AAEM releases position statement on NP and PA residency

[LT_Oneal_PAC]

Continuing with their brand, they demonstrate commitment to dividing the team by putting others down and intruding into the advancement of education of others. No matter what you do, you can’t make them happy. Not enough training, but no you can’t train with us. We are supposed to lead you, but not to be better. You’re a danger to patients, but we can’t allow you to have the knowledge that would help you. F these guys.

https://www.aaem.org/resources/statements/position/em-training-programs-for--pas-and-nps?fbclid=IwAR2Mv2_KCL55OXUtxwI1sfyJ0I83aeBNaT3XcP5vYspVCq8qRjPJk3hI6xc

[Joelseff]

Continuing with their brand, they demonstrate divide the team by putting others down and intruding into the advancement of education of others. No matter what you do, you can’t make them happy. Not enough training, but no you can’t train with us. We are supposed to lead you, but not to be better. You’re a danger to patients, but we can’t allow you to have the knowledge that would help you. F these guys.
https://www.aaem.org/resources/statements/position/em-training-programs-for--pas-and-nps?fbclid=IwAR2Mv2_KCL55OXUtxwI1sfyJ0I83aeBNaT3XcP5vYspVCq8qRjPJk3hI6xc

They don't want us playing in their yard but want to tell us how to play in our yards.

Sent from my SM-G975U using Tapatalk

[LT_Oneal_PAC]

24 minutes ago, Joelseff said:

They don't want us playing in their yard but want to tell us how to play in our yards.

Sent from my SM-G975U using Tapatalk
 

Yep

[dfw6er]

so this all started over on reddit when someone saw that UNC was going to start a PA PGY fellowship and pay the PA fellows more than the ER residents.  They were all sorts of pissed off and all sorts of BS facts about PAs were being circulated.....especially that PAs "fellows" were stealing procedures and cases from the ER residents wherever one of these PA fellowships coexisted w/ ER residencies.  

Apparently it caused such an uproar that UNC took the page down and posted that they were not going to go through with it.   Then it caused AAEM and the RSO to release their own position regarding PA fellowships.

TL;DR.....they're pissed PA fellows make more than them, they're pissed PA fellows "steal" valuable learning cases from them, they're pissed PAs are trying to become independent.

Edited February 27, 2020 by dfw6er

[Guest Paula]

I thought AAEM had positive policies for PA/NP in the past but apparently I'm wrong.  Unless they are now changing their tune.  It's sad that medicine has these type of reactions rather than to take a look at the way medical education is delivered in today's modern health care climate.  I would like to see PAs becomes the independent PCP of the future and do away with physician PCP's.  If physicians are soooo smart then they can continue in the specialties and PAs can shine in primary care, EM and surgical fields with residencies.

 

 

[dfw6er]

The NPs moving towards DNP degrees, independent practice attainment in more and more states, and dubious studies showing their care is equivalent to or superior to physicians has really left a bad taste in the mouth of the physician residents and attendings.  Many of them already think NPs and PAs are the same thing so you can see the problem there.  Add to that talk on forums from PAs stating they want complete independence as well and the anti-MLP movement is naturally gaining traction.  

Also there's the exponential growth in both PA programs and NP programs....and many of the NP programs are online and have very low standards of education/training.  Then what was it?  YALE, IIRC....opens up a damn online program.....I think that was a huge mistake personally.  Then the physicians find out they're underpaid compared to those with lesser education than them during residency and that the PGY "fellowships" might be taking cases and procedures away from them in residency, then the "fellowship" trained PAs might take their jobs in the ER because they work for less.........well, it's the perfect conditions to set up this newfound position by AAEM/EMRA, etc.

It's not going to get better unless the NPs are reigned in so the PAs aren't forced to ask for independence to remain viable employment candidates.  The PA fellowships need to rethink the nomenclature for their trainees too.  AGME ER residencies also need to pay the residents better.  60K per year for a PGY-3 resident is laughable considering the amount of interest their loans are accruing.  

[ventana]

AAEM and AAEM/RSA Position Statement on Emergency Medicine Training Programs for Physician Assistants (PAs) and Nurse Practitioners (NPs)

AAEM and AAEM/RSA are aware that academic and other emergency departments sponsor additional training for PAs and NPs. We believe the following is in the best interest of the patient and our specialty.

AAEM and AAEM/RSA recommendations for emergency medicine based training programs for PAs and NPs.

We believe that such programs:

1. Should be clear to the public by avoiding the use of the following terms: doctor, intern, internship, resident, residency program, fellow, fellowship. 
2. Should be structured, intended or advertised as to prepare its participants to practice only as members of a physician-led team.
3. Should not interfere with the educational opportunities of emergency medicine residents and medical students.
4. Should be initiated with the consultation of the residents and faculty.

