Are EMs in the same boat as FM physicians?

[BostonEmergencyMed]

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My sole ambition is to become an emergency medicine physician in my home state of Massachusetts.
The adrenaline from being in an emergency situation. The excitement from not knowing what to expect. And the satisfaction of helping those who have found themselves in an unfortunate predicament.

However, I am very big on job security. I don't care if my salary drops -- but I don't want to be unemployed.
I have heard that NPs and PAs assuming the role of family practice physicians is common practice now, and I was wondering if the same goes for EM physicians.

I intend on practicing in an urban environment, and in a hospital setting.

My question is: Do I have anything to worry about? I just want to live comfortably and do what I love. I don't expect to drive an exotic car, or live in a lavish home. I just hope I can practice where I want, and not have to worry about nurses taking my job.

Thanks.

 

[namethatsmell]

My sole ambition is to become an emergency medicine physician in my home state of Massachusetts.
The adrenaline from being in an emergency situation. The excitement from not knowing what to expect. And the satisfaction of helping those who have found themselves in an unfortunate predicament.

However, I am very big on job security. I don't care if my salary drops -- but I don't want to be unemployed.
I have heard that NPs and PAs assuming the role of family practice physicians is common practice now, and I was wondering if the same goes for EM physicians.

I intend on practicing in an urban environment, and in a hospital setting.

My question is: Do I have anything to worry about? I just want to live comfortably and do what I love. I don't expect to drive an exotic car, or live in a lavish home. I just hope I can practice where I want, and not have to worry about nurses taking my job.

Thanks.

You may find your thoughts on your second paragraph change over time, but as best as anybody can foresee I wouldn't worry about your third paragraph/job security.

 

[RustedFox]

Pre-med?

Dude, worry about getting into, and then "through" medical school, first.

I like your fire; but until you've done an MS3-level rotation, there's an overwhelming probability that you don't know what it is that you're getting into. Maybe you've shadowed; maybe a family member is an EP. But its different when you're actually doing it for real.

I say this because I know for sure that my "sole ambition" changed radically from pre-med to match.

 

[cbrons]

I have heard that NPs and PAs assuming the role of family practice physicians.

NPs and PAs are not physicians, so they are not assuming the role of a physician, family practice or otherwise.

 

[RustedFox]

Don't everyone go and beat up on him (not that you did, cBrons - but I can see how its easy to do so). His question is legit - and with all the chatter about NPs vying for solo practice rights in certain places, he's not completely off the mark.

I really... REALLY thought that my sole ambition was internal medicine when I was at your stage. Maaaaan, was I EV-er wrong.

 

[takeurmeds02]

Meh, it would be interesting to see if and how the scope of NP/PA's changes within the next few years. They do okay by themselves for the lower acuity things in the ER with some informal consults from the other ER docs from time to time. But I couldn't see NP/PA's doing much more though. Obviously, this could change depending on how those programs evolve in how they train their students.

(my experience as an ER scribe)

 

[WilcoWorld]

If you get into and through med school and residency you will have plenty of jobs open to you. However, you do specify that you want to work in an urban environment in Mass, and it might be tough to find a decent job in Boston.

 

[Angry Birds]

There is no foreseeable threat from NPs/PAs. Our job is way too high risk for them to take it over.

As for Boston, you will be able to find a job within 30 min of the city, if not in the city itself.

 

[Tecmo Bowl]

MDs/DOs who aren't EM trained, and weren't grandfathered in, that work in the ED, put the hospital at a huge malpractice risk. This risk is only multiplied for non MDs/DOs. It is for this reason why most hospitals will never allow NPs/PAs to solo practice in the ED. There is also the aspect of system based standard of care. People expect that when the come into an ER anywhere in the country for an actual emergency, that an MD/DO will treat them.

 

[Angry Birds]

Let me tell you that even after four years of residency I still feel that I have to give it my 150 percent every day because of how sick patients can be. I doubt an NP or PA would WANT this sort of responsibility.

 

[deleted480308]

My EM professor always says it like this, "some people are cool with getting antibiotics from an NP/PA but when your grandma gets wheeled in with a car door hanging out of her chest they all call for the doctor"

 

[swamprat]

I think this is a premed/med student worry. I Used to think that as well however now living it as a second year resident I'm very far from concerned about mid levels taking over our job. It's not easy, you need to know a lot and the majority of mid level providers I have met don't have close to the level of knowledge or experience to even comfortably deal with many fast track patients without popping over to our side to discuss the case with one of us.

 

[The White Coat Investor]

F _ _ _ _ M_ _ _ _ _ _ _ P _ _ _ _

 

[Daiphon]

F _ _ _ _ M_ _ _ _ _ _ _ P _ _ _ _

Can't you just do a search for this? d;-)

 

[deleted547339]

F _ _ _ _ M_ _ _ _ _ _ _ P _ _ _ _

Lemme get that C

 

[emergentmd]

Nothing to worry about. I would say 95% of EM trained docs can handle the ED load. 10% of well trained and experienced NP/PAs can handle the ED load. 0% of inexperienced NP/PAs can handle the ED load.

