UNC midlevel residency program

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The University of Iowa started the first EM APP residency.

From their website:

"Proudly the first EM APP residency program in the country"

"The residency program's fundamental philosophy is to train the EM Advanced Practice Provider with the core competencies and skills sets allowing them to practice in any emergency, acute care, or intensive care setting, including solo coverage of a critical access hospital emergency department."

"EM Advanced Practice residents will be allowed to see all patients needing care in the emergency department. As you progress through the curriculum, we expect you to become more comfortable and efficient caring for a larger number of patients as well as seeing more critically ill patients."


Department of Emergency Medicine | Carver College of Medicine | The University of Iowa

medicine.uiowa.edu medicine.uiowa.edu
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alpinism said:
The University of Iowa started the first EM APP residency.

From their website:

"Proudly the first EM APP residency program in the country"

"The residency program's fundamental philosophy is to train the EM Advanced Practice Provider with the core competencies and skills sets allowing them to practice in any emergency, acute care, or intensive care setting, including solo coverage of a critical access hospital emergency department."

"EM Advanced Practice residents will be allowed to see all patients needing care in the emergency department. As you progress through the curriculum, we expect you to become more comfortable and efficient caring for a larger number of patients as well as seeing more critically ill patients."


Department of Emergency Medicine | Carver College of Medicine | The University of Iowa

medicine.uiowa.edu medicine.uiowa.edu
Click to expand...
Image result for map spreading gif520 × 362
 
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This is all our doing, we should have been more involved in the admin stuff and how healthcare is ran in this country. We just wanted to be the clever scientists and let people with business degrees run things. Now we are facing these money hungry corporations wanting to replace us with substandard providers.
TheComebacKid said:
EM as a specialty is definitely leading the charge on midlevel provider propagation. I've grown to appreciate midlevels and how they advocate for their own practice. Can you blame them? If I was a midlevel I would be doing exactly what they are doing

One of the faculty at my residency program trained at UNC. She is exceptional clinically. It's sad to see a place like UNC, especially with all their big names there (Tintinalli, Brice, etc) let this happen.

I'm glad I am getting out of training before it happens at my current shop.

We can blame hospitals and healthcare corporations all we want. We can blame the midlevels. It doesn't change the fact that WE are the problem. The old guard right now doesn't care about you. They made their killing in EM, banking 350/hr for the past several decades.

The most dangerous person is the "ED medical director", usually a physician, many whom will sell you out at a moments notice after sitting on some hospital committee and thinking about ways to advance their own career.
Click to expand...
Exactly!
This is all our doing, we should have been more involved in the admin stuff and how healthcare is ran in this country. Nope, We just wanted to be the clever docs and let people with business degrees run things. Now we are facing these money hungry corporations wanting to replace us with substandard providers.
 
UnoMas said:
Hmm no I would argue it's Anesthesia that has been leading the charge against midlevel provider expansion. EM and all other specialties just didn't care for like the past 20 years and have been asleep at the wheels. The surgeons are not losing sleep over this right now but soon they will come for them. They are here for EM now.

There is no inter-specialty unity among physicians. It's how we got to where we are in the first place.
Click to expand...
Said it for years, “no interspeciality unity”. Even amongst the ones in our specialty. We would rather chop each other’s heads off (particularly during residency) and run off to cuddle mid levels.
 
Slatches said:
This is all our doing, we should have been more involved in the admin stuff and how healthcare is ran in this country. We just wanted to be the clever scientists and let people with business degrees run things. Now we are facing these money hungry corporations wanting to replace us with substandard providers.

Exactly!
This is all our doing, we should have been more involved in the admin stuff and how healthcare is ran in this country. Nope, We just wanted to be the clever docs and let people with business degrees run things. Now we are facing these money hungry corporations wanting to replace us with substandard providers.
Click to expand...

Well, if the sentiments here accurately echo reality and they aren't hysteria, you could technically advocate this viewpoint through research. The tricky part is to get hospitals to fork over the data...
 
jw3600 said:
What do Chair of EM Jane Brice and residency PD Nikki Binz have to say about the complete degradation of their emergency medicine physician program?