 

Approved: February 26, 2020

[LT_Oneal_PAC]

1 hour ago, Paula said:

I thought AAEM had positive policies for PA/NP in the past but apparently I'm wrong.  Unless they are now changing their tune.  It's sad that medicine has these type of reactions rather than to take a look at the way medical education is delivered in today's modern health care climate.  I would like to see PAs becomes the independent PCP of the future and do away with physician PCP's.  If physicians are soooo smart then they can continue in the specialties and PAs can shine in primary care, EM and surgical fields with residencies.

 

 

You’re probably thinking of ACEP, which has typically been “Pro” PA, and I by that I mean That have not been anti-PA.

[LT_Oneal_PAC]

49 minutes ago, dfw6er said:

The NPs moving towards DNP degrees, independent practice attainment in more and more states, and dubious studies showing their care is equivalent to or superior to physicians has really left a bad taste in the mouth of the physician residents and attendings.  Many of them already think NPs and PAs are the same thing so you can see the problem there.  Add to that talk on forums from PAs stating they want complete independence as well and the anti-MLP movement is naturally gaining traction.  

Also there's the exponential growth in both PA programs and NP programs....and many of the NP programs are online and have very low standards of education/training.  Then what was it?  YALE, IIRC....opens up a damn online program.....I think that was a huge mistake personally.  Then the physicians find out they're underpaid compared to those with lesser education than them during residency and that the PGY "fellowships" might be taking cases and procedures away from them in residency, then the "fellowship" trained PAs might take their jobs in the ER because they work for less.........well, it's the perfect conditions to set up this newfound position by AAEM/EMRA, etc.

It's not going to get better unless the NPs are reigned in so the PAs aren't forced to ask for independence to remain viable employment candidates.  The PA fellowships need to rethink the nomenclature for their trainees too.  AGME ER residencies also need to pay the residents better.  60K per year for a PGY-3 resident is laughable considering the amount of interest their loans are accruing.  

Disagree except residents should be paid better. 
 

 they don’t own the term residency. We’ve been using it for 30 years. If it hasn’t created problems yet then it’s not going to. We have established precedent using this term. I really don’t care about the term “resident” other than it’s the principle of the matter. We decide what it’s called. Not them. 
 

Also, I have just as much right to these procedures as they do. They do not determine my scope of practice. I work in a CAH where I see all comers as a solo provider. Not having access to all educational opportunities, then I might miss out on something that could save someone’s life one day. They can’t say out of one side of their mouth I’m under train, then decry me trying to get that training, then pout about my numbers. 
 

you will never get the approval of physicians at large. Their advocacy groups aren’t meant for us, so they will always fundamentally be opposed to us. It’s time we determined our own destiny. While that may include some form of collaboration, which I think it should, it should be how we see fit, not them.

[lemurcatta]

Complain that we only have 2,000 hours of clinical training, then become outraged over the internet about our efforts to increase clinical training. The AAEM only exists to protect their own interests. 

[medic25]

2 hours ago, LT_Oneal_PAC said:

You’re probably thinking of ACEP, which has typically been “Pro” PA, and I by that I mean That have not been anti-PA.

Agreed; between the two organizations, AAEM has always been the more anti-PA or NP organization.  The recently updated their position statement on APPs, and at the same time dissolved their "allied health" membership category that had allowed for APPs to join, feeling that it was against their philosophy to allow non-physicians to be a part of the organization.

[ProSpectre]

1 hour ago, LT_Oneal_PAC said:

they don’t own the term residency. We’ve been using it for 30 years. If it hasn’t created problems yet then it’s not going to. We have established precedent using this term.

Yea there's a new post on r/medicine about this, it shows the first program was in 1971. So that's pushing 50 years. Definitely precedent for use of the term. 

[GMM2019]

Have to admit... the meltdown on Reddit has been very entertaining to me lol. Have never seen so many triggered 20 something year olds.

I'm convinced that med school is just one giant crap shoot anyway these days. All the physicians I work with just have their kids do research with a MD colleague or shadow them. Easy peasy recommendation letters and resume fillers. You help my kid, I help yours. Have literally never seen so much nepotism, and this is technically considered a top hospital system... One MD's son works as a healthcare admin manager in the practice.... gee, wonder how he got that job. 

Edited February 27, 2020 by GMM2019

[PAtoMD]

Here is a well written post by a PA on r/medicine in response to all the recent negative posts on Reddit. I thought it was well spoken and researched.

