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.
And, this among other things is why I bailed on a 24 year career to do full time telemedicine. Did nights for almost all of it and have just watched this mess get worse year after year and it's not that nobody cares, but the important folks ask either the wrong questions or the wrong people.
I always felt badly for midlevel providers who would call our Transfer Center needing to transfer patients to a higher level of care because they oftentimes were unable to perform intubations and had no respiratory support in their facilities if they did. Hard times for sure.
There is absolutely NO alternate for an ER doc who has graduated from medical school (MD or DO), gone through residency and is experienced in emergency medicine. The switch to mid-level practitioners is dangerous, at best. And now, we are seeing the CDC being gutted by incompetent leadership and misguided policies. Healthcare in this country is INDEED becoming less safe and accessible. Ed, I fully endorse your advice for everyone to remain as healthy as possible!
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.
And, this among other things is why I bailed on a 24 year career to do full time telemedicine. Did nights for almost all of it and have just watched this mess get worse year after year and it's not that nobody cares, but the important folks ask either the wrong questions or the wrong people.
I always felt badly for midlevel providers who would call our Transfer Center needing to transfer patients to a higher level of care because they oftentimes were unable to perform intubations and had no respiratory support in their facilities if they did. Hard times for sure.
There is absolutely NO alternate for an ER doc who has graduated from medical school (MD or DO), gone through residency and is experienced in emergency medicine. The switch to mid-level practitioners is dangerous, at best. And now, we are seeing the CDC being gutted by incompetent leadership and misguided policies. Healthcare in this country is INDEED becoming less safe and accessible. Ed, I fully endorse your advice for everyone to remain as healthy as possible!
Are we safe if this is true?