How much power do you have as a provider?

Also: EM PAs are a good thing; NP/ PA money & satisfaction; Covid money drying up; and are PA's being replaced by AP's?

Jul 02, 2023

This feels like the beginning of a movement

In early June, the Association of American Medical Colleges wrote about the effects of thousands of medical residents joining unions. Recall that about a year ago 1300 LA County USC Medical center union members went on a 3-day strike. Nurses have also joined the picket lines in historic numbers. What are the provoking factors? Just to name some: not being included in hospital policy making, pandemic burnout, working long hours, and low pay. Residents have definitely shown they’ve had enough, and they’ve demonstrated resolve. How long will it take before others follow suit? Will EM physicians and EM NPs & PAs be next?

Healthcare is a mess. Despite shrinking healthcare budgets, we still are the most powerful, richest country on the planet. We throw the most money at healthcare vs any other country, but that doesn’t translate into a great healthcare delivery system.

Also, when one considers all the critical planning, decisions, and actions required to operate an ED, its truly remarkable what little say providers have. This problem is one of the key complaints many unionizing medical residents have.

When staffing companies turned to private equity, frontline providers and patients weren’t the winners. Providers have been voicing their concerns pre-pandemic, during the pandemic, and post-pandemic. What has been the effect?... staffing group bankruptcies, provider burnout, and providers leaving the workforce.

Money is limited, but it can be managed so much better. Healthcare company budgets have been strained, and one of the reasons has been the impact of staffing crisis. Yes, mismanaging burned-out or disgruntled talent will cost you more money. Burned- out, disgruntled staff are more likely to miss shifts for reasons they previously might not. Burned-out, disgruntled staff are less likely to help cover open shifts without bonus pay. It costs companies more to pay bonus pay to burned-out, disgruntled folks to cover vacant shifts. It costs more to pay Locums. It costs more to replace talent during periods of high frequency of staff turnover. It costs more to offer attractive bonuses to recruits so they take jobs at facilities with concerning and troubled reputations.

We don’t run our households like this. Those that earn money that contributes to the household budget have standing, and their voice matters. Folks at home have to face each other when money has been mismanaged. We work hard at home to maintain households and the home itself. We distribute responsibility and work equitably but hold each other accountable as well. Everybody has skin in the game.

Much of the issues above can be improved by providers having more of a say so. The problem is that providers don't have enough say so, or at least our words don't have sufficient impact. It appears that in locations throughout the US, healthcare professionals are consolidating their voices to ensure they are loud enough to be heard. Some are willing to go on strike or have gone on strike when their voices have not had sufficient effect.

We know that a one size solution does not always fit every situation. For some locale’s, unions are the solution, while it may not be effective for other sites. However, we should definitely have more prominent seats at tables. We should definitely be more involved in shaping our own operational environments.

The EM market is estimated at over $140 billion and projected to exceed over $200 billion by 2030. My concern is that not enough of that money is being efficiently spent to care for ED patients properly. Not enough of that money is being used to recruit and retain qualified EM providers. Certainly we, as a workforce, can do much better that the status quo. We need to be heard. When we are not, we need to act.

Listen to EM NP&PAWorkforce Podcast

Emergency Medicine

EM PA’s earn good marks

The Journal of American College of Emergency Physicians posted an article that discusses the contribution of PAs in the ED. The authors used at least 6 sources to examine published literature discussing PAs in the ED. We’ve heard colorful anecdotes about bad PA practice in the ED. This systematic review of EM PA practice is valuable and refreshing.

Move ‘em on out!

To some of you this may be old news, but in my travels across the country I’ve learned that not every ED has tried every intervention out there to address ED patient crowding. A southwestern IL ED and Massachusetts General ED in Boston have both found success implementing a discharge lounge to reduce ED waiting times and LWOTs.

ED boarding remains after Covid

Boarding has been defined as a duration of 4 hours when trying to transition a patient from an ED bed to an in-patient bed, or when trying to transfer the patient to another facility. Some hospitals are reporting that they exceed this standard nearly 90% of the time. We know that the Covid pandemic created a historic boarding crisis. Now that the pandemic is over, it appears a boarding problem remains.

House of Medicine

NP & PA pay

I suspect that many of you have reviewed a number of salary reports during your career. Many times, I find NPs & PAs commenting on those reports and opining that the listed salaries seem lower versus what they see firsthand in markets. Take a look at this quick read that briefly reviews NP pay by location and industry. This second article discusses increasing PA pay, but also increased dissatisfaction with the job. I believe that a challenge for job hunters is having reliable pay data for the specific site and surrounding geographic area of interest.

“Physician Assistants” or “Assistant Physicians?”

Check out this article that discusses a growing trend: Assistant Physicians. Don't confuse this with Physician Assistants. APs are med school grads who have not completed a residency. They must collaborate with a residency trained physician for supervision. A number of states have already passed laws granting them licensure. Where does this leave PA’s?

Hospitals, health systems, and more

The Covid bonus money is gone

During the Covid epidemic, New York state allowed out- of- state nurses to practice there without NY state licenses in order to fill needs created by the pandemic. This resulted in hospitals contracting with nursing agencies at very expensive rates to bring in out-of-state nurses. This allowance is about to end, but some hospitals have contracted through 2026 at very high agency rates.

The good stuff

Read about an NP who has opened up a pediatric urgent care in South Carolina. Her clinic is an alternative to the ED and pediatrician’s clinic. She’s filling a need, increasing access to care, and helping to decongest EDs and pediatric clinics.

Also, read about Maryland NPs & PAs who have been acknowledged for superior patient care performance in addiction medicine, pulmonary medicine, and emergency medicine. Other clinicians are overperforming taking care of patients in underserved urban areas. All of these clinicians are increasing access to high quality care. This what NPs & PAs do best!

Thanks for reading the Emergency NP & PA Workforce Newsletter! Subscribe for free to receive new posts and support my work.

This newsletter is sponsored by Ivy Clinicians, the simplest way for emergency physician assistants, and nurse practitioners to find jobs they love.

Please check out the new EM NP & PA Workforce podcast here.