Edit: for the love of god. Can a UNC resident make a throwaway and freaking talk about this? There's 40 of you. How are the interns not freaking out?
Click to expand...
I would say this...

If you interviewed at UNC this year, and there was zero mention of any PA residency program, you should simply not rank them. To me, that reveals some component of deceit, since this has likely been in the making for some time now, and doesn't reflect well on the transparency of the leadership. There is no better way to protest than to simply give UNC the middle finger and leave them off your list.

Some of the legends of EM worked/trained at UNC and are still there today. It's time they step up and first own their part in this, and secondly make some serious changes. It won't happen unless you force their hand.
 
osamine said:
I would argue that low acuity is important to see during training to determine appropriate level of care and not over test etc. wouldnt it? I don’t know if any residents can chime in and elaborate why this is not the case.
Click to expand...
Nah bro, doctors should exclusively see super hard complex cases; while supervising 6 midlevels seeing "easy" cases. Welcome to the future model of medicine.
 
TheComebacKid said:
I would say this...

If you interviewed at UNC this year, and there was zero mention of any PA residency program, you should simply not rank them.
Click to expand...

There was no mention of this when I interviewed.
 
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Dr Mantis Toboggan said:
Sure but it’s the rare program where there’s a resident always available to see every patient. So it’s either the attending sees some by themselves or you fire up some midlevels.
Click to expand...

it’ll be a cold day in hell before some academic attendings pick up a patient primarily on a busy shift
 
Lexdiamondz said:
it’ll be a cold day in hell before some academic attendings pick up a patient primarily on a busy shift
Click to expand...
I had one attending who would get upset if he had to see patients... he was just a moody person. He also didn’t really have anything to teach so just had to move the meat with him. There was another who worked overnight and would see how far you could go before he started pucking up charts. He was amazing because he could see 10 patients in 10 minutes lol. He let the senior resident run the show. Too bad he had to marry a nurse and leave the job when it didn’t work out... I digress
 
So...I trained at one of these "powerhouse" residencies that had a midlevel residency program. I will try to provide a balanced perspective on this.

I will preface what I am about to say with the fact that I am in no way "pro-midlevel" as a whole. I believe they are to act as "physician extenders," do as they are told, and for physicians to have complete firing/hiring power over them.

There does need to be some kind of post graduate training for midlevels however, as the quality of some of the new grads I've seen (especially in a CMG setting) is just atrocious.

That being said, the midlevels at my particular "residency" sort of self select for the program. Meaning that, they are already so strong clinically (probably top of their class), that they probably didn't need to do the "residency" in the first place, but chose to anyway. They were often better than some of our junior residents.

I'm not saying this can be generalized on the whole, just describing my experience.
 
Just received an email from UNC dispelling the rumors that this program would be rolling out this year and without the knowledge of anyone who would be affected by it.
 
Content below:

“Dear Residents & Prospective Residents,

As you may know, there was a very premature release of information this week announcing the introduction of a proposed new advance practice provider (APP) Emergency Medicine (EM) education pathway.

To be clear: UNC does not have an APP EM education pathway, and no pathway will be introduced this year.

As is our practice with all major department initiatives, any future discussion about an advanced education pathways for APPs will be developed in partnership with EM residents and faculty.

Please know that the release of this information was extremely premature and inaccurate. It had always been our plan to introduce a proposal for an APP emergency medicine education pathway to residents and faculty in a person-to-person setting at a future date so we could provide background, take questions and solicit input. We sincerely apologize for causing concern among our own residents and prospective residents.

Misinformation Shared

In addition to the timing miscue, there has also been a spread of misinformation about a proposed APP education pathway or “residency.” Inaccurate information online indicated that these APP learners would be paid more than emergency medicine residents. This is not true and would never be true. If you see social media posts to this effect, please feel free to quote me in correcting this mischaracterization.

We Support APPs Education & Training

The UNC Department of Emergency Medicine advocates for our emergency department patients to be cared for by the best-trained clinician teams. UNC welcomes the opportunity to collaboratively determine how best to train APPs to support emergency physicians in patient care.

Why Match with UNC?

