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[thegenius]

A question I have is ARE THERE DIFFERENCES in outcomes between EDs who staff with BC/BE EPs, EDs who staff with non BC/BE EPs, and EDs who staff with PA/NPs? I know the NPs have poorly done research inferring no differences, but has ACEP/AAEM done any research on this?

If there are no differences in outcomes, then perhaps we should do things differently....

Please present this evidence

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[BoardingDoc]

What are you talking about?

I assume that petegriffin works in TX and is trying to keep new grads away in the hope that this will protect his/her current rates. Or they were trying to be comical and met with limited success.

 

[jw3600]

Hearing these horror stories makes me glad that our NP's and PA's are good. Seriously, they accurately apply clinical decision rules, have appropriate workups, etc. One last night told me "I know they're PERC negative and their Wells is 0, but something tells me they have a PE. Can you go see them?" I saw them, agreed, and told him to order the CTA. Large bilateral PE's.

We get it. You love midlevels and the money they make you and your department.

 

[thegenius]

It's a pretty ridiculous argument to suggest that outcomes for all ER patients is the same with someone of 2 years training vs. 8 years. Outcomes are probably true for Fast Track patients or those seen at an Urgent Care, but I would argue that those patients probably didn't even need to be there in the first place. I question whether Urgent Cares actually improve the quality of health in this country, it has been argued that they do not (I'm trying to find the link).

I do agree it's sad that if hospitals want to have Neurosurgery, Cardiology, Oncology, Nephrology, etc. they get doctors who are board certified in those fields. But for the ED? Just staff it with anyone...because emergency services are apparently not that important.

 

[deleted941485]

It's a pretty ridiculous argument to suggest that outcomes for all ER patients is the same with someone of 2 years training vs. 8 years. Outcomes are probably true for Fast Track patients or those seen at an Urgent Care, but I would argue that those patients probably didn't even need to be there in the first place. I question whether Urgent Cares actually improve the quality of health in this country, it has been argued that they do not (I'm trying to find the link).

I do agree it's sad that if hospitals want to have Neurosurgery, Cardiology, Oncology, Nephrology, etc. they get doctors who are board certified in those fields. But for the ED? Just staff it with anyone...because emergency services are apparently not that important.

Idk man. When I read the notes from my NSX referring doc. The first person there is a PA banging out the consult.

They are locusts and they are everywhere.

 

[miacomet]

Yet they won't work nights....

 

[deleted941485]

Yet they won't work nights....

.

If You inject enough of these MLPs through the educational system, they will start working nights because that is their only option.

 

[Boatswain2PA]

It's a pretty ridiculous argument to suggest that outcomes for all ER patients is the same with someone of 2 years training vs. 8 years.

I certainly have not made that argument. Just wondered why ACEP/AAEM hasnt done studies to prove the better outcomes. Seems that could go a loooooong way toward defending your profession.

Yet they won't work nights..

Mlps certainly do have better shifts than EPs.....generally. I do equal day and night shifts, with all the circadian disturbances.

 

[miacomet]

.

If You inject enough of these MLPs through the educational system, they will start working nights because that is their only option.

They will just avoid ER and pick another field. Midlevels have a unique ability to avoid the more unpleasant aspects of medicine.

 

[Birdstrike]

They will just avoid ER and pick another field. Midlevels have a unique ability to avoid the more unpleasant aspects of medicine.

I could never live with myself, if I pushed my kids into becoming an MD and then they were unhappy and blamed me. So I've promised myself I'll stay neutral on it, and let them make up their own minds, if not gently nudge them away from it. But I'm much more inclined to give a thumbs up on a mid-level track for this exact reason. The ceiling on salaries may be lower, but it also seems there's a lower ceiling on the misery.

Maybe that's a "grass appears greener on the other side" thing, but it definitely seems that way, from my vantage point.

 

[miacomet]

I could never live with myself, if I pushed my kids into becoming an MD and then they were unhappy and blamed me. So I've promised myself I'll stay neutral on it, and let them make up their own minds, if not gently nudge them away from it. But I'm much more inclined to give a thumbs up on a mid-level track for this exact reason. The ceiling on salaries may be lower, but it also seems there's a lower ceiling on the misery.

Yup. You just don't have to fully adult.

 

[TooMuchResearch]

They will just avoid ER and pick another field. Midlevels have a unique ability to avoid the more unpleasant aspects of medicine.

Our group does seem to have a high attrition rate for recent PA school grads. They leave for daytime hours, urgent care, surgical something or other without call, etc.

 

[miacomet]

Our group does seem to have a high attrition rate for recent PA school grads. They leave for daytime hours, urgent care, surgical something or other without call, etc.

Yup. They all want to work in the Urgent Care, then they realize it involves weekends....

