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Thoughts on EM PA Residencies Heard at SEMPA


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Last week I attended the SEMPA virtual conference.  The statements that have come from AAEM, ACEP, EMRA, and other organizations about opposing the use of the terms residency and fellowship for formal post-graduation training programs as well as advocating for limiting and ensuring close physician supervision of EM PA's and NP's came up a number of times.  Here are some of the perspectives I heard:

  • From a former ACEP president who has worked extensively with PA's: her perspective was that this was being driven by fear in current EM residents and younger EM docs about economic issues: limited job opportunities, potential for lower income, etc.  While she wouldn't speak about supervision per se, she was very supportive of PA's and didn't want more supervision.  Her perspective was that the economic fears should be addressed by seeking additional practice locations for EM docs, e.g. telemedicine, corrections, etc.  She also felt that as these docs had more contact with PA's and the quality care they provide that they might change their tune.
  • From Dr. Mel Herbert, founder of EM:RAP: similar, that these statements were being driven by economic fears.  He didn't think that there was much to be gained by directly confronting these statements, but instead recommended continuing to provide good care which would speak for itself.
  • From Vituity, an EM staffing company that sponsors at least 4 EM PA residencies: they have no plans to cut their training programs and may increase them.  They are not going to change from calling them residencies.  They don't have any plans to put out public statements, but aren't changing course.  They feel that their programs produce quality practitioners they want to hire.
  • From USACS: they definitely value EM PA's (coming from a former SEMPA president who's a VP with Vituity).  They have had discussions about whether to make a public statement or if so what to say, but no decisions yet.
  • From the SEMPA president: there are no plans for SEMPA to make public statements, instead focusing on having representation at various task forces, e.g. ACEP's future EM workforce group - where SEMPA is represented.

My take:

  • EM PA residencies will continue, and probably grow slowly.  Their names and use of the terms "residency/fellowship" won't change.
  • The anti-PA & NP statements from these organizations will continue - driven by economic fear, though couched in other terms publicly.
  • These statements won't change the hiring practices of EM staffing groups.  Though from my perspective, these do often priorities retaining physician hours over PA/NP hours.
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  • 1 year later...

My take: there is no recorded evidence that EMPAs decrease quality of care in the ED. Most of the scope creep issues come from the NP side. We PAs understand our position and our profession and where we fit in the healthcare system. 
 

I do not know any PAs with doctoral degrees who misrepresent themselves as “doctors”. Further education of PAs and NPs for that matter should be seen as a way to improve care and decrease negative outcomes. We will never be able to achieve the level of income a physician is able to get. We are and those pursuing the PA profession should be ok with. 

our training mirrors that of a physician and we do require more patient contact hours, this equates to better patient care. A formal academic degree producing training should be a requirement for those seeking to work in high paced / demand clinical environments such as the ED.

The current standard for this is the Army-Baylor EMPA program. PAs and NPs are an integral part of our nation's healthcare system, we lead the world in patient outcomes and access to care, anyone who disagrees has no experience outside of the US.

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