My direct answer is that the UNC Emergency Medicine Residency program offers the highest level of emergency medicine training to prepare you for your career, as future leaders of Emergency Medicine. We are a community of passionate educators who care deeply for our students and residents.

We’re Listening

On Sunday, February 23, UNC EM leadership held a face-to-face meeting to provide a briefing to residents but, most importantly, listen to their concerns. As a department, we value collaboration and transparency.

Again, we apologize for creating concern. Please share your input and questions by emailing me directly.

Nikki Binz, MD, FACEP
Director, Emergency Medicine Residency Program
Clinical Associate Professor”
 
TheSingularity said:
So...I trained at one of these "powerhouse" residencies that had a midlevel residency program. I will try to provide a balanced perspective on this.

I will preface what I am about to say with the fact that I am in no way "pro-midlevel" as a whole. I believe they are to act as "physician extenders," do as they are told, and for physicians to have complete firing/hiring power over them.

There does need to be some kind of post graduate training for midlevels however, as the quality of some of the new grads I've seen (especially in a CMG setting) is just atrocious.

That being said, the midlevels at my particular "residency" sort of self select for the program. Meaning that, they are already so strong clinically (probably top of their class), that they probably didn't need to do the "residency" in the first place, but chose to anyway. They were often better than some of our junior residents.

I'm not saying this can be generalized on the whole, just describing my experience.
Click to expand...

But that's a big problem going forward. You already have some 3 year medical schools that can then pump out ER docs with 3 years of residency.
Meanwhile a PA can go to school for 24-36 months and then do a 1-2 year "Residency".

At that point it would not be surprising at all if a top PA graduate is actually clinically better than a weak MD/DO graduate from a bad residency program at the conclusion of their training.

Now its one thing to complain about midlevels using the phrase "residency trained" when they are still clinically inferior to their physician colleagues which just creates confusion with the public. It's another when they can actually be better. And now you have opened that door.
 
That’s the power of this forum at work my friends.
Let’s keep fighting the good fight.

STEMI_voy said:
Content below:

“Dear Residents & Prospective Residents,

As you may know, there was a very premature release of information this week announcing the introduction of a proposed new advance practice provider (APP) Emergency Medicine (EM) education pathway.

To be clear: UNC does not have an APP EM education pathway, and no pathway will be introduced this year.

As is our practice with all major department initiatives, any future discussion about an advanced education pathways for APPs will be developed in partnership with EM residents and faculty.

Please know that the release of this information was extremely premature and inaccurate. It had always been our plan to introduce a proposal for an APP emergency medicine education pathway to residents and faculty in a person-to-person setting at a future date so we could provide background, take questions and solicit input. We sincerely apologize for causing concern among our own residents and prospective residents.

Misinformation Shared

In addition to the timing miscue, there has also been a spread of misinformation about a proposed APP education pathway or “residency.” Inaccurate information online indicated that these APP learners would be paid more than emergency medicine residents. This is not true and would never be true. If you see social media posts to this effect, please feel free to quote me in correcting this mischaracterization.

We Support APPs Education & Training

The UNC Department of Emergency Medicine advocates for our emergency department patients to be cared for by the best-trained clinician teams. UNC welcomes the opportunity to collaboratively determine how best to train APPs to support emergency physicians in patient care.

Why Match with UNC?

My direct answer is that the UNC Emergency Medicine Residency program offers the highest level of emergency medicine training to prepare you for your career, as future leaders of Emergency Medicine. We are a community of passionate educators who care deeply for our students and residents.

We’re Listening

On Sunday, February 23, UNC EM leadership held a face-to-face meeting to provide a briefing to residents but, most importantly, listen to their concerns. As a department, we value collaboration and transparency.

Again, we apologize for creating concern. Please share your input and questions by emailing me directly.

Nikki Binz, MD, FACEP
Director, Emergency Medicine Residency Program
Clinical Associate Professor”
Click to expand...
 
I mean, an announcement on the UNC website is not really a “rumor”. We will see what happens there going forward.


boolin_1 said:
so they're going to roll it out next year quietly, at a more convenient time for them
Click to expand...
STEMI_voy said:
Just received an email from UNC dispelling the rumors that this program would be rolling out this year and without the knowledge of anyone who would be affected by it.
Click to expand...
 
