Well I apologize then. Doctor Squad, as a non MD or DO or whatever, I still think you should show a little "respect" for someone who has graduated from medical school and almost completed a residency. However much you think you may know as a medical student, you have only reached the tip of the iceburg.
Well, for once we agree. I have only reached the tip of the iceberg. 10 years from now, I still will have only reached the tip of the iceberg (it is a pretty big iceberg after all). I think you have a very jaded view on how much a newly minted FP grad knows about emergency medicine however.
Wow, for someone with such extensive hospital experience, you really know very very little. First, physicians are limited vehicles.
No, legally (with the exception of certain nuclear and chemotherapy agents) they aren't. A licensed physician can open an office and practice the full extent of medicine and surgery. Now, as I pointed out in my post, this is a
legal distinction.
They are controlled by the entity which allows them to practice medicine, thus the hospital.
Be careful of your use of the word "controlled". One can not legally (within the CMS regulations) control the practice of a physician. They can, as described below, be limited.
For example, hospital A does not allow thoracentesis done on the floor, only in the OR, hospital B does not allow anyone other than a surgeon to put a CVL or chest tube in, hospital C does not allow for conscious sedation with Diprovan in the ER, etc. There are many a differences b/t who is allowed to do what at which hopsital, and the attendings are not the limiting factor.
You are correct, there are rules (limitations) placed by the hospital. These are not however legal limits but rather what a hospital allows by policy. If a non-surgeon places a CVL at hospital B from your example above, he/she can be disciplined from the hospital, but not charged legally. If that same non-surgeon wished, they could open a clinic and place central lines all day.
If an FP signs on to work in an ER, the hopsital can say you can't do this, this and this, so your whole argument there is shot to hell. But thanks for playing
You are correct. At great expense (credentialling committees are usually composed of senior medical staff) a hospital could create a "second class" of ED attending. However, that is almost never done. A hospital or medical system most often credentials physicians departmentally (a general surgeon, an internist, an emergency physician) as you have described above. The odds that a lone FP grad could inspire such a change in policy (and incurred expense) so as to hire him/her to work only double covered shifts, are long to say the least. It simply would not be politically feasible. Possible yes, realistic, no. But thanks for playing yourself.
Do you follow your logic? So a FP differentiates from a PA b/c of attending oversight, yet you go onto speak of PAs doing autonomous burr holes...hmmm, I see. That is, uhm, what is the word, uhm, a CONTRADICTING point.
No, it isn't. If the FP went to do a burr hole (assuming he was credentialled to do so) no physician could legally stop him or her without creating quite an issue. If the neurosurgeon who provided ultimate oversight for the PA placing the burr hole autonomously by protocol said to stop, any further action by the PA would be illegal (and also likely against hospital policy as described above). Again, the issue is that a physician, by virtue of the legally unlimited nature of their license, can't simply fill a PA's role. It would be a contradiction for a physician to act as a physician assistant.
And of course they are two different creatures, thank you captain obvious. But if you can TRAIN one to do these simple procedure, why can you not TRAIN the other....hmmm, funny thing. There are some orthopods that have FP or IM sports meds come in to first assist with surgery, b/c you know what, you can TRAIN these medical doctors how to do these things.
Absolutely you can. And according to the American Board of Emergency Medicine and the American Council on Graduate Medical Education's Residency Review Committee for Emergency Medicine, that training would take a minimum of two and one half years for a physician who has already completed a residency in another specialty. Remember, we aren't just talking about training someone on one or two procedures but rather on all of emergency medicine.
Its an interesting concept. But of course your too short sighted to see the obvious with your holier than thou argument. No one ever said a FP can come straight out of residency could do ER like an ER trained physician, but can they fill in adequately and be trained to improve in their job? I would think so, but I guess the PhD would know better, no?
I suppose the question isn't could they (be trained to improve in their job) but rather why should they be? There are residencies widely available in emergency medicine. The OP entered residency at a time when those options were available. A quick check of his / her posting history reveals (as I quoted) that they (the OP) are only looking for a job for one year while they apply to a PM&R residency. Why should an emergency medicine group take on this inexperienced person and begin what would be a lengthy "training" process, all the while assuming the liability for the OPs actions, which have been proven in closed case reviews to result in more lawsuits than would a EM residency trained physician's? To what benefit? Look, there is a training pathway available to the OP. It is one he / she is doing for PM&R. Simply do a second residency. I've never claimed that the OP isn't trainable, I merely opined that it wouldn't behoove an emergency department to do so outside of a formal residency training program.
I'm not hung up on the doctor title, I'm hung up on showing someone proper respect. They have been where you haven't been, where you can only imagine and will experience soon, yet you somehow have a knowledge base equivalent to them....man your first month of internship will be a wakeup call for sure.
I am not claiming to have a knowledge base equal to theirs. I am claiming that theirs is not equal to a residency trained emergency physician's. I am also claiming that many professional groups, research initiatives, and insurance companies have decided that the knowledge base the OP is presumed to have as an FM residency trained physician is inadequate to safely practice emergency medicine. As is mine - which is why I will do a residency. And I can't imagine that internship isn't a wake up call to everyone who goes through it. But thanks for the warning.
Oh and I'm sure that the two months of ER experience is the only thing that matters in the practice of ER. I mean if that were the case, why not just make a ER residency 36 months straight of ED, cuz by your logic thats all that matters right? No off service rotations, like OB, Cards, Peds, Surgery, trauma, etc....and alot of those FPs have MORE months of than ER (considering most ER residencies have 1 month or none of Gsurg, I actually would give the advantage to diagnosis of an acute abdomen to the new FP). You are correct, the approach to a patient is different in the two, but I believe above I stated you can TRAIN someone can you not? I mean they have went through 4 years of med school to TRAIN them, and 3 more years of residency to TRAIN them, so could they not be TRAINED more. Just food for thought.
Absolutely. I guess we agree twice. As you state, "the approach to a patient is different in the two" - the FM resident looks at the patient in the hospital bed and (I would imagine) thinks "what will his needs be on discharge. What medications and treatments can we use as tertiary prevention to keep this from occurring again?" The EM resident (again, I imagine) looks at the natural course of the disease, looking for those clues that would tip them off to the presence of the diagnosis should the patient have presented to the ED at the current time. And your comment "considering most ER residencies have 1 month or none of Gsurg, I actually would give the advantage to diagnosis of an acute abdomen to the new FP" is a bit insulting. Do you realize how many patients complaining of abdominal pain are seen in the ED and sent home without seeing a surgeon? I think after 18 - 24 ED months during residency the advantage in the diagnosis of an acute abdomen goes to the EP, over the surgeon and the FP. Only the EP will have to separate all of the belly pain patients de novo. The surgeon will have a "heads-up" from the ED - and likely the CT verified diagnosis - before ever laying hands on the patient.
You are young in your training, and that does explain alot of your opinions. But you will learn eventually.
Absolutely. Out of curiosity, where are you in your training and what discipline?
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Outch, that was a hit below the belt. Just Kidding...
