SAEM publishing of Doc vs APP ...authored by USACS et al.

[Frazier]

Saw this posted on another website. The timing is unfortunate as 2021 has already been a pile-on. Posting it here as folks might hear others use it as a citation, good to read.

Funny enough USACS is a credited author.

...As alluded to on other groups, it might make for "gotcha" fodder to the "over-utilization/waste" argument.

Emergency Physician and Advanced Practice Provider Diagnostic Testing and Admission Decisions in Chest Pain and Abdominal Pain (Emergency Physician and Advanced Practice Provider Diagnostic Testing and Admission Decisions in Chest Pain and Abdominal Pain - PubMed )

"Conclusion: Diagnostic testing and hospitalization rates for chest pain and abdominal pain between APPs and physicians is largely similar after matching for severity and complexity. This suggests that APPs do not have observably higher use of ED and hospital resources in these conditions in this national group."

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[NYEMMED]

Saw this posted on another website. The timing is unfortunate as 2021 has already been a pile-on. Posting it here as folks might hear others use it as a citation, good to read.

Funny enough USACS is a credited author.

...As alluded to on other groups, it might make for "gotcha" fodder to the "over-utilization/waste" argument.

Emergency Physician and Advanced Practice Provider Diagnostic Testing and Admission Decisions in Chest Pain and Abdominal Pain (Emergency Physician and Advanced Practice Provider Diagnostic Testing and Admission Decisions in Chest Pain and Abdominal Pain - PubMed )

"Conclusion: Diagnostic testing and hospitalization rates for chest pain and abdominal pain between APPs and physicians is largely similar after matching for severity and complexity. This suggests that APPs do not have observably higher use of ED and hospital resources in these conditions in this national group."

Of course they would write this.
USACS’s entire staffing algorithm is based on 1 Attending “supervising” several Midlevels on shift (sorry won’t say APP or APC).

 

[blue.jay]

In many countries around the world, Registrars/Medical officers who staff ER/casualty are non-residency trained medical school mbbs grads. They triage pts as medical vs surgical for admission and do basic urgent care stuff much like PA/NP. US is the only country to have a robust EM training and own board certification/speciality but seems like US healthcare system is drifting to third world country style by having these NP/PA click on bunch of order sets, scan whatever part of the body the patient complains, give a dose of vanc/zosyn for anyone with any infection and admit generously thereby minimizing the value of residency training. The true value of the training dealing with very sick patients, STEMI, cardiac arrest doesn‘t happen too regularly to justify staffing ED with fully MDs

Perhaps, looking back EM should have been 1-2 yr fellowship after FM thereby giving graduates more flexibility.

 

[RustedFox]

In many countries around the world, Registrars/Medical officers who staff ER/casualty are non-residency trained medical school mbbs grads. They triage pts as medical vs surgical for admission and do basic urgent care stuff much like PA/NP. US is the only country to have a robust EM training and own board certification/speciality but seems like US healthcare system is drifting to third world country style by having these NP/PA click on bunch of order sets, scan whatever part of the body the patient complains, give a dose of vanc/zosyn for anyone with any infection and admit generously thereby minimizing the value of residency training. The true value of the training dealing with very sick patients, STEMI, cardiac arrest doesn‘t happen too regularly to justify staffing ED with fully MDs

Perhaps, looking back EM should have been 1-2 yr fellowship after FM thereby giving graduates more flexibility.

I would have done this for sure.
FM residency with an EM-add on or "track".

 

[alpinism]

In many countries around the world, Registrars/Medical officers who staff ER/casualty are non-residency trained medical school mbbs grads. They triage pts as medical vs surgical for admission and do basic urgent care stuff much like PA/NP. US is the only country to have a robust EM training and own board certification/speciality but seems like US healthcare system is drifting to third world country style by having these NP/PA click on bunch of order sets, scan whatever part of the body the patient complains, give a dose of vanc/zosyn for anyone with any infection and admit generously thereby minimizing the value of residency training. The true value of the training dealing with very sick patients, STEMI, cardiac arrest doesn‘t happen too regularly to justify staffing ED with fully MDs

Perhaps, looking back EM should have been 1-2 yr fellowship after FM thereby giving graduates more flexibility.

Ehhh having worked extensively overseas they're not really comparable to our midlevels at least in my experience.

Medical officers are basically general practitioners who've completed medical school and internship but haven't chosen a specialty.
The closest analogy would be family physicians that work shifts in the low acuity section of a typical american emergency department.

 

[cyanide12345678]

Ehhh having worked extensively overseas they're not really comparable to our midlevels at least in my experience.

Medical officers are basically general practitioners who've completed medical school and internship but haven't chosen a specialty.
The closest analogy would be family physicians that work shifts in the low acuity section of a typical american emergency department.

Agreed. The registrars and medical officers in Pakistan have at least done 5 years of medical schools and one year of post graduate training (called house job in Pakistan) where they are seeing 40-50 patients a day sometimes. After that, they are considered general practitioners - the equivalent of what most states have in the US to practice medicine. Most people in the US can get a state medical license after one year of post graduate training and step 3. They have medical licenses, but can't be board certified without a residency. So the training is still far superior to that of a PA/NP.

 

[WilcoWorld]

Can we please discuss the actual study?

The docs appear to have seen significantly tougher cases (as appropriate). Does anyone know if their "adjustment" was legit, or just an after the fact shoehorning of data into the previously developed conclusion?

"To reduce selection bias, we created inverse propensity score weights (IPWs). To estimate the average treatment effect for APP visits for each outcome, we included IPWs in a multivariable linear probability model with a dummy variable indicating treatment by an APP and used a facility fixed effect."

I don't know enough about propensity matching to say...otherwise I'll be forced to have my hot take - "When you factor in the dummy variable APP's = docs"

 

[bravotwozero]

Who sponsored the study?