AAEM Position on APPs

[enalli]

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You were talking about having the proverbial knife in your back, kinda makes you out to be a victim with that proverbial scenario.

Okay, you got me...you're tougher than me. congrats.

Did you even bother to read what I wrote? Yes, I believe physicians are the victims in this situation, to use your wording (I also believe PAs are victims, for what it's worth). Stop getting hung up on the word "victim." It's just a word, no one will come to take your Man Card away. That's not the phrasing I would use (you're the one who brought it up on the first place), but it's not an entirely wrong description of the facts. I don't give a **** about being tougher than you, we're all adults here, not teenagers trying to get street cred.

 

[doctalaughs]

Somehow all these other countries (almost all 1st world nations on earth) have managed to provide healthcare to more of their citizens for lower cost without resorting to lesser-trained providers proliferating and providing semi-independent care. US taxpayers are getting a raw deal - pay more for less experienced and lesser trained people taking care of them.... cut it any way you want, there is NO way thats a good thing or something our country should be proud of.

 

[Rowdy Burns]

NPs currently have a bunch of bills in the Arkansas Legislature that will be heard before the health subcommittee.

As for Swami, he is stuck in the academic world and so out of touch with reality and the vast majority of physicians it ain’t even funny. He should stick to making podcasts.

 

[NicMouse64]

NPs currently have a bunch of bills in the Arkansas Legislature that will be heard before the health subcommittee.

As for Swami, he is stuck in the academic world and so out of touch with reality and the vast majority of physicians it ain’t even funny. He should stick to making podcasts.

There are hearings all over the country. You will soon be competing for jobs with NPs in at least 25 states.

 

[WilcoWorld]

I don't know if any of you are active on Twitter, but here is a response from Swami of EMRAP fame regarding AAEM's statement:


This is why physicians lose. Every. Single. Time.

We live in a society where we are so politically correct that we can't say "NP training is inadequate." This is not a personal attack on the individual NP or their character. But if you are talking about patients, it's a fair point to bring up.

As a physician, I know my limitations, within my own profession. If a patient needs a crich and I have a trauma surgeon/ENT standing next to me, I am going to defer to them ever single time to do it, because I fully concede that they are more experienced than I am, and they have better training when it comes to a surgical airway than I do. They have done more hours of surgical airway training than I have. I don't go around saying, "We should be allowed to do crich's independently without trauma surgery supervision".

If midlevels truly cared about patient care, they would own up to the fact that experience matters. Medical school is the most competitive specialized schooling to get into in the country for a reason. Just like I give it up to the surgeon who has given up their careers to practice the surgical airway, I don't see why midlevels can't do the same for physicians.

I know midlevels will play it as the physicians who have the fragile ego's, but in reality, it's them. I am confident that my training is solid because medical school and a medical residency is literally the gold standard. If midlevels want to create something similar and put in MORE time training than physicians, be my guest and I will gladly support them in their quest for independent practice.

Off topic, but EMRAP jumped the shark around 2017 if you ask me.

 

[Zebra Hunter]

Off topic, but EMRAP jumped the shark around 2017 if you ask me.

Coincidentally around the time that Mel took a step back from doing segments and they brought Swami on. Also around the time that they started trying to market towards mid-levels.

 

[TooMuchResearch]

Off topic, but EMRAP jumped the shark around 2017 if you ask me.

Agree, quality went really down hill around the time they started referring to the listeners as providers.

 

[d2305]

With the majority of the new PAs being women, It wouldn't surprise me if NP/PA merged. Kind of like DO/MD.

 

[WilcoWorld]

With the majority of the new PAs being women, It wouldn't surprise me if NP/PA merged. Kind of like DO/MD.

This reads as a non sequitur to me, care to explain the connection in greater detail?

 

[jw3600]

This reads as a non sequitur to me, care to explain the connection in greater detail?

