Emergency departments often care for patients on the worst days of their lives. Emergency medical staff must be prepared to face critical illness, trauma, and death across the life spectrum—from pediatric to obstetric to neurosurgical emergencies. The challenges are so rigorous that emergency physicians spend about 15,000 hours in training before they are permitted to treat patients independently. But according to a 2018 survey of emergency physicians, the person that patients must trust with their lives is increasingly no longer a physician, but a non-physician practitioner such as a nurse practitioner or physician assistant.
But according to a 2018 survey of emergency physicians, the person that patients must trust with their lives is increasingly no longer a physician, but a non-physician practitioner such as a nurse practitioner or physician assistant.
According to the 2018 survey, 97% of emergency physicians reported that they currently or previously worked in a facility that also employs nurse practitioners and/or physician assistants. These non-physicians (PAs and NPs) were not only treating minor conditions, but are also treating patients with the most serious conditions. More than a third of the emergency physicians surveyed noted that NPs and PAs in their emergency department treated patients categorized with an emergency severity index (ESI) level of 1, which is defined by deadly conditions such as full cardiac arrest or stroke.
The study showed that, in many cases, non-physician practitioners are not discussing the treatment of these high acuity patients with a physician. For example, only half of the emergency department physicians reported that non-physician practitioners caring for ESI level 1 patients were required to notify them of the patients’ status in “real time.” Ten percent of emergency room doctors noted that there was no requirement for non-physician practitioners to notify them about the care provided to these critically ill patients at all, and 16.3% reported a requirement to notify a physician after the patient left the department. That means more than 25% of critically ill patients in this survey never saw a physician in the emergency department.
In other words, an unacceptable number of critically ill patients are not receiving access to care by a physician during treatment in the emergency department.
Nurse practitioners and physician assistants also frequently perform procedures and interpret radiologic imaging without physician supervision. Sixty percent of respondents reported that non-physician practitioners at their facilities were permitted to interpret radiographic imaging without supervision. Nearly 27% of physicians reported that non-physicians in their emergency department were permitted to perform lumbar punctures, a procedure in which a long needle is inserted in a patient’s back to draw a sample of spinal fluid. A minority of physicians (2%) reported that nonphysicians were permitted to electrically cardiovert (shock) patients without supervision.
Nearly a third of emergency room physicians in the survey noted that non-physician practitioners have been increasingly granted increased responsibility for caring for complex patients. Bearing that in mind, since the article was published in 2018, patients in the emergency department today are likely receiving even less physician-supervised care.
But on the worst day of your life, who do you want caring for you? A fully trained, board certified emergency physician with at least 15,000 hours of experience? Or a nurse practitioner or physician assistant with just a fraction of the training?