STEMI_voy said:
Misinformation Shared

In addition to the timing miscue, there has also been a spread of misinformation about a proposed APP education pathway or “residency.” Inaccurate information online indicated that these APP learners would be paid more than emergency medicine residents. This is not true and would never be true. If you see social media posts to this effect, please feel free to quote me in correcting this mischaracterization.



Nikki Binz, MD, FACEP
Director, Emergency Medicine Residency Program
Clinical Associate Professor”
Click to expand...
We literally have screen shot......

Someone needs to send this guy screenshots.

I don't know if I can believe this guy. Remember once you matched, you signed a contract and stuck for 3 years. The tunes can be very different after March 15th
 
STEMI_voy said:
Content below:

“Dear Residents & Prospective Residents,

As you may know, there was a very premature release of information this week announcing the introduction of a proposed new advance practice provider (APP) Emergency Medicine (EM) education pathway.

To be clear: UNC does not have an APP EM education pathway, and no pathway will be introduced this year.

As is our practice with all major department initiatives, any future discussion about an advanced education pathways for APPs will be developed in partnership with EM residents and faculty.

Please know that the release of this information was extremely premature and inaccurate. It had always been our plan to introduce a proposal for an APP emergency medicine education pathway to residents and faculty in a person-to-person setting at a future date so we could provide background, take questions and solicit input. We sincerely apologize for causing concern among our own residents and prospective residents.

Misinformation Shared

In addition to the timing miscue, there has also been a spread of misinformation about a proposed APP education pathway or “residency.” Inaccurate information online indicated that these APP learners would be paid more than emergency medicine residents. This is not true and would never be true. If you see social media posts to this effect, please feel free to quote me in correcting this mischaracterization.

We Support APPs Education & Training

The UNC Department of Emergency Medicine advocates for our emergency department patients to be cared for by the best-trained clinician teams. UNC welcomes the opportunity to collaboratively determine how best to train APPs to support emergency physicians in patient care.

Why Match with UNC?

My direct answer is that the UNC Emergency Medicine Residency program offers the highest level of emergency medicine training to prepare you for your career, as future leaders of Emergency Medicine. We are a community of passionate educators who care deeply for our students and residents.

We’re Listening

On Sunday, February 23, UNC EM leadership held a face-to-face meeting to provide a briefing to residents but, most importantly, listen to their concerns. As a department, we value collaboration and transparency.

Again, we apologize for creating concern. Please share your input and questions by emailing me directly.

Nikki Binz, MD, FACEP
Director, Emergency Medicine Residency Program
Clinical Associate Professor”
Click to expand...
Sounds a lot like, “we’re definitely going to do this to you because we were always going to do this to you but intended to play it smarter from a public relations standpoint. By that we mean after you are locked in for 3 yrs. Hopefully long enough before next years match for the furor to cam down. And yeah, we were absolutely going to pay them more but will have to review that given the poor optics right now.”
 
Posted on EM Docs FB group:


I am the EM residency program director at UNC. I am passionate about my program and care deeply about my residents. I have been silent until now because my priority was, and always will be, my residents, and it was imperative that I listened to them first.

Inaccurate information has spread (admittedly some incorrectly posted on our own website) regarding a proposed APP training program at UNC.

Here are the facts:

· UNC Emergency Medicine does not have an APP EM education pathway, and no pathway will be introduced this year.

· UNC Emergency Medicine will not and would never pay APP trainees more than resident physicians.

· UNC Emergency Medicine feels that, although additional education for APPs working in the ED would be helpful, calling APP trainees “residents” is incorrect as it risks confusing APPs with physicians.

UNC will continue to be leader in inter-disciplinary emergency medicine education with a focus on creating highly skilled teams that provide excellent patient care. Also, I, as the UNC EM residency program director, will always continue to put my residents first and advocate for their wellness and future careers to the best of my ability.
 
pollyspockets said:
Posted on EM Docs FB group:


I am the EM residency program director at UNC. I am passionate about my program and care deeply about my residents. I have been silent until now because my priority was, and always will be, my residents, and it was imperative that I listened to them first.