It's, at best, a stupid logical train to follow. At worst, it's pretty damn sexist.

 

[MechEDoc]

NP/PA won't merge in the foreseeable future. They come from different tribal lineages.

 

[BoardingDoc]

With the majority of the new PAs being women, It wouldn't surprise me if NP/PA merged. Kind of like DO/MD.

You're implying that the main difference between PA programs and NP programs is their respective gender composition?

 

[d2305]

It used to be PAs were mostly male and NPs were mostly female. Now new PAs are mostly female and NPs mostly female. The training is different, but the end result is the same (more or less). "Times they are a changin."

 

[MechEDoc]

collaboration indicates an equal level of training and knowledge. Double speak, ever heard of it? They are just using buzzwords that have no meaning to hide their true intentions. Independent practice. That's the goal and they are slowly moving goalposts. This was never the intention of those who started the PA profession. The idea was to be closely supervised in the medical model. Not "collaborating" or whatever words you decide to come up with today or tomorrow to mean "equivalent" and "independent" or "evil doctors" etc. etc.

This! I collaborate with surgeons, IM, neurology, etc, in the care of a patient. In rare cases I collaborate with NPs and PAs. Most of the time, I supervise and review their work. Surgeons don't send notes for me to co-sign as a collaborator. People who's actions I can direct do send notes for me to sign in attestation.

 

[8741empls]

This reads as a non sequitur to me, care to explain the connection in greater detail?

This is the Latin way to say, “that’s the dumbest thing I’ve read in a long time.” Right?

 

[Kuratz]

My sister will soon be a BSN grad. We recently had a conversation whereby she was very excited to tell me that she could do an "ER"-NP program completely online for the first two years... and get to keep working full time! And she only has to do ten, 40 hr weeks of rotations for her clinical component. This genuinely blows my mind. We now have NPs with very little floor experience coming through and wanting to practice independently after a less-than-rigorous didactic curriculum based in the nursing mindset followed by 400 clinical hours. There is also a very low barrier to entry to begin with. There is no way in hell I would allow a loved one to be treated solely by an MS3 who had just finished their first rotation, and yet we have people treating patients who arguably don't even have this level of knowledge and experience. I just about **** my pants when I confirmed this on the NP program's website. It's a respected university too. Unbelievable. I will however give the nursing lobby credit for allowing such a patently ridiculous situation to even fathom seeing the sunlight. It's obvious to any physician that this is dangerous and unacceptable because we understand the complexity of medicine cannot be remotely mastered in 400 hours. But the problem is that the general public has zero concept of medical knowledge. Pretty easy to convince them that it doesn't take 7 years to learn to prescribe antibiotics for an ear infection, and by proxy anything else than can walk into an office. NPs effectively capitalized on this and know where to play their cards. I hope docs can start to win back the "narrative" from this insanity. Because it is insanity and frankly unfair to patients.

As an aside I pushed my sister on how she thought this could prepare her for the career she envisioned. "Why should I hire someone from that program when I could hire someone like my wife (who is a PA student) who has a very structured intense curriculum and a full year+ of clinic"....Her: "Huh, good point" (As if the quality of training had never dawned on her)
Come to find out many of her nursing preceptors who had completed an NP program were still working as floor nurses since they couldn't find a job. They are hypersaturating the market with every young nurse seeing an easy path to more money and seemingly no gatekeeper. Quality is at an all time low. Perfect time to be assertive.

 

[Boatswain2PA]

all you say is true then what's so bad about the AAEM position?

I dont have major heartache with it. I think it's a little over the top on a few things though. EPs in every ED? Only way to do that is change definition of an ED, or change requirement for hospitals to have an ED. Most places I work you cant find an BC EP within 100 miles.

With the majority of the new PAs being women, It wouldn't surprise me if NP/PA merged. Kind of like DO/MD.

NPs could probably put PAs out of business if they improved their educational process to become comparable with PA programs. Unfortunately for us all, there is race to the bottom instead.