[kargiver]

AAEM has been, and continues to be, difficult in dealing with regarding relations with other providers and getting along in the sandbox.  When dealing with them politically in the past, they have always maintained the sanctimonious position that docs are the "be all, end all" of healthcare and everything revolves around them.  When presented with real issues, their parroted line has always been "a board certified MD/DO has to be in charge."  Of course, this is completely devoid of reality, just as their various position statements are, but they sure are good at fanning the flames... 

Their collective approach has always struck me as that of a spoiled child not getting their way and throwing a tantrum about it.  and so it continues...

G

 

[PACali]

On 2/27/2020 at 8:14 AM, kargiver said:

AAEM has been, and continues to be, difficult in dealing with regarding relations with other providers and getting along in the sandbox.  When dealing with them politically in the past, they have always maintained the sanctimonious position that docs are the "be all, end all" of healthcare and everything revolves around them.  When presented with real issues, their parroted line has always been "a board certified MD/DO has to be in charge."  Of course, this is completely devoid of reality, just as their various position statements are, but they sure are good at fanning the flames... 

Their collective approach has always struck me as that of a spoiled child not getting their way and throwing a tantrum about it.  and so it continues...

G

 

How is their membership status? more or less than ACEP? Does any know. ACEP is at least willing to work with us. 

[TexasPA28]

On 2/26/2020 at 10:47 PM, ProSpectre said:

Yea there's a new post on r/medicine about this, it shows the first program was in 1971. So that's pushing 50 years. Definitely precedent for use of the term. 

 

The first MD residency program was created in 1893 at Johns Hopkins by Dr Osler and Dr Halsted.  

Back then residency was real/legit as they were REQUIRED to live in the hospital.  There was none of this "sign in/sign out" or work hours shiftwork nonsense.  Residents were required to take care of their patients 24 hours a day, 7 days a week, 365 days a year.

 You can see the original resident rooms in the old hospital building on campus.  Back then, residency was not done for a prescribed number of years -- it was a continuous exercise that lasted until the preceptors determined that the resident had seen enough of a broad variety of cases to "graduate."  Some internal medicine residents stayed for 8 or 9 years before moving on.

Nowadays, residency, both for MDs and PAs, is a joke.  It's nothing close to the original.  

The term "residency" needs to be dropped for both MDs and PAs.  It doesn't describe what "residents" do anymore.

[Guest Paula]

Awesome history lesson on residency.  The term could be changed to clinicals.....but then the nurses would have a cow. 

[fishbum]

1 hour ago, Paula said:

Awesome history lesson on residency.  The term could be changed to clinicals.....but then the nurses would have a cow. 

To further muddy the waters, our hospital system has a "nurse residency" program for new RNs. Basically training in a particular unit as far as I'm aware.

[cinntsp]

The "public" is not confused about a PA or NP using the term resident or fellow any more than they are when pharmacists, grad students, or anyone else uses them.

Also...it's not our problem that physician residents have low salaries.  It isn't a reflection of PA encroachment or whatever. Their salaries have always been low.

[GMM2019]

Change PA residency to "squireship"... the MD/DO people haven't claimed that as theirs yet!  

[kargiver]

20 hours ago, PACali said:

How is their membership status? more or less than ACEP? Does any know. ACEP is at least willing to work with us. 

I don't know the exact numbers - they aren't published anywhere and last I knew was 2013-14 numbers.  ACEP was bigger then - I suspect its bigger now. Certainly been around much longer.  There is a lot of in-fighting between AAEM and ACEP - I consider ACEP real world and AAEM the academy.  Like most in the academy, they are out of touch with reality... and so it goes.  

ACEP has at least accepted the reality that working with APPs is the future and that the idea that a board certified ED physician can and will staff every ED in the country isn't realistic.  There is a lot of angst behind the scenes politically about APP encroachment but as time has shown, it just isn't warranted.  When dealing with groups around the country, I came to the conclusion that most APPs self-select to lower acuity positions (they actually buy into what is taught to them that they don't know it all and aren't expected to) and it's the rare breed that steps into the role of "independent level" practice in any ED setting and is able to flourish.

G

[sas5814]

10 hours ago, GMM2019 said:

Change PA residency to "squireship"... the MD/DO people haven't claimed that as theirs yet!  

Lets change nothing but call it indentured servitude. Maybe they will shut up.....

[rpackelly]

The term “resident” is not currently legally exclusive.  If you look at a number of state practice laws “holding out” legislation legally prohibits individuals from identifying themselves by certain terms like doctor, physician, physician assistant, PA, etc.   Resident has not been one of those terms in any state I have examined.  So the AAEM can opine however they want but they have absolutely no authority in the matter.