That's right by I think there is also a MD in that eHospital but just like in a real hospital they still have NPs there when you would atleast expect an MD at that level of decision making. Most of the job they do is so bad, just doing barr minimum to keep the patient alive till the day person shows up.Did I read that correctly? Tele-ICU which is ALSO an NP?
Hospitalists may only be bothered by inappropriate admissions, but believe it or not, inappropriate discharge is also a thing in emergency medicine. And many times, there is no next line of defense for those folks.
So much this. Reminds me of a case I had a few months ago. A diabetic lady in her 60s came in w/ fever, tachycardia (130s) and severe hyperglycemia (3-400s or so). Labs and UA came back normal. The NP I'm nominally 'supervising' and the hospitalist NP decide to discharge her because the patient "wants to go home" (she was actually fine being admitted after I told her that this might/probably will be serious, they had told her that there wasn't anything to do for her in the hospital). Next day blood cultures grow out gram negative rods...
It's like this for me pretty much every time I work with a PLP. The stories go on and on and on. It's super painful. The ones that bounce back dead are worst 🙁
No, I completely agree with you. I think EM docs are crucial to our system not being overloaded with BS admits and to safely discharge people. My point is that EM is in a very bad position. Inappropriate admission? Goes to hospitalist. Inappropriate discharge? 99% of the time won't result in death but will make life worse for the patient and PCP. My point is, there is no immediate consequence that the hospital quantifies for the MBA to say "this is bad." I really feel for you guys getting shafted here
Are CCM docs looking for a way to address these issues before they're screwed?
I've certainly seen an increase in APP staffing. Is there also a proliferation of fellowship spots? People say the CCM job market is robust and it's not difficult to find a job. I was fortunate and got a great one, but only because I was very lucky - I was sweating bullets for a while that I'd end up someplace I really didn't want to be. Mostly I got crickets from places I reached out to. So I'm already a bit wary of the optimism that some people are throwing around with respect to the CCM job market. Just coming from the application cycle it looked pretty tough out there to me.
Most of the APPs I work with are very good. There are a few that I don't trust at all, and basically have to do their work for them. These folks increase my workload significantly, those are few and far in between. Most are great and fun to work with.
Most of us don’t have control over the hiring practices of hospital administrators - admin decides how they want to staff an ICU and how much they want to pay. Not much your average CCM doc can do to address these issues. I’m sure there are a few new fellowships every year and there are existing ones that have expanded citing COVID. Right now things are great, but CCM is heading the same way, just give it a few years.
And the doc gets the blame, right?
This is why we must take advantage of every opportunity we get to become members of hospital credentialing committees and have a say in writing hospital bylaws. If enough of us take a stand when BS like this gets brought up in meetings, then it will make it much harder for such outrageous and dangerous things to take place in the future."I passed muster, if you will, as the first non-physician, full-time, sole provider here as an NP working in the ER alongside the docs," he says. "It was so successful that we ultimately eliminated all the docs here and replaced them all with nurse practitioners or physician assistants."
Nurse Practitioner Elected Medical Staff President
A high-achieving nurse practitioner who was elected to the influential position of medical staff president with more than 50% of the all-physician vote explains his unusual rise through the ranks.www.healthleadersmedia.com
Effective April 1, 2020, all seven urgent care clinics of the Edward-Elmhurst Health System will replace physicians with nurse practitioners. At least 15 physicians have been eliminated, and physicians will no longer provide patient care or medical direction in the urgent care clinics. The hospital system indicates its business model will provide lower acuity care at a lower cost.