 

[Boatswain2PA]

This! I collaborate with surgeons, IM, neurology, etc, in the care of a patient.

So do I, every shift.

 

[NicMouse64]

So do I, every shift.

The use of confusing and double speak language to conflate the physician profession with the NP/PA professions is probably the most successful achievement of the two professions thus far.

 

[doctalaughs]

So do I, every shift.

This is a comment on the system (not your personal ability). I’m a specialist and every time I see a consult that comes from a midlevel I think “great, this is going to be a super easy one.”

I’m right about 90% of the time. And usually its because they haven’t consulted their supervising doc who would likely already know the answer. Do I get super obvious easy consults from physicians? Sure, but it’s more like 20%.

I’m not complaining - its easy money. I’ll take the consult fee for my 60 seconds of time. But sort of sad for our patients and our system. I cant imagine how much worse this will be with complete lack of any legal requirement for formal supervision.

 

[KeikoTanaka]

This is a comment on the system (not your personal ability). I’m a specialist and every time I see a consult that comes from a midlevel I think “great, this is going to be a super easy one.”

I’m right about 90% of the time. And usually its because they haven’t consulted their supervising doc who would likely already know the answer. Do I get super obvious easy consults from physicians? Sure, but it’s more like 20%.

I’m not complaining - its easy money. I’ll take the consult fee for my 60 seconds of time. But sort of sad for our patients and our system. I cant imagine how much worse this will be with complete lack of any legal requirement for formal supervision.

This has been one of the AOAs biggest advocacy points against the proliferation of independent NP/PA practicing in various states. It might "Save" the hospital money in the short term, but the amount of specialists who will be getting paid more will hurt them in the long run.

 

[deleted109597]

I dont have major heartache with it. I think it's a little over the top on a few things though. EPs in every ED? Only way to do that is change definition of an ED, or change requirement for hospitals to have an ED. Most places I work you cant find an BC EP within 100 miles.

How do they find BC pathologists? BC surgeons? BC anesthesia?
Oh, that's right. They value those positions and feel it's worthwhile. They give zero ****s about the ER.

 

[wholeheartedly]

This has been one of the AOAs biggest advocacy points against the proliferation of independent NP/PA practicing in various states. It might "Save" the hospital money in the short term, but the amount of specialists who will be getting paid more will hurt them in the long run.

But I've never met an admin who can grasp the concept of things being "penny wise and pound foolish"so I wouldn't expect them to get a clue any time soon.

It's also going to be interesting to see what happens to the patient perspective when all of a sudden these midlevels who've pushed for parity can no longer spend more time with patients and instead have to push patients through fast just like the docs. There will be a lot less "NP's spend more time with me and listen better."

 

[alpinism]

How do they find BC pathologists? BC surgeons? BC anesthesia?
Oh, that's right. They value those positions and feel it's worthwhile. They give zero ****s about the ER.

ERs have never been valued by the rest of medicine.

That's why they used to be staffed by moonlighting interns before EM was started as a specialty.
Its also why we continue to fight turf wars and take merit badge classes over 40 years later.

 

[MechEDoc]

These small, rural ERs value their own existence infinitly over patient care. Their volume are too small (usually less < 30k) per year to fully afford continuous BCEM staffing. Their payor mix sucks, the support staff is mediocre, the town is a little rough, and it becomes obvious as to why they cannot staff their ERs with qualified staff. If patient care was valued, then some of these hospitals should cease operations (depending on their geographic location) and others will have to limp along as they are so far removed from larger population centers that it is better to accept poorer quality local care than endure long prehospital trips.

I have worked in a variety of these towns doing the firefighter thing for two different CMGs (hopefully never again). I have consistently found the hospitals to provide poor quality care, poor pay, the towns had below average schools, and the opportunity to having meaningful social groups is low. Most all the physicians commuted from elsewhere. Rather than facing these challenges head on, these hospitals limped along in a very dysfunctional manner and churned through physicians.

