No more hiding info from you It's time you knew more!
Also: more violence in the ED; pediatric crisis; decongesting the ED; and where to land the stork
Contract management groups (CMGs) have been in the news quite a bit lately. After all, two of the biggest CMGs have declared bankruptcy within about two months of each other. Recent discussions have provided real examples of how this affected real people. As some CMGs’ profit margins have thinned due to multiple factors, they have looked to mitigate losses on the backs of the labor force: EPs, NPs, and PAs.
The recent failure of Envision and American Physician Partners has highlighted the need for employer transparency. However, rather than expecting that employers will voluntarily offer all relevant information to the labor force, providers should be proactive in seeking answers to specific questions.
One thing is for sure: EPs, EM NPs, and EM PAs are the engines that produce high revenue for CMGs. That’s a tremendous amount of power. That power is most realized when it is matched with knowledge about who the CMG decision makers are, how profits are distributed on clinician pay, and other topics meaningful to providers.
Emergency Medicine
More violence in the ED
On August 13 a fight in a Chicago ED left employees and a visitor injured. It is believed that the fight was connected to a city shooting that had just occurred, and victims were brought to the ED for treatment. Of course, hospital administrations can’t control violence outside of the hospital campus, but it can take meaningful steps right now to improve protection for the people who are charged with providing care in some of the most challenging circumstances. Checkout ACEPs recommendations on how to improve protection for ED workers.
Kids in crisis
The number of pediatric patients presenting to the ED with psychiatric complaints continues to rise. For many EDs the challenge is that they have insufficient or zero resources to provide care adequately for these patients. Many of the young patients end up being boarded for days, and weeks in the emergency department. The Joint Commission has already stated that such patients should not be boarded for more than 4 hours. I truly cannot recall a time when any psychiatric patient was boarded 4 or less hours!
There is a focus by healthcare leaders on developing resources in communities so that some patients can managed responsibly and avoid unnecessary ED visits. However, there is also need for more resources to respond to psychiatric pediatric patients already in the ED. I suspect that we will see more NPs and PAs filling new clinical psychiatric roles to help address this crisis.
House of Medicine
Can’t widen the road?…Create other lanes
We know that all across the country there are communities with not enough ED beds and nurses; and not enough in-pt beds and nurses. We have heard of multiple strategies to address overcrowded ED waiting rooms, as well as delays to seeing a provider. We struggle when we feel the ED is being used as the primary care team of patients.
Some healthcare leaders are developing plans to increase patient access to ambulatory care in hopes of avoiding unnecessary ED visits. Some of these resources are brick and mortar facilities, “hospital at home” programs, and telehealth platforms that coordinate follow up care after ED visits. If these efforts are impactful on a large scale, keep an eye out for an emerging need for more NPs & PAs to help manage patients in these other settings.
Save the nurses!
Clinician burnout is now a fixed characteristic of our health care work force. How do you salvage a highly trained nurse who is poised to leave health care because of burnout? Use modern technological resources and re-visit an old idea. Read how St. Luke’s in Missouri is doing just that.
Hospitals, health systems, and more
It’s raining jobs
The COVID-19 epidemic disrupted the healthcare labor force across America with such an overwhelming impact that many hospitals and health systems have still not yet recovered. Check out this article that lists job vacancies at the best hospitals in the country. You might already work at one of these, or one of these centers might be a potential option for you.
What to expect if you're expecting
From February 2023 to June 2023 there were at least 42 healthcare departments closed or services ended. Maternity services are not immune from closures. In fact the numbers of maternity closures are increasing. In addition to decreasing access to care, this increases challenges to surrounding maternity wards who have to absorb the extra patient volume. To further complicate the matter, OB-GYN residency applications have decreased.
The Good stuff
NPs & PAs to the rural rescue
It appears that there is no one clear, universally agreed upon definition of a rural community. From a population criterion, the number can range from 2,500to 50,000 people. To put things in perspective, the average daily attendance to Disney World’s Magic Kingdom is about 55,000. What is agreed upon is that rural communities struggle with having sufficient healthcare providers. Read how NPs and PAs are filling the healthcare gap in rural Pennsylvania. Increasing patient access to quality care in areas where physicians are leaving is a top benefit that NP and PA practice offers.
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