Primary Care Docs in Rural ERs

[FlameBoy]

What do you all think of primary care docs (FP, IM) working in rural ERs?
In all the small towns around where I live, there are no EM boarded docs in the little hospitals (ER volume 10-15K/yr), they are staffed by primary care working full time emergency, almost always in single coverage and often also functioning as the night hospitalist.
Why aren’t these positions filled by EM docs?
Do you think they should be allowed access to the formal organizations; AAEM or ACEP? These guys are currently cut off from membership.

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[VA Hopeful Dr]

What do you all think of primary care docs (FP, IM) working in rural ERs?
In all the small towns around where I live, there are no EM boarded docs in the little hospitals (ER volume 10-15K/yr), they are staffed by primary care working full time emergency, almost always in single coverage and often also functioning as the night hospitalist.
Why aren’t these positions filled by EM docs?
Do you think they should be allowed access to the formal organizations; AAEM or ACEP? These guys are currently cut off from membership.

Because, like many specialists, they don't want to move into too rural a place.

 

[Arcan57]

What do you all think of primary care docs (FP, IM) working in rural ERs?
In all the small towns around where I live, there are no EM boarded docs in the little hospitals (ER volume 10-15K/yr), they are staffed by primary care working full time emergency, almost always in single coverage and often also functioning as the night hospitalist.
Why aren’t these positions filled by EM docs?
Do you think they should be allowed access to the formal organizations; AAEM or ACEP? These guys are currently cut off from membership.

1. There are not enough residency trained ED docs that economic pressures have forced them into staffing all "undesirable" locations. Many EPs experience with EDs in BFE begin and end with moonlighting in residency.

2. No, they should not. The purpose of ACEP and AAEM are to advance the practice of emergency medicine, something that admitting large numbers of unqualified practitioners into membership does not help. EM is much more than a dumbed down IM/FP + ATLS/PALS. It is its own specialty and its professional organizations fought very hard to make residency training in EM mean something.

 

[EdibleEgg]

1. The hospital in this neck of BFE has been trying to hire EM docs for quite a while. There's no reason to get upset about FP/IM guys filling the spots when there aren't any EM's that want the job.

2. The reason the job isn't filled by EM guys is they don't want the job. I know I'm a little biased on this, but I can make a good argument that it makes just as much sense to have FP's in these postions as it does to have EM boarded docs.

3. I completely agree with Arcan. However, I don't think takes away from the legitimacy of EM board certication to admit that some jobs require a skill that doesn't fit the mold of either residency completely.

 

[Arcan57]

1. The hospital in this neck of BFE has been trying to hire EM docs for quite a while. There's no reason to get upset about FP/IM guys filling the spots when there aren't any EM's that want the job.

2. The reason the job isn't filled by EM guys is they don't want the job. I know I'm a little biased on this, but I can make a good argument that it makes just as much sense to have FP's in these postions as it does to have EM boarded docs.

3. I completely agree with Arcan. However, I don't think takes away from the legitimacy of EM board certication to admit that some jobs require a skill that doesn't fit the mold of either residency completely.

1. I don't think anybody really gets upset, other than some of the absolutely baffling transfers (isolated left leg parasthesia in the setting of recent cocaine use in a 34yo otherwise healthy woman treated with tPA comes to mind) we have to take.

2&3. I can understand the desire to have a doc that can be one-stop shopping for the entirety of the hospital (especially on overnights). In a climate that is medicolegally friendly, the increased M&M of emergent patients may be offset by other benefits (willingness to run floor codes/rapid response teams, more efficient holding orders, stingier with admitting patients, etc.)

I do wish there was a way to provide better training on critical diagnoses and skills to rural non-EM trained physicians. The key would be to find something that improved their skills without improving their marketability. Otherwise, many would leave for suburban/urban jobs.