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?
I just encountered this website by chance, and I’m a bit perplexed as to the true nature of the PPP’s mission and values. As a Emergency Department Physician Assistant with an undergraduate degree in Cellular and Molecular Biology, a PA-C degree from UTMB and over 7 years of clinical experience in the Emergency Department setting I have to say I’ve encountered many PAs that provide objectively superior care to many MDs and DOs.
We all remember those Attendings that residents and midlevels alike found horrible to work with….
Of course we can also look the other direction to point out inferior care by PA’s and NPs. We are all human.
My real question being, is this organization truly about patient safety? It seems to me after briefly perusing your site that it is less about objective patient outcomes and more about preserving the modern status quo for current Doctors.
Why not instead focus more on breaking down the barriers to becoming a doctor?
Add residency slots. Make being a resident less of a hell and more of an experience conducive to learning and living at the same time?
Make a bridge program for PAs and NPs to take the USMLEs and gain the same training as Doctors. There are many suggestions as to how to increase access to care, not just focus on beating down your medical colleagues.
I went to PA school instead of Med school because I didn’t feel the desire to put myself through the MD or DO program in order to become a Healer. And in the end, it’s about the art and science of Healing, isn’t it?
– Respectfully yours,
Boone C Allen, PA-C
I wanted to comment that one of “the barriers to becoming a doctor “as another comment or mentioned, is a person not being willing to.commit the time, energy and sacrifice that is takes to become a physician. There is. No reason to make it easier per say. Every spot is filled in medical school. What we need is more residency slots to train more physicians. There are plenty of people willing to put in the hard work to become experts in the field and those that don’t want to do that can make the choice to not be a physician.
well, I was a biochemistry major, and then did 4 years of medical school, one of internship, 4 of residency, 10 years on academic university faculty teaching and research, and 30 years of private practice. So if we are comparing numbers here……
I am a member of PPP because of the abominable care that midlevels perpetrated on my family. Mistakes a first year medical student (not intern – medical student) wouldn’t make. I thought I had bumbled into a bad NP or two, and then I researched the situation, and found that what I had experienced was not an anomaly, but an acceptable incompetence within the midlevel world.
So – the mission of PPP as stated, is to protect patients, and that is why I am here. Protect them from midlevels attempting to get full practice authority and practice without physician direction.
Your judgement of the superior care of PAs to MDs/DOs may be sincere, but, honestly, you are not really in a position to judge. You do not have the education or experience of a Physician. There are things you may not understand the rationale behind.
You ask for PAs and NPs to be allowed to take the USMLE. Turns out, that experiment has already been done. After Mary Mundinger and AANP pressured NBME to allow clinical DNP candidates (presumably the cream of the corp) to take the Step 3, the NMBE created a somewhat watered down version of the STEP 3. Over five years, the total pass rate for the DNPs was 42%. The pass rate for physicians is 97% on the first try.
So – Fail.
Hi Dr Shaffer,
Are you talking about all NPs or just the ones who are trying to take the USMLE? A lot of NPs (including myself) work for doctors. We are very helpful in terms of reaching patients with common illness who otherwise would not receive treatment because MDs have far too many patients already. We treat the common and refer the complex to the doctor or to a specialty. In my mind, I have never considered myself to be a doctor nor would I ever want to be a doctor. Medicine is completely different from nursing and I prefer nursing. I serve a critical need because many MDs decide they are somehow above serving the patients I see. Either that or they are really just too busy to see them. I think we can all work together here if you can put aside your apparent anger and be open minded. It is a shame about your family’s experience but there are plenty of MDs out there who are also guilty of malpractice. A lot of doctors need to look beyond their degrees and accolades and try to be more open about healthcare and how to best serve patients.