My point is, there aren't enough EPs. So to get to that critical mass we would have to create more residencies.
What do we do about the lack of ents and pcps? There are enough eps. The issue is these dumps of hospitals who see 1 pph. That includes FSEDs are a waste of resources.
That’s exactly my point. Call it an urgent care and let those people admit. I have no issue with that. Hospitals dont like it cause of $$$$. But if you can’t provide the service either spend the money to do it or don’t. But you shouldn’t be able to pretend.
Disagree. There's a ton of benefit for rural critical access FSEDs. Even if they only see 1 pph. You don't want to be trying to have an appendectomy there, but emergency medicine can be important. Timely STEMI care. Timely trauma interventions. Unless we are willing to put doctors on boxes prehospital, then there needs to be a place for the ambulance to get to within 30 minutes in general. Helicopters aren't the answer either.
I'm not a fan. You can't telemedicine a procedure.
I'm in agreement that they shouldn't be. But Fetus wants them closed, and I want them to only have emergency docs. They don't need the upstairs portions at all.
I'm not of the opinion that there's a ready supply of midlevels qualified to do these level of procedures. Can they be trained? Absolutely. Procedures can be done by technicians. But getting them to that point is not as easy.
That's actually a decent idea. Lots of smaller places have tele-ICU stuff overnight, no reason small EDs couldn't do the same.
The issue is you have docs out there who dont know those skills. putting an FP doc out there doesn't ensure anything you are talking about. What really happens is you have the best trained docs working in places with all the resources. Meanwhile the docs who have no idea what they are doing are the ones working with no resources or support.
There is not a ready supply of qualified physicians. IMO a MLP who wants to do EM and did some training and did some extra time at a real ED is far better than the typical FM doc who works at an Urgent care and then starts moonlighting in an ED. They have no idea what they are doing.
I don't think putting an FP doc out there fixes anything either. However, in the vacuum of no doc vs less qualified doc, there's a level I would want my in-laws to get.
I am not sure that there are not enough ER docs. I work in a semi-rural area. There is a reasonable payer mix and an excess of emergency departments. Two hospital systems are competing against each other and building neighboring emergency departments (a certificate of need is not required in this state), all of these departments need to be staffed and are currently running at less than 2 patients per hour per physician. There are multiple other similar departments throughout the state. I would guess at least half the patients seen in these departments do not see a board-certified emergency medicine physician for the bulk of their care (nominal overview of "supervised mid levels" versus FP or non-boarded physicians). Among the patient's I see on a daily basis, at least 50% are clearly for non-emergent conditions. These could easily be siphoned off a FP walk-in clinic.
Again, I agree. Those places don't have interventional cards (or many don't have gen surgery). There is no guarantee of a decent FM doc. Those guys don't know the first thing about what we do. Change it to what it is which is an urgent care center with Ct capabilities. Yes im not working there. Having a well trained EM doc see 0.5 pph is a waste of resources. There was an article to this effect in one of the EM journals about FSEDs. The guy is 100% right. The issue is not about the best use of resources though. it is that our jobs think they own us (they often do) and this is our answer to that issue.
Curious as to how many ED's do not have an actual ED MD - I worked at one of the smallest hospitals in the country at one point - we had an average inpatient census of 6 - and we essentially had ED MD's 24/7 - albiet only one actual employed MD (others were locum's) and he lived less than a mile from the hospital and would drive in when a patient showed up.
Lmao your anti-FM bias is laughable and absurd. You know in many places FM residents run codes etc. right? And that a CT surgeon (assuming you aren't trolling) has next to no medical knowledge in the context of managing bread and butter ED patients.
I would still admit that IM and certainly any other specialty has no business being in the ED simply given their lack of ability to see kids/ob gyn.
Sure dude. So you can restrict care when FM staffed places largely provide adequate care?
Surely this is straight up naïveté or lack of experience. If you had an intubated family member who had cold would you want an intensivist caring for them? I sure as hell would. I wouldn't want an IM doc doing it. If I was truly ill I would want an EM doc in the ED caring for me. Are there some decent FP docs working in the Eds. Yes.
You're free to try and change the legislation. Are your midlevels providing optimal care over the course of a year? 🙄 Considering you guys don't even see their patients. Or EDs that advertise ABEM only then have a ED doc at home and an NP in-house who doesn't even have relevant experience lolol. Fix the real issues at hand.
No doubt that an IM doc should not be in an ED given both Peds and ObGyn patients. But why don't you guys ban unsupervised midlevels from the ER and ensure any midlevel has strict supervision?
Yawn. its youngins like you who know nothing who are really what we worry about. Do you have any idea about my practice? no, we dont do this. Does it happen somewhere? yep. I would likely be in the minority but i would rather an MLP with an EM doc at home than a FP doc in the ED who doesnt even know what they dont know. the self selection of FM docs has to do with them realizing they dont like clinic and either couldnt match into EM or found out late in the game they want to do EM.
And ignorant LOL
Your god complex is hilarious. And your NP-inhouse/ED-doc at home reference led to a dead 20 year old girl with a missed diagnosis that a 3rd year med student would have caught in their sleep. It's now turned into a big lawsuit.
Ive worked in different parts of the US. i dont know what case you are referring to but again i dont know of a single hospital that uses the NP/ED doc model. Few if any ED docs would be so dumb as to sign up for that model. Also, as someone who works with med students and FP/IM residents trust me when I say you overestimate their skills/knowledge. med students lack the clinical experience to be good. They may be able to recite the krebs cycle and thats cute but they dont have the experience to differentiate a kidney stone vs GB pathology. Truly the RNs are better because it is pattern recognition. Note I didnt say NPs.. im saying RNs. take your 3rd year med student and show them a person with acute renal colic they will rarely have any idea whats going on whereas a RN or minimally experience ED doc (like an intern 2 months in) can make that diagnosis as they wheel the patient back.
There were 2 threads on this very forum about the case I'm talking about. Such places exist and you saying you aren't aware of them shows your true lack of insight into what happens at the national level. And yes the very good RNs who also have 30 years experience will be better at pattern recognition of their daily job vs someone who hasn't ever stepped foot in that setting. No ****.
Peter Rosen is dead? I can't find anything about the EM doc. There was some physicist that died in 2006.