 

[deleted109597]

I certainly have not made that argument. Just wondered why ACEP/AAEM hasnt done studies to prove the better outcomes. Seems that could go a loooooong way toward defending your profession.

I don't have to. The standard is BC in the speciality you're working in for everything but EM (and sometimes ICU). This needs to change.

 

[miacomet]

I don't have to. The standard is BC in the speciality you're working in for everything but EM (and sometimes ICU). This needs to change.

Well, since most midlevels aside from Boatswain won't work off hours, irrelevant. They need to improve the work ethic, or leave.

 

[deleted941485]

I could never live with myself, if I pushed my kids into becoming an MD and then they were unhappy and blamed me. So I've promised myself I'll stay neutral on it, and let them make up their own minds, if not gently nudge them away from it. But I'm much more inclined to give a thumbs up on a mid-level track for this exact reason. The ceiling on salaries may be lower, but it also seems there's a lower ceiling on the misery.

Maybe that's a "grass appears greener on the other side" thing, but it definitely seems that way, from my vantage point.

If my children pick medicine, they better get a nice scholarship because I’m not paying for it. I just think that all those years of overachieving, lost opportunities, and self denial should get you somewhere more than stuck as a cog in a machine run by idiots who got a degree in bussiness management and spent most of their time at the frat house and mindlessly regurgitating some pseudo intellectual garbage about free markets or meaningless buzzwords that only give the appearance of intelligence.

 

[emergentmd]

If my children pick medicine, they better get a nice scholarship because I’m not paying for it. I just think that all those years of overachieving, lost opportunities, and self denial should get you somewhere more than stuck as a cog in a machine run by idiots who got a degree in bussiness management and spent most of their time at the frat house and mindlessly regurgitating some pseudo intellectual garbage about free markets or meaningless buzzwords that only give the appearance of intelligence.

I agree that medicine is a great sacrifice of time and stress that you can not put a number on. But most high paying fields, including C suites, also make great sacrifices.

The sacrifices you make in your 20's is made up for the high pay you get in your 30's and beyond.

For every Lawyer that banks $1mil sitting on his Yacht there are 1,000 making 80K slopping away at redundant paperwork working for "the man = Yacht guy" never to make even 100K
For every engineer making 500K+/yr at Google or Microsoft, there are 1,000 making 80K working at lesser known companies with much less job security topping out at 150K
For every C suite CEO making $1 mil/yr, there are 1,000 making 80K trying to climb the corporate ladder kissing A$$es along the way never making it to the $1 mil mecca.
For every Doc making $1mil/yr owning their own practice/clinic/lab/SDG/surgical center/ER, there are 1,000 docs making 300K+ working for the "man"

I am willing to sacrifice my 20's to be guaranteed a 300K payday working for/under the "man" vs making 80K working/under their "man"

Anyone who doesn't own their own practice or makes the ultimate decision essentially works for some "man"

 

[emergentmd]

I certainly have not made that argument. Just wondered why ACEP/AAEM hasnt done studies to prove the better outcomes. Seems that could go a loooooong way toward defending your profession.

This is comical and shows your lack of insight.

I know fire is hot and can burn, I don't have to prove it by putting my hand in a fire.
I know that divorce will suck you dry, I don't have to get one to prove my finances would take a hit.
I PAs would suck running an ER, I don't have to staff an ER with all PAs to prove it.

If PAs are so great, I think your society should do a study showing that PAs are EM's equal. Why don't they? Because they would be kicked out of the C suite and don't want dead bodies all over the ER.

I have had shifts where I saw 15 pts my 1st hour. I have had shifts where I saw 40+ patients in 8 hrs. I have had shifts where I had 3 codes requiring intubation, central lines all coming in 15 minutes. I handled all of this because I am EM trained and do not need to pause because I was unsure. There is ZERO PAs I have ever seen who could handle any of these 3 situations. I know many EM docs who would have no trouble dealing with these 3 situations.

 

[Boatswain2PA]

Glad you know all that.

Got some studies that would prove it to adminiscritters who dont care about what you think you know?

 

[GonnaBeADoc2222]

Glad you know all that.

Got some studies that would prove it to adminiscritters who dont care about what you think you know?

Proof does not matter. All that matters is $$$.

 

[Alvarez13]

Glad you know all that.

Got some studies that would prove it to adminiscritters who dont care about what you think you know?

Maiming and killing patients is considered unethical by many research societies and world governments.

 

[MechEDoc]

Glad you know all that.

Got some studies that would prove it to adminiscritters who dont care about what you think you know?

Team Health is pretty up front that there are larger payout for FM in the ED than BCEM. The didn't publicly parse out data by PA/NP vs BCEM vs MD/DO NOS.

 

[thegenius]

Glad you know all that.

Got some studies that would prove it to adminiscritters who dont care about what you think you know?

I want to read them