 

[TheComebacKid]

I don't understand why we need BCEM staffing in these rural EDs. I would take FM/IM physicians working in these places over NP/PA any day. And I do believe there are A LOT of people in those fields who are interested in working in an ED.

Our hospital gets transfers from these rural EDs, which almost always involves a NP on the phone who is really confused when you ask if they can get more access than a 22 in the hand prior to transferring an anemic and hypotensive patient with bleeding varices.

 

[GonnaBeADoc2222]

How do they find BC pathologists? BC surgeons? BC anesthesia?
Oh, that's right. They value those positions and feel it's worthwhile. They give zero ****s about the ER.

Wait there's no opportunity for surgery or pathology fellowship after FM residency? What if they spent a lot of time as a kid with a microscope?

🤣

 

[deleted109597]

These small, rural ERs value their own existence infinity over patient care. Their volume are too small (usually less < 30k) per year to fully afford continuous BCEM staffing. Their payor mix sucks, the support staff is mediocre, the town is a little rough, and it becomes obvious as to why they cannot staff their ERs with qualified staff. If patient care was valued, then some of these hospitals should cease operations (depending on their geographic location) and others will have to limp along as they are so far removed from larger population centers that it is better to accept poorer quality local care than endure long prehospital trips.

But again, they have no problem hiring pathologists (required). Sure, some of them might not have cardiology, and the ICU might by staffed by the FM hospitalist. I've worked in lots of them as well. This is why these places shouldn't have hospitals, but instead simply FSEDs and transfer to tertiary centers. Nobody in their right mind would want to stay at these veterinary hospitals, so we shouldn't keep propping them up.

 

[Boatswain2PA]

I don't understand why we need BCEM staffing in these rural EDs. I would take FM/IM physicians working in these places over NP/PA any day. And I do believe there are A LOT of people in those fields who are interested in working in an ED.

Our hospital gets transfers from these rural EDs, which almost always involves a NP on the phone who is really confused when you ask if they can get more access than a 22 in the hand prior to transferring an anemic and hypotensive patient with bleeding varices.

I would take a professional EM PA over a FP in an ED. (Caveat- I am talking a FP who has done nothing but FP, not a FP with recent/significant ED experience).

 

[Fox800]

I would take a professional EM PA over a FP in an ED. (Caveat- I am talking a FP who has done nothing but FP, not a FP with recent/significant ED experience).

C0lor me shocked.

 

[TooMuchResearch]

I don't understand why we need BCEM staffing in these rural EDs. I would take FM/IM physicians working in these places over NP/PA any day. And I do believe there are A LOT of people in those fields who are interested in working in an ED.

Our hospital gets transfers from these rural EDs, which almost always involves a NP on the phone who is really confused when you ask if they can get more access than a 22 in the hand prior to transferring an anemic and hypotensive patient with bleeding varices.

You haven't met the non-BCEM physicians my group has replaced. :scared face: Not saying PA would definitely be better, but I wouldn't let those folks near my family.

 

[Indebt4Life]

The "data" that suggests that midlevels are equivalent to physicians is BS. Garbage in equals garbage out. We are trying to put together the same garbage research studies to hand to legislators that will just read the title and assume it's legit.

 

[Indebt4Life]

Go support AAEM on facebook. Glad that they deleted all the hateful reviews from midlevels. Shocked?!? They must have learned that move from AANP who does the exact same thing. The AANP blocks people who don't support them. I am glad these organizations are feeling the heat. It's time for physicians to take back medicine.

 

[VA Hopeful Dr]

You haven't met the non-BCEM physicians my group has replaced. :scared face: Not saying PA would definitely be better, but I wouldn't let those folks near my family.