Inaccurate information has spread (admittedly some incorrectly posted on our own website) regarding a proposed APP training program at UNC.

Here are the facts:

· UNC Emergency Medicine does not have an APP EM education pathway, and no pathway will be introduced this year.

· UNC Emergency Medicine will not and would never pay APP trainees more than resident physicians.

· UNC Emergency Medicine feels that, although additional education for APPs working in the ED would be helpful, calling APP trainees “residents” is incorrect as it risks confusing APPs with physicians.

UNC will continue to be leader in inter-disciplinary emergency medicine education with a focus on creating highly skilled teams that provide excellent patient care. Also, I, as the UNC EM residency program director, will always continue to put my residents first and advocate for their wellness and future careers to the best of my ability.
Click to expand...
I did 2 EM rotations as med student and 1 as an intern, can I join the EM docs FB group?😛
 
jesus this is a cluster F

UNC shyte the bed proper here

zero sympathies for them either

Its obvious they're trying to pull the wool over the eyes of a gambino!!!!
 
UnoMas said:
We literally have screen shot......

Someone needs to send this guy screenshots.

I don't know if I can believe this guy. Remember once you matched, you signed a contract and stuck for 3 years. The tunes can be very different after March 15th
Click to expand...
i actually laughed at this part because i distinctly remember reading the salary with my own eyeballs multiple times before they took the page down. sounds like they're trying to cover their tracks.

We do have some power though, i've seen this issue being discussed in multiple groups between here, reddit, twitter, and facebook.
 
kaygeebee said:
i actually laughed at this part because i distinctly remember reading the salary with my own eyeballs multiple times before they took the page down. sounds like they're trying to cover their tracks.

We do have some power though, i've seen this issue being discussed in multiple groups between here, reddit, twitter, and facebook.
Click to expand...
Impact on rank lists matters
 
Lol. Dr Binz in damage control mode. You know what sucks? She probably had no control over this (and likely doesn't want it) but was be forced to make these statements and later will be canned as a scapegoat when the higher ups need someone to blame.
If a prospective EM resident ranks UNC after this I will have no sympathy for them when they graduate as a lackluster doc because they fell for this hook, line, and sinker.

There is a sucker born every minute. If you can't identify them, it's probably you.
 
pollyspockets said:
Posted on EM Docs FB group:

I am the EM residency program director at UNC. I am passionate about my program and care deeply about my residents. I have been silent until now because my priority was, and always will be, my residents, and it was imperative that I listened to them first.

Inaccurate information has spread (admittedly some incorrectly posted on our own website) regarding a proposed APP training program at UNC.

Here are the facts:

· UNC Emergency Medicine does not have an APP EM education pathway, and no pathway will be introduced this year.
· UNC Emergency Medicine will not and would never pay APP trainees more than resident physicians.
· UNC Emergency Medicine feels that, although additional education for APPs working in the ED would be helpful, calling APP trainees “residents” is incorrect as it risks confusing APPs with physicians.

UNC will continue to be leader in inter-disciplinary emergency medicine education with a focus on creating highly skilled teams that provide excellent patient care. Also, I, as the UNC EM residency program director, will always continue to put my residents first and advocate for their wellness and future careers to the best of my ability.
Click to expand...

I'm not a proponent of MLP-bashing but I wonder if it will be the case that the MLP residents and residents will be getting paid proportional to the amount of schooling and rigor of the pathway. I hope we get to see some sort of increase for residents who have put in twice the schooling and have paid twice as much to receive their education.
 
Wow, this is incredibly disconcerting and this seems so incredibly disingenuous.
 
jw3600 said:
Lol. Dr Binz in damage control mode. You know what sucks? She probably had no control over this (and likely doesn't want it) but was be forced to make these statements and later will be canned as a scapegoat when the higher ups need someone to blame.
If a prospective EM resident ranks UNC after this I will have no sympathy for them when they graduate as a lackluster doc because they fell for this hook, line, and sinker.

There is a sucker born every minute. If you can't identify them, it's probably you.
Click to expand...

This is insane!
 
TheSingularity said:
So...I trained at one of these "powerhouse" residencies that had a midlevel residency program. I will try to provide a balanced perspective on this.

