEO of my hospital in So Cal during our orientation and asked him his thoughts of utilizing PAs in the ED at our hospital in the future (we currently staff 0 PAs & NPs with 500 patients a day). He stated that mid level providers are the future for the ED and they are currently working on utilizing them in the near future. Currently there are only1-3 MD/DOs on staff at any given time. Considering that with those numbers you need 8.3 providers covering, I doubt you are meeting guidelines. Or Press-Ganey scores or really any kind of quality measure. Link to comment Share on other sites More sharing options...
xxbowiexx Posted May 16, 2012 Share Posted May 16, 2012 i would be interested in seeing Press-Ganey score on an ER that sees 500 pts a day as well. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 16, 2012 Moderator Share Posted May 16, 2012 i would be interested in seeing press-ganey score on an er that sees 500 pts a day as well. an er that busy probably neither uses nor cares about satisfaction scores...oh no, 3 out of 500 won't come back....lots of really busy , county type facilities opt out of bs like p-g and the joint commission(yes, they are optional) Link to comment Share on other sites More sharing options...
primadonna22274 Posted May 16, 2012 Share Posted May 16, 2012 I assumed it was a typo (50, not 500). We routinely had 130-150/d with 3-4 docs and 4 PAs /24 hr coverage. Terribly inefficient system that could have been managed by 2/3 that staff. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 16, 2012 Moderator Share Posted May 16, 2012 we see around 250/day with a 77 bed er and 12 bed obs unit. we staff 4 pa's and 6 docs/day. at any given time there are 2-3 pa's and 2-3 docs except in the middle of the night and early am when there is just 1 of each. Link to comment Share on other sites More sharing options...
surgblumm Posted May 17, 2012 Share Posted May 17, 2012 I'm with EMEDPA on his first comment. I only practiced EM 24 hrs per week for 16 years but we were the difference between the Doc's going crazy as we handled almost everything that they did and did all the scut work such as suturing and splinting etc. We have an important position on the Trauma team and when I was the AAPA Liaison to the American College of surgeons, we won the right to take the entire course for credit and every class of 16 must have four PAs or NPs in them. Link to comment Share on other sites More sharing options...
treejay Posted May 17, 2012 Share Posted May 17, 2012 .... like in Washington, PAs can practice without the "supervision" of a Physician, .... I hadn't heard this? What does it mean they can practice without the "supervision" of a MD/DO? They don't need to be affiliated with a supervising physician? Link to comment Share on other sites More sharing options...
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