ED Census Declines Leading to PA Staffing Cuts

[ohiovolffemtp]

At my former FT ED job and both of my current PT ED jobs we've had declines in census over the past 2-3 years.  In each case, there have been cuts to the numbers and length of the PA/NP shifts.   The worst was my former FT job where there was a 45% in PA/NP staffing hours per day vs 3 years ago.  One of my PT jobs just announced cuts today.  Some observations:

• In each case, the staffing co's cite a reported nation-wide decline in ED visits of 6% or more.
• At each site, the physician hours are being cut less, if at all.  That seems odd to me because on average in the areas where I work a PA or NP makes about 40% what an EM doc makes.  While Ohio requires a doc to be in the ED at all times, it doesn't require them to see all patients.
• There's a big push at all sites for the doc to chart a face-to-face encounter on as many patients as possible, so the visit can be billed at the 100% incident-to rate vs. the 85% PA/NP rate.

It just seems odd that the staffing cuts hit us harder, even though our cost/benefit ratio is so much better.  I've seen this behavior both from the large national staffing companies and small ones.

Fortunately, at my current FT job - not in Ohio, I'm the only provider in the ED for the 12 overnight hours, so I'm not at risk of being cut since we all are travelers and the docs couldn't do successive 24 hour shifts.

Are other folks seeing this where they work?  Other thoughts?

[MediMike]

I'm guessing the reasoning is multifactorial, not sure what you and your fellow PAs production numbers are but if the docs are cranking out that many more per hour it could be one of the reasons, plus can you imagine the blowback from the major EM organizations if they started cutting MD positions over APPs? I'd guess add in production #s, ability to bill 100% on all patients, and playing nice all together.

While I don't work the ED my wife does and both of her shops are actively hiring MDs and APPs in the PNW.

[Guest HanSolo]

I have heard ED numbers are down in part due to the rise of urgent care. I haven't personally looked into the data on the topic but it seems plausible. 

[EMedPAC]

Our #s have been down over the past couple years due to UCs opening up around us. I think someone gathered they see about 6-10% of the patients we used to see. Fortunately none of the APPs have been fired. However, we have had 2 APPs leave over the past year and management has used that opportunity to cut a PA shift (instead of hiring more to replace them).