Yeah there are lots of midlevels I'd trust in the ED before me

 

[NicMouse64]

Yeah there are lots of midlevels I'd trust in the ED before me

Would you feel the same way if you pursued the one year EM fellowship?

 

[VA Hopeful Dr]

Would you feel the same way if you pursued the one year EM fellowship?

That depends: did I do the fellowship 10 years ago and haven't done EM since? Did I finish 2 years ago and have worked in a fairly busy ED since? Do I only work alternating Tuesdays that coincide with a waxing moon? Are hypotheticals stupid?

 

[NicMouse64]

That depends: did I do the fellowship 10 years ago and haven't done EM since? Did I finish 2 years ago and have worked in a fairly busy ED since? Do I only work alternating Tuesdays that coincide with a waxing moon? Are hypotheticals stupid?

I'm asking mainly if someone were to do EM in a small rural hospital full-time. I didn't mean specifically, but more from your experience whether these Fm->EM fellowships at least minimally prepare a FM for EM practice.

 

[VA Hopeful Dr]

I'm asking mainly if someone were to do EM in a small rural hospital full-time. I didn't mean specifically, but more from your experience whether these Fm->EM fellowships at least minimally prepare a FM for EM practice.

I have never actually met anyone who has done one of those fellowships. The only FPs I've seen in the EDs where I've worked (which were obviously not small rural ones as it was in residency and med school) were guys who had been working in EDs since the 80s.

 

[MechEDoc]

I would take a professional EM PA over a FP in an ED. (Caveat- I am talking a FP who has done nothing but FP, not a FP with recent/significant ED experience).

While I'm mixed on this one, I believe that there is lots of merit to this argument. With good telemedicine and aggressive training and protocols to design out certain aspects of EM (e.g. intubation is rarely needed when one can place a LMA, LPs can be skipped -> Abx and transfer*, IO instead of central line, RIC instead of cordis and on and on), I think smaller ERs could provide higher care than now, but would have to transfer out more patients.

In the above fantasy, I would use good PAs hands down over FP (they'd get all butt hurt, mismanage, etc), and possibly good NPs (they are out there!).

*I'm aware of normal pressure hydrocephalus, but that can be transferred too!

 

[CajunMedic]

I don't understand why we need BCEM staffing in these rural EDs. I would take FM/IM physicians working in these places over NP/PA any day. And I do believe there are A LOT of people in those fields who are interested in working in an ED.

Anybody get emails from the ACEP Rural EM section message board? There's been a discussion going on all day about this very thing. Then somebody on the Board of Directors dropped this little bomb. Not sure if it's a thinly veiled threat, or not.

"I want to encourage open dialogue and discussion but I would also like to focus the group on the task force that was previously requested and potential objectives you would like to come out of it by working collaboratively with other organizations. I understand some of you feel passionately about Associate Membership, and while I admire your passion, our membership and our Council have spoken decisively and voted against it.That is not going to change. If the Section goes in that direction with a resolution, the discussion on improving rural EM will not go forward. My advice would be to keep the discussion patient, not provider, focused."

 

[Rowdy Burns]

I thought this was comical, any other time you’d have to tear that white coat off of their lifeless body

 

[NicMouse64]

I thought this was comical, any other time you’d have to tear that white coat off of their lifeless body

Lol so they pretty much just admitted that is why they wore the white coat. Nice.

 

[jw3600]

“Lab coat.” These people lol.

 

[d2305]

Pathology will be one of the first to be replaced by AI. Paps are already automated. I still wouldn't want my LP done by a machine.

 

[KeikoTanaka]

All these

Pathology will be one of the first to be replaced by AI. Paps are already automated. I still wouldn't want my LP done by a machine.

AI Will only ever enhance or augment the physician, enough of this replacing lol. It'll make one Pathologist super efficient. It'll maybe ruin some job prospects, but never replace. You still need someone to prepare the slides, dye, etc. etc. Then, you confirm what the AI thinks. It'll make you faster.

