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- Oct 1, 2014
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Hi all,
Long time reader here. I have appreciated the collective wisdom on this board for years.
I'm a new attending (2014 grad) and am working at a rural ED in California. Closest tertiary hospital is 50 miles, closest university quaternary hospital is about 150 miles.
We're busy for a rural hospital, ~55k visits/year.
My job is ok overall, the nursing staff is actually pretty great, the ancillary staff is hit or miss, as are the hospitalists/specialists. Double coverage physician staffing during the day, single coverage at night, which honestly is absolutely brutal.
My real question is about midlevel (an accepted term where I work, not meant to be derogatory) supervision. Our ED has about half of the patient volume seen in a "rapid care" area where patients are seen, treated, and dispositioned by PAs and NPs. Supervision is indirect. PAs/NPs can ask for help on a patient, or ask a clinical question, but it is entirely up to them to choose to do so. On an average shift, I get 20-30 charts to sign for patients seen by the PA/NP, and I have probably been told about one or two of them.
I am expected to sign these charts without having the opportunity to see the patient. Many have been gone for 6+ hours by the time I see the chart. Charting by these providers is minimal, with no real medical decision making/ED course documented. Most of the cases are truly low acuity, ESI 4/5 cases, but there is the mix of back pain in the ~50 yr old population, febrile infants, epigastric pain in ~45 year old patients, "mechanical fall" in the elderly, etc., that on the surface are simply and low acuity, but have the potential for disastrous underlying pathology.
PAs/NPs sign the charts, give them to me, then leave. I have the opportunity to call the patient back and ask questions, but that is difficult in the setting where I am seeing over two patients per hour in a high acuity setting.
I am curious if this is a common scenario in rural settings with shortages of ED docs, or is this a crazy scenario. My gut says that this is the very definition of a high risk scenario that could have devastating outcomes for patients and my personal professional career (from a medical legal standpoint). I am told by some that this is very common, that I should get used to it as it's the wave of the future. I would like some feedback from other attendings - is my gut right, and I should flee, or is this "the real world" that they didnt talk about in residency?
Sorry for the long post, and thank you for any responses.
Long time reader here. I have appreciated the collective wisdom on this board for years.
I'm a new attending (2014 grad) and am working at a rural ED in California. Closest tertiary hospital is 50 miles, closest university quaternary hospital is about 150 miles.
We're busy for a rural hospital, ~55k visits/year.
My job is ok overall, the nursing staff is actually pretty great, the ancillary staff is hit or miss, as are the hospitalists/specialists. Double coverage physician staffing during the day, single coverage at night, which honestly is absolutely brutal.
My real question is about midlevel (an accepted term where I work, not meant to be derogatory) supervision. Our ED has about half of the patient volume seen in a "rapid care" area where patients are seen, treated, and dispositioned by PAs and NPs. Supervision is indirect. PAs/NPs can ask for help on a patient, or ask a clinical question, but it is entirely up to them to choose to do so. On an average shift, I get 20-30 charts to sign for patients seen by the PA/NP, and I have probably been told about one or two of them.
I am expected to sign these charts without having the opportunity to see the patient. Many have been gone for 6+ hours by the time I see the chart. Charting by these providers is minimal, with no real medical decision making/ED course documented. Most of the cases are truly low acuity, ESI 4/5 cases, but there is the mix of back pain in the ~50 yr old population, febrile infants, epigastric pain in ~45 year old patients, "mechanical fall" in the elderly, etc., that on the surface are simply and low acuity, but have the potential for disastrous underlying pathology.
PAs/NPs sign the charts, give them to me, then leave. I have the opportunity to call the patient back and ask questions, but that is difficult in the setting where I am seeing over two patients per hour in a high acuity setting.
I am curious if this is a common scenario in rural settings with shortages of ED docs, or is this a crazy scenario. My gut says that this is the very definition of a high risk scenario that could have devastating outcomes for patients and my personal professional career (from a medical legal standpoint). I am told by some that this is very common, that I should get used to it as it's the wave of the future. I would like some feedback from other attendings - is my gut right, and I should flee, or is this "the real world" that they didnt talk about in residency?
Sorry for the long post, and thank you for any responses.