No physician in the ER?
This is not a positive trend.
I know and work with some wonderful NPs and PAs. They’re my professional family.
But they should not be expected to staff emergency departments without a physician on site.
It’s wildly unsafe. And it places unfair expectations on their shoulders.
There just isn’t a replacement for medical school and residency.
I have worked in a busy piedmont NC ED in an independent group for 43 years. We have always had APPs in our ED. We have never felt it safe to go over 1:1 coverage. Our APPs always have a boarded physician working side by side with them to help handle the tough decisions that always arise. Many of our APPs do intubations and central lines but I guarantee you they would not want to see our volume and level of acuity without boarded physicians present. We are happy to have them working side by side with us in this appropriate setting.
This jar was opened years ago. Remember Dr. Henry? Paraphrasing... A mid level provider can do 90% of what we do. We got thrown under the bus and devalued. The thought is that anyone can be an ER doc, family practice, IM, orthopedics, PM&R, whatever. Can't manage an airway? No problem as long as you are boarded in anything, you can work ER. Why is any of this surprising with APPs? Administration has dealt with understaffing for well over a decade by tossing APPs into the schedule instead of ER docs. None of this is new and this will only increase with time. Eventually, there will be a teledoc ER physician in a department staffed by APPs and this will be the norm. And, of course, the ARNP lobby is perfectly ok with this too. When they push for independent practice, this is the end goal.