Scopes of Training

[RandomERDoc69]

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I hear of NPs and PAs doing scopes now. My question is what is stopping us from changing our scope? How hard would it be for me to get with a GI doc and say train me in scopes and I will double your productivity for a certain pay? What impact does that have on malpractice coverage? I know NPs and PAs can do it and they get coverage? It is a thought I have had an am just very curious. Why can't some of us ER docs do what the NPs and PAs can do?

 

[Pinner Doc]

I hear of NPs and PAs doing scopes now. My question is what is stopping us from changing our scope? How hard would it be for me to get with a GI doc and say train me in scopes and I will double your productivity for a certain pay? What impact does that have on malpractice coverage? I know NPs and PAs can do it and they get coverage? It is a thought I have had an am just very curious. Why can't some of us ER docs do what the NPs and PAs can do?

Why pay a doctor when they can pay a midlevel for much less?

 

[RandomERDoc69]

Why pay a doctor when they can pay a midlevel for much less?

Are you guys seeing this done more at your shops?

 

[dozitgetchahi]

I hear of NPs and PAs doing scopes now. My question is what is stopping us from changing our scope? How hard would it be for me to get with a GI doc and say train me in scopes and I will double your productivity for a certain pay? What impact does that have on malpractice coverage? I know NPs and PAs can do it and they get coverage? It is a thought I have had an am just very curious. Why can't some of us ER docs do what the NPs and PAs can do?

When I lived in rural Alabama, there were local FM docs who were doing scopes. They claimed to have been trained to do so in residency.

It was a ****show. Missed cancers and perfed bowel were happening with some frequency. I clearly remember where an FM guy perfed the transverse colon and somehow ended up with the scope inside the spleen…that was a big surgical repair.

I don’t think it’s worth doing something if you aren’t really qualified to do it. Saying “but the midlevels do it” isn’t good…midlevels do all sorts of incompetent stuff they’re not really qualified to be doing.

 

[xaelia]

There's not really anything stopping you from changing your scope – except maybe getting malpractice cover (which isn't mandatory, but yikes).

If you want to take a weekend course and start doing cosmetics, charging whatever your clients will pay, sure – you're a doctor, you're licensed as a doctor by the medical board. There's a range of activities you could do outside of EM, each with some risk/reward.

 

[The Knife & Gun Club]

In ICU they’re slowly adding in EGD as within the scope of practice usually for a limited set of indications. Our ED recently added trans esophageal echo to the credentialing for all EPs once they complete certain CME. One of our EM/crit docs got flouro credentials to put in IVC filters and ecmo cannulas.

The short answer is nothing and if you can make a reasonable case to your hospitals credentialing committee there’s no reason you can’t do whatever you’d like.

If a surgery center wants to give you cred to do a procedure and med mal insurance to cover it you can go to town.

Only hurdle is insurance may not pay for someone not boarded in that speciality.

 

[DeadCactus]

From a legal standpoint, a physician is a physician. You can go set up a drive-through neurosurgery center after intern year. Training and certification are issues of malpractice coverage, billing, and credentialling. Mid-levels have more luck transitioning between specialties because they cost less and their is a perception that they will be supervised and have a limited scope.

 

[southerndoc]

Why pay a doctor when they can pay a midlevel for much less?

Can't wait to see the outcomes and complications data on this. Not a chance in hell would I allow an NP to scope me as a substitute for a doc that's been training on it for years. Weekend course and let's scope! WTH

 

[hoot504]

An EGD is a level of complexity higher than any procedure we regularly do in the ER. With that comes what I would assume is a significant time sink which isn't compatible with the vast majority of my shifts in the pit. I'm all for expanding our scope (pun intended just like the thread title) and am open minded but I don't see this as being realistic.

 

[Pinner Doc]

Are you guys seeing this done more at your shops?

Our hospital system won’t pay for a board certified physician to increase our staffing, but just hired two new NPs with no experience in EM. They’re floundering. It’s like working with first year med students. One had never done a rectal exam.

 

[VA Hopeful Dr]

From a legal standpoint, a physician is a physician. You can go set up a drive-through neurosurgery center after intern year. Training and certification are issues of malpractice coverage, billing, and credentialling. Mid-levels have more luck transitioning between specialties because they cost less and their is a perception that they will be supervised and have a limited scope.

Plus the medical board will have something to say if you're doing something you aren't explicitly trained to do and have a bad outcome.

 

[xaelia]

One had never done a rectal exam.

Sounds conveniently "out of scope" ...

 

[TysonCook]

...look at their application and the subsection for privileges... and call them out on it and/or your credentialling committee. I guarantee they checked the box(s) that state "competent in x,y,z" etc. I think that only when we hold others to standards do we help the patient.

 

[TooMuchResearch]

In ICU they’re slowly adding in EGD as within the scope of practice usually for a limited set of indications. Our ED recently added trans esophageal echo to the credentialing for all EPs once they complete certain CME. One of our EM/crit docs got flouro credentials to put in IVC filters and ecmo cannulas.

The short answer is nothing and if you can make a reasonable case to your hospitals credentialing committee there’s no reason you can’t do whatever you’d like.

If a surgery center wants to give you cred to do a procedure and med mal insurance to cover it you can go to town.

Only hurdle is insurance may not pay for someone not boarded in that speciality.

Fun fact: we all got trained on TEE despite a number of us doubting a true mortality benefit. I'm pretty sure we lost or broke the probe. I don't remember hearing anything but I haven't seen it in a long time.