From ACEP's Rural Section- with good mention of SEMPA and the future of EMPAs

[dkuhns1]

Workforce Crisis in Rural EDs Accelerates -Rural Emergency Medicine Section Newsletter, September 2012

 

Randolph Knight, MD

“Who will staff the Emergency Departments of rural America?” wonders John Rogers, MD, past head of the Rural Section of ACEP.

In his new role as a Director of ACEP, Dr. Rogers brings his perspective as a longtime Emergency Physician practicing in rural Georgia. And what he’s seeing is a widening workforce deficit appear at hospital after hospital

“A lot of the rural physicians are reaching retirement age now. How you will replace them is a big issue. Some states are now seeing a change from physician staffing (in Emergency Departments) to nurse practitioners or physician assistants,” says Dr. Rogers.

Because of his experience providing Emergency care in a rural setting, Dr. Rogers brings an important voice to the deliberations taking place among ACEP’s leadership. And he believes that the Board of Directors is more mindful than ever of the unique challenges facing hospitals in America’s heartland. Dr. Rogers is just finishing his first year of three years’ election to the Board of Directors.

The biggest shift in mindset, Dr. Rogers notes, is that the Board of Directors is aware that they are responsible for Emergency care for the public, regardless of the setting. He says that the needs of ruralEmergency Medicine doctors is no longer a neglected corner of ACEP. “The College has adopted a philosophy that they’re responsible for Emergency care everywhere, and that includes rural Emergency care.”

Thus, there are extensive and ongoing conversations taking place among the Directors about the workforce crisis in rural hospitals. One link that Dr. Rogers has been able to point out is that once the trend toward mid-level providers takes hold in rural hospitals, there may be a temptation among hospital administrators, abetted by state and federal officials, to extend the trend toward suburban and urban settings as well. This would effectively displace a large portion of the current Emergency Department physician workforce.

“Why not get the cheapest personnel who can ‘do the job,’” states Dr. Rogers, identifying the temptation before politicians now debating the future of physician payments. “Why wouldn’t they apply that thinking to a metropolitan area?”

And yet, quality, safety and performance issues need to be continuously examined, he says. “Can one physician be effectively monitoring 4 or 5 mid-levels?,” asks Dr. Rogers. “I wonder about quality and safety in that situation.”

One solution Dr. Rogers and the Board of Directors envision for supporting rural Emergency Care is the expansion of telemedicine. The Telemedicine Section will have an increasing role in educating ruralEmergency doctors in how to simultaneously serve understaffed EDs and keep treatment standards high. Part of the enhanced role of Telemedicine will require changes in federal rules governing Critical Access Hospitals, Dr. Rogers says. And to that end, he has the ear of an unnamed Midwestern US Senator who shares his vision. No legislation currently exists, Dr. Rogers says, but the gears of change are starting to turn.

Another long-term goal is better training of the physician assistants who will work in rural Emergency Departments, Dr. Rogers says. He notes that there now exists a Task Force involved in outreach to the Society of Emergency Medicine Physician Assistants, SEMPA. The Task Force and SEMPA pledge to help work out details for a curriculum tailored to PA needs. Mindful that physician assistants get two years of post-undergrad training as opposed to eight years for doctors, Dr. Rogers sees a vital role in the College accepting the reality of mid-levels in rural EDs. “It is not practical at this time to staff every ED with residency-trained and board-certified Emergency Physicians. It’s a nice goal, but what are we going to do in the meantime?” he wonders.

One goal of the Rural Section of ACEP has been to increase the exposure to rural care issues by EM residents. Dr. Rogers says several impediments remain before this goal can be achieved. The issue of money is central: CMS funds for graduate medical education, vital for maintaining academic Emergency Medicine departments, would be threatened with departure of residents to rural rotations, Dr. Rogers notes. There is also the issue of supervision: residents must have supervision by approved faculty. Yet credentialing and insuring the staff in a rural hospital to facilitate training residents poses logistical challenges. The rules of the ACGME’s Residency Review Committee (RRC) do not currently permit telemedicine support to qualify as appropriate supervision. Dr. Rogers hopes to start that conversation.

As the leadership of Emergency Medicine prepares to convene in Denver this fall, Dr. Rogers promises, issues of real importance to the College’s rural members will continue to have a voice at the highest levels.

[EMEDPA]

great news for pas who work in critical access/rural environments. Thanks for posting David.

[kargiver]

More good fruits from the labors of building relationships with our physician colleagues. Thanks for posting this, David.

 

G