Hostile takeover

[realruby2000]

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Hey all,

This past year i've had an opportunity to hear from many different docs from a wide variety of specialties complain how other professions are intruding their own. For example, an optho was telling me that optometrists were stealing most patients and that medicare considered them both the same. I was also told Radiology is slowly being outsourced to india, NP's are doing a lot of FP work, CRNAs doing a ton of anesthesia etc. etc.

Where does EM stand in situations like this? Are they immune or are they just as susceptible? I've seen tons of PAs in ERs doing almost the same thing EPs do and was wondering will they pose a threat to the EP? Do you think it will come down to hospitals staffing tons of PAs and only very few EPs just to watch over them?

 

[Scrubbs]

PA's and NP's can handle the small stuff - simple lacs, URI's, splints, "my toe itches", etc. They generally work in a fast care/urgent care subdivision of the ED. With more and more people using the ED as a primary care office, having this sort of set up is invaluable. It basically relieves the EP's from getting side tracked with simple cases, and allows them to focus on the truly sick/critical patients. Our hospitals have 12hrs of fast care coverage and its REALLY helpful. In a busy ED, it really helps with patient flow.

I see these professionals as working side-by-side with us. They are becoming an integral part of efficient urgent care. As for "posing a threat" to my job security... absolutely not. PA's and NP's function on a different level. They are not handling the codes, AMI's, CVA's, Hypertensive Emergencies, etc.

 

[rdennisjr]

Actually, while I fully agree with the original response I just need to add a slight clarification. Speaking for the PA side of the house, we can and do handle the same situations as the physicians do - it is dependent on the hospital where you are at. Many of us do run codes, handle hypertensive urgency/emergency, AMI, etc - but that is generally not our primary position. In any situation we need to be able to handle those cases because we can't just sit back and say - "Sorry, not a doc, guess you die".

That being said however, the original response is quite correct - we general do handle a 'fast track' kind of set up so that the attendings can focus on the sicker folks. Also in general, the PA profession has no desire to become competitors to physicians - we are dependent practicioners and will continue to be so in the future. Teammates, not job stealers!

Dennis

 

[NinerNiner999]

Job security aside, I'm sensing the real question is what impact will PA's and NP's have upon the salaries of EMPs? As it becomes more likely hospitals will utilize PAs for their urgent care/fast track settings, will cost-effectiveness reduce the salary of EP's? Why would you spend $250-300k/year on one EP when you can spend the same amount of money to cover 4-5 PA's? Using this scenario, will the job market for EP's narrow even quicker when PA's become industry standard?

 

[pinbor1]

I would hope that it would have minimal impact in our job market. Most hospitals I'm familiar with have single to double coverage when it comes to the ED, I figure that instead of opening expanding to triple coverage, they would end up hiring a PA. Now when it comes to our salary, I would like to think that the lower cost of hiring a PA over a new EP would me greater saving that would reflect in your overall salary.

 

[deleted6669]

"Why would you spend $250-300k/year on one EP when you can spend the same amount of money to cover 4-5 PA's?"

a good em pa makes a lot more than 60 k.
starting range is around 65-80k right out of school with many making around 125 k. in my er group of 15 pa's(all very experienced) the salary range is 110-160 k/yr. the docs all make around 300k. so 2-3 pa's salary = 1 doc, probably closer to 2 when you figure in the cost of benefits/retirement, etc.
we see everything except multisystem trauma, obvious mi's, obvious cva's, and peds/elderly trainwrecks so probably 85% -90% of the same patients.
we staff 3 docs and 4 pa's at a time( busy west coast trauma ctr).

 

[Sessamoid]

Job security aside, I'm sensing the real question is what impact will PA's and NP's have upon the salaries of EMPs? As it becomes more likely hospitals will utilize PAs for their urgent care/fast track settings, will cost-effectiveness reduce the salary of EP's? Why would you spend $250-300k/year on one EP when you can spend the same amount of money to cover 4-5 PA's? Using this scenario, will the job market for EP's narrow even quicker when PA's become industry standard?

I'm not sure you fully understand the way that the money flows in the medical world yet. For the most part, hospitals don't employ emergency physicians nor PAs. In general, the PAs work for the physician group (or corporate contract holding bastards), so it's generally the physicians (or the corporate contract holding bastards) who make a small profit from the patients that the PA sees. The hospitals generally have little to nothing to do with how the docs and PAs get paid.

PAs are used for that part of the patient population where it isn't cost effective to take on more physician staffing hours, but that we'd still like to serve rather than having them leave the waiting room due to overly long waiting times.

 

[NinerNiner999]

Sessamoid - thanks for the clarification. Our PD recently had a meeting with us residents urging us to "think long and hard about the decisions we make" because "the world of EM is shrinking and the influx of mid-level providers will have a negative impact on our future salaries." Do you see this to be the case or the opposite? How will mid-level providers impact our salary and job market?