The Horse is Out of the Barn | Emergency Physicians Monthly
Care Crisis — Physicians terminated from all Edward-Elmhurst Health System clinics replaced by APPs. https://youtu.be/FFx-44zpHY0 Effective April 1, 2020, all seven urgent care clinics of the Edward-Elmhurst Health System will replace physicians with nurse practitioners. At least 15 physicians...epmonthly.com
In these cases I don't think anyone got blamed. The first was an urgent care miss, the patient lived and I think just moved on with life. The urgent care didn't appear to be in the same network as the hospital and there was no feedback or QC. The second that I clearly recall was in an ER in meltdown, old group fired, new group not yet in, hospital business leaders making (medical) staffing decisions, etc. No one cared. The guy was a transient laborer from out of state, going through a divorce, etc. People just moved on.
And that's how the cycle perpetuates. "I need my job, so i better comply." Don't complain there isn't another job you can go to because you perpetuate the problem
Unfortunately, most ER docs have the mentality to check in, check out, and forget about the hospital. Being involved in medical staff committees is necessary to get representation and respect.
I'm not suggesting anyone abandon mid-levels they're currently required to supervise. You're missing the point, completely. I'm saying that on a macro level, we should all be arguing they go on their own and not be tied to physician supervision, at all. 100% independent, no physician supervision or co-sign needed. Let them sink or swim on their own, let patients and the results decide.
They absolutely do want docs part of the decision making. Because they know we're gullible and will bend to whatever they suggest is best. It's true. Watch every doc group you've ever seen (outside of a few surgeon groups here and there) and they immediately cave, the minute the hospitals suggest docs are doing something in "their own best interest." (Oh, the horror!) The docs cave immediately every time and own the guilt, without question, and without even questioning the hospitals and insurance company that do exactly that, 100% of the time! Yet they let the hospitals greed-on, with impunity. Start watching for this. Once you look for it, you'll see it everywhere.
I’ve been saying this for a long time. If an NP or CRNA is doing the same function as me and they are under my supervision, I would put them on a very short leash and limit what I allow them to do. I don’t want to bail out an independent midlevel when they are in over their heads. If the **** hits the fan, everyone will be named in the lawsuit, even if your role was minimal or late in the process. You’re a bigger target than the midlevel for the lawyers. I would very clearly document the patient’s condition and what I do if care is transitioned from the independent midlevel to me.
Yes. Hospitals have already said mid-levels can do our jobs for cheaper, will hire them to do so, use them to put us out of work and drive down are salaries. It's checkmate, flat line, code blue and *GAME OVER*
This (complete midlevel independence) is probably what it will need to come to if there's any hope of salvaging some of these fields. The only incentive these hospitals will respond to is monetary, i.e. if suddenly they're facing a 5-10x increase in malpractice suits and suddenly losing millions or billions per year that comes directly from their bottom line. As a thought experiment, what do people think would happen if HCA went from a net income of $3.75 billion (HCA in 2020 for anyone wondering) to a drop to say $2 billion -> $1 billion and no C-suite bonuses for 2-3 yrs in a row and people looking at worthless equity options they own. The medical system would be "shocked" at how quickly changes get implemented and the "root cause" of the problem gets sorted out. Corporations can be extremely efficient in changing when they're properly motivated. Most tragic of all is that patients will be the ones to suffer along the way. That still bothers me and I wish I had some idea of how it could be avoided.
Hospital medicine will follow
Unfortunately, it's pretty common now...
I don’t necessarily disagree that FM/IM shouldn’t be working in the ED anymore with IM, but don’t know why you’re aiming your hate at IM/FM. I’m not sure your target audience is here... I don’t think any US MDs applying IM are yearning to do anything more than the month of required EM and eyeball sick patients coming up to the floor in residency. I think the ones working in the ED now were grandfathered in or are working in areas where EM physicians aren’t available. It’s also a better solution than having NPPs.
That rate is hard to find these days.
Crazy world we live in for sure. It’s a mess and it doesn’t look like it’s going to get better any time soon.
www.statnews.com
Lol. Serio.
Sounds like a blast to me. Hit me up
Fine by me, I get paid by the hour and it's not my emergency.
I'm a little light on them at the present, I wouldn't mind a few more intubations.
Sounds like my current job, but with more pay!