 

[enalli]

Pathology will be one of the first to be replaced by AI. Paps are already automated. I still wouldn't want my LP done by a machine.

All this talk about computers replacing pathologists and radiologists is hard to take seriously when they can only somewhat manage ECGs. You're trying to tell me the machines* that can barely keep up with 12 squiggly lines are really close to cracking the code of histology slides and CTs? Ohhhkayyy

(*I know it's not the same machines/algorithms; just let me have this.)

 

[Greoric]

All this talk about computers replacing pathologists and radiologists is hard to take seriously when they can only somewhat manage ECGs. You're trying to tell me the machines* that can barely keep up with 12 squiggly lines are really close to cracking the code of histology slides and CTs? Ohhhkayyy

(*I know it's not the same machines/algorithms; just let me have this.)

Respectfully, you're grossly underestimating what AI will be able to do even within our life times. In short, literally NO job is safe from automation. The "dumb" AI will take over labor tasks (they're already taking over transportation, the single biggest employer of highschool educated men). No, simple AI won't be able to perform the physician's, or the NP's or the PA's job. But when AI meets the qualification of AGI (Artificial General Intelligence), watch out. Nothing is safe.

 

[Rekt]

Respectfully, you're grossly underestimating what AI will be able to do even within our life times. In short, literally NO job is safe from automation. The "dumb" AI will take over labor tasks (they're already taking over transportation, the single biggest employer of highschool educated men). No, simple AI won't be able to perform the physician's, or the NP's or the PA's job. But when AI meets the qualification of AGI (Artificial General Intelligence), watch out. Nothing is safe.

11 year old account, second post ever is to bump a five month old thread and post about how AI is going to take over medicine? nice.

I've been on the internet since before I could even read and every single year it's constantly stated how AI and/or automation is going to takeover X. This year is always the year!

The world is about the same. Sure, factories and warehouses are more automated. Sure there's a couple cars finally that can drive themselves after thirty years, but it's not widespread and is a long way off from automating transportation completely, let alone getting into healthcare. '

The biggest barrier for automation and AI isn't technology, it's litigation and regulation.

 

[scummie]

11 year old account, second post ever is to bump a five month old thread and post about how AI is going to take over medicine? nice.

I've been on the internet since before I could even read and every single year it's constantly stated how AI and/or automation is going to takeover X. This year is always the year!

The world is about the same. Sure, factories and warehouses are more automated. Sure there's a couple cars finally that can drive themselves after thirty years, but it's not widespread and is a long way off from automating transportation completely, let alone getting into healthcare. '

The biggest barrier for automation and AI isn't technology, it's litigation and regulation.

I'd like to see AI work up "demented old lady weakness". Let me know how that turns out, I'll bring the popcorn.

 

[scummie]

I dont have major heartache with it. I think it's a little over the top on a few things though. EPs in every ED? Only way to do that is change definition of an ED, or change requirement for hospitals to have an ED. Most places I work you cant find an BC EP within 100 miles.

Absolutely! People assume that when they come to an ER they are going to see a doctor. They assume that they are board certified in that specialty. You don't go see someone to do your bypass without assuming they are actually a board-certified surgeon with years of training. Notice why the CT surgery mid-levels do floor stuff? They're not second assist in the OR. If we don't protect our turf, you're going to see people arguing why we can't be replaced for a lower cost.

I totally agree with the position every single ER should be staffed with BC/BE EM physicians. Why is this okay for our specialty but not any other? Why do we allow people not certified or trained in our specialty to practice what we do? I'm not going to FM clinics pretending to know which statin to give somebody or new inhaler for their COPD should be given. Hospitals can get away with hiring people not qualified to be in EM because there are no consequences or significant oversight! We need to put our foot down. Hospitals don't want to pay what they need to in order to secure the right staffing. And that's not just in the ED but in many aspects of the hospital. Nurse staffing shortage, anyone?

Stay out.