I will preface what I am about to say with the fact that I am in no way "pro-midlevel" as a whole. I believe they are to act as "physician extenders," do as they are told, and for physicians to have complete firing/hiring power over them.

There does need to be some kind of post graduate training for midlevels however, as the quality of some of the new grads I've seen (especially in a CMG setting) is just atrocious.

That being said, the midlevels at my particular "residency" sort of self select for the program. Meaning that, they are already so strong clinically (probably top of their class), that they probably didn't need to do the "residency" in the first place, but chose to anyway. They were often better than some of our junior residents.

I'm not saying this can be generalized on the whole, just describing my experience.
Click to expand...

So the solution to poorly trained physicians... is to supplant them with midlevels that have done "midlevel residency" ?
 
pollyspockets said:
Posted on EM Docs FB group:


I am the EM residency program director at UNC. I am passionate about my program and care deeply about my residents. I have been silent until now because my priority was, and always will be, my residents, and it was imperative that I listened to them first.

Inaccurate information has spread (admittedly some incorrectly posted on our own website) regarding a proposed APP training program at UNC.

Here are the facts:

· UNC Emergency Medicine does not have an APP EM education pathway, and no pathway will be introduced this year.

· UNC Emergency Medicine will not and would never pay APP trainees more than resident physicians.

· UNC Emergency Medicine feels that, although additional education for APPs working in the ED would be helpful, calling APP trainees “residents” is incorrect as it risks confusing APPs with physicians.

UNC will continue to be leader in inter-disciplinary emergency medicine education with a focus on creating highly skilled teams that provide excellent patient care. Also, I, as the UNC EM residency program director, will always continue to put my residents first and advocate for their wellness and future careers to the best of my ability.
Click to expand...
Key point: No pathway will be introduced this year.
 
pollyspockets said:
Posted on EM Docs FB group:


I am the EM residency program director at UNC. I am passionate about my program and care deeply about my residents. I have been silent until now because my priority was, and always will be, my residents, and it was imperative that I listened to them first.

Inaccurate information has spread (admittedly some incorrectly posted on our own website) regarding a proposed APP training program at UNC.

Here are the facts:

· UNC Emergency Medicine does not have an APP EM education pathway, and no pathway will be introduced this year.

· UNC Emergency Medicine will not and would never pay APP trainees more than resident physicians.

· UNC Emergency Medicine feels that, although additional education for APPs working in the ED would be helpful, calling APP trainees “residents” is incorrect as it risks confusing APPs with physicians.

UNC will continue to be leader in inter-disciplinary emergency medicine education with a focus on creating highly skilled teams that provide excellent patient care. Also, I, as the UNC EM residency program director, will always continue to put my residents first and advocate for their wellness and future careers to the best of my ability.
Click to expand...

the public relation **** storm is making UNC look bad, but remember that there are plenty other programs that also have these Advance Practitioner tracks. the other programs are listed above. UNC is getting **** blasted right now but the rest of them are just staying quiet. we have to keep the momentum and let it carry to other programs we are willing to drop from the rank list
 
pt: Are you a doctor?

mlp: No, I'm a residency trained advanced provider

pt: fawk Yeah!!

edit: c suite: fawk yeah!!! $$$$$
 
boolin_1 said:
the public relation **** storm is making UNC look bad, but remember that there are plenty other programs that also have these Advance Practitioner tracks. the other programs are listed above. UNC is getting **** blasted right now but the rest of them are just staying quiet. we have to keep the momentum and let it carry to other programs we are willing to drop from the rank list
Click to expand...
I distinctly remember someone telling a good CA program to go eff themselves mid season and cited bc he doesnt believe in mlp training along side mds.

everyone on the spreadsheet collectively lost their shyt on the guy while I silently applauded lol

to you sir, you the real OG
 
Listen2Savage said:
I distinctly remember someone telling a good CA program to go eff themselves mid season and cited bc he doesnt believe in mlp training along side mds.

everyone on the spreadsheet collectively lost their shyt on the guy while I silently applauded lol

to you sir, you the real OG
Click to expand...

It was UC Davis if my memory is correct. They just added one this year.
 
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