So where are you going to find all of these well experienced NP/PAs?

Currently, ED boarded docs have unsurpassed job security. I can literally find 20 jobs tomorrow if i wanted. I get weekly cold calls to help out, daily emails on job openings. Staffers texting me to help cover shifts.

I could literally work 30 days this month if I wanted to. That is how short EM docs are.

 

[exsanguination]

MDs/DOs who aren't EM trained, and weren't grandfathered in, that work in the ED, put the hospital at a huge malpractice risk. This risk is only multiplied for non MDs/DOs. It is for this reason why most hospitals will never allow NPs/PAs to solo practice in the ED. There is also the aspect of system based standard of care. People expect that when the come into an ER anywhere in the country for an actual emergency, that an MD/DO will treat them.

This is the crux of the matter

Where is the hospital's (or, I suppose you could say more generally the "bean counter's") risk tolerance for error and thus malpractice payout.

I think at some point standard of care will fall down to some inappropriate but cheaper PA/NP with a 6mo to 1 year "mini-residency" (which already seem to be popping up). This will replace any current Medicare/insurance/payor requirement that the ED be staffed with a residency trained EM MD/DO. It's simple economics.

Our nice job situation currently will correct itself eventually. All pendulums swing back the other way.

And there are definitely hungry PA/NPs out there looking to play doctor at all levels, regardless of whether they understand the implications.

 

[primadonna22274]

I've been a FM PA and an EM PA. Now a FM physician PGY2. There will always be a need for well-trained physicians to be captain of the ship.
The job outlook is bright for years to come. Don't sweat it.

Sent from my SAMSUNG-SM-N910A using Tapatalk

 

[Boatswain2PA]

I've been a FM PA and an EM PA. Now a FM physician PGY2. There will always be a need for well-trained physicians to be captain of the ship.
The job outlook is bright for years to come. Don't sweat it.

Funny thing about your analogy of "Captain of the ship". Used to be physicians "owned" medicine. They not only led the medical team (residents, PAs, NPs, nurses, techs, etc), but they also were leaders in healthcare administration. While its been a long time since physicians could own hospitals, they could exert legitimate influence on administration because, being independent, physicians could always walk away from the hospital leaving it high and dry.

Unfortunately physicians have lost much of their leadership in healthcare administration (see the never-ending string of posts about Press-Ganey scores, etc). Much complaining here, but not much activity in physicians coming together and putting an end to things like this that harm our patients and create toxic work environments.

Now with the growth of PAs and NPs physicians have another challenge. The militant NP mafia is pushing for independent practice in every state, which can be a boon for hospital administrators who are more than willing to pay a NP 20% of what a EP makes, while shunting the malpractice risks toward the insurance companies. This leaves the PA profession, which has historically been a dependent provider working FOR the physicians, at a disadvantage because the admin-critters prefer the NPs. Meanwhile, since there is once again no collective effort by physicians to stop the encroachment of NPs, some PAs see the need to strive for independent practice as a means of competing against the NPs.

Where is the physician leadership to "Captain the ship"?

 

[filhodeinferno]

...while shunting the malpractice risks toward the insurance companies... "?

Funny thing about malpractice risk....as much as I hate the thought of being sued, the risk of it happening just might be the single biggest force in preventing NP encroachment on medicine in general.

 

[spittman]

I'm an MS2 currently thinking about EM, and everyone (outside of EM) is quick to tell me about the downsides. All the day-in and day-out medical aspects aside, one "job security" thing I'm curious about:

I heard from a general surgeon that at his hospital the regional corporations that EM docs use to negotiate contracts are frequently competing against one another. This means that every 4-5 years when the contract for the ED is up, the EM docs almost completely turnover when another regional corp. offers the hospital administrators a cheaper deal.

Is this the norm around the country? I.e. – even though there are plenty of EM jobs available, are EM docs moving from hospital to hospital?

 

[The White Coat Investor]

Not sure why you resurrected this thread to ask this question, as it isn't even related to the OP's question. However, your question is far better than the OP's, so I'll answer it.

The threat of CMGs is HUGE to the independent practice of emergency medicine (rather than the corporate practice of emergency medicine where shareholders skim off the profits from your hard work (typically lowering your income by 20-40% and dramatically decreasing your control over your job.) In fact, I think we're down to something like 10% of emergency docs who own their job.

The big players in the market are EmCare and Teamhealth. Unfortunately, they also somewhat own ACEP, a big reason why AAEM was even founded.

At any rate, when they take over, they're usually able to convince 70-80% of the docs there working independently or with another CMG to stay. Some of the others retire, a few go somewhere else because they hate CMGs more than they love where they live, and a few are forced out for low productivity. If they couldn't convince them to stay, they'd have to replace all the docs at once, which is difficult for a big contract, especially a multiple hospital one.

It's not a job security issue so much as a pay and quality of life issue.