Community Docs Can't Handle the Simplest Issues

[docB]

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Doc - I'm curious why (it seems) you think midlevels are a bad thing here. Even in the perfectly constructed ED you would have a certain percentage of less-acute patients. Lets say you remove the PMD "referred" patients from your ED, you would still have a mix of high, medium, and low acuity patients. What do you see wrong with using mid-levels, especially those who work under the supervision of a "real" doctor (ie - you), in these situations. It seems to me that a mid-level could remove some of the chaff so you could catch up on paperwork, and help out with the higher-acuity patients when you are swamped. What am I missing??

I'm not saying anything against midlevels. I'm saying that the ever expanding census in our EDs, particularly of non-acute patients, are creating these perceived physician shortages. This has resulted in an increases in the use of midlevels, non-boarded docs an so on. I'm not disparaging PAs. I'm just noting that if we were triaging properly there wouldn't be much of a role for them in the ED.

That said I don't see anything changing and I think the role of PAs will continue to expand in the ED for years to come.

 

[GeneralVeers]

I'm not saying anything against midlevels. I'm saying that the ever expanding census in our EDs, particularly of non-acute patients, are creating these perceived physician shortages. This has resulted in an increases in the use of midlevels, non-boarded docs an so on. I'm not disparaging PAs. I'm just noting that if we were triaging properly there wouldn't be much of a role for them in the ED.

That said I don't see anything changing and I think the role of PAs will continue to expand in the ED for years to come.

How can we triage properly? By sending people away? I talked to one of our colleagues at a NorthWest area hospital who do the triage/wallet biopsy program. Basically the hospital demands that they turn away a certain number of patients every month, however in order to meet the EMTALA requirements the hospital essentially makes them do a free exam. The ED physician's time is wasted on a patient they can't bill for.

 

[docB]

How can we triage properly? By sending people away? I talked to one of our colleagues at a NorthWest area hospital who do the triage/wallet biopsy program. Basically the hospital demands that they turn away a certain number of patients every month, however in order to meet the EMTALA requirements the hospital essentially makes them do a free exam. The ED physician's time is wasted on a patient they can't bill for.

I mean triage at the system level. Teaching people, PMDs, EMS that urgent care type stuff should not come to the ER. I'm really talking about a whole system revamp.

The way that we're doing the non urgent patient screenings now is, I agree, silly and onerous to the EP. They do have one benefit though and that is that they educate the patient that the ED is not for non-urgent issues.

 

[GeneralVeers]

I mean triage at the system level. Teaching people, PMDs, EMS that urgent care type stuff should not come to the ER. I'm really talking about a whole system revamp.

The way that we're doing the non urgent patient screenings now is, I agree, silly and onerous to the EP. They do have one benefit though and that is that they educate the patient that the ED is not for non-urgent issues.

Not going to happen. We have a perfect storm of ignorant population, greedy EMS providers, and ambulance-chasing lawyers that would prevent any sane emergency medical system from being developed. Sadly it is only getting worse as the U.S. population becomes increasingly scientifically ignorant, and more quick-fix oriented.