Surviving for years in Emergency Medicine
Also: tired of waiting; right number of EPs; rural America; show me the money; and tough financial times ahead
How Long Can You Practice EM?
Being a healthcare provider is becoming increasingly challenging. Physicians are finding it harder to remain in the industry. In particular, working emergency department overnight shifts; rotating shift start/stop times, weekends, holidays take a quite a toll on oneself. Work demands of EM providers have increased in the past twenty years. The effects of the pandemic on EM providers have been well documented, and we are well aware of the rising rates of provider burnout.
We know that 2023 marked a lesser number of EM residency matches. One theory is that medical students witnessed first-hand how EPs were being negatively impacted by work. Read about challenges that veteran EPs face.
There has been an increasing focus on the utilization of EM NPs & PAs in the ED. We are now seeing a wider variance of experience among us, but that doesn’t always translate into higher pay. Sometimes big employers aren’t looking for the right EM NP/PA; they just want one right now. So, you may experience a pay rate exactly the same or a few bucks more than somebody with drastically less experience than you. Good for the junior clinician! The floor for pay should be raised.
In some instances, experienced APCs are asked or expected to do more and see more in order to make up for junior clinicians’ learning curve. EM NPs/ PAs who have been practicing EM for an extended number of years and have developed commensurate advanced skills should be commanding higher pay for the increased acuity they see and the increased risk they incur.
These clinicians have honed efficient work habits, and they minimize the need for active EP supervision, which helps to decrease the burden on EPs. When EM NPs/PAs don’t see a promising outlook on pay, it can be challenging to remain in EM 10+, 15+ years. Further, EM NPs & PAs continue to be untapped resources within the ED. They have much to offer, from life experience, previous work experience to unique and valuable perspectives of ED operations. They can serve in leadership positions in the department, hospital, and within the employer’s infrastructure.
Employing EM NPs & PAs for 15-20 years is very beneficial to any employer, department, and hospital. However, achieving this feat will prove to be increasingly challenging in current circumstances. Now is the time to re-think how best to preserve this growing, diverse, and valuable workforce.
Emergency Medicine
“Sorry, but I have to go”
In 2022, ED patients left the department before completing the encounter at a rate double that of 2019. With this comes a loss of revenue that eventually has downstream effects. Decreasing lengths of stay increases the likelihood that patients will stay to completion of their management. Look for revamp efforts in your ED to decrease waiting times. EM NPs/PAs see considerable number of patients in the ED. You see what works and what doesn’t. Your input is valuable. Be prepared to speak up and contribute. Show everybody your full worth.
How Many EM Residencies Do We Need?
Increased EM residency vacancies this year hit the headlines causing much discussion. Check out this article that questions what ideal EM residency growth should look like. Until this gets figured out there is no question that a continued reliance on EM NPs and PAs will continue.
House of Medicine
Re-examining Rural American Patients
As we have learned, many American hospitals have closed over the past few years. Currently, others face the same fate. However, one way for hospitals to potentially avoid closure is to apply for “Rural Emergency Hospital” designation and receive federal funds. We will see an increasing number of applications. This is an example.
Healthcare executives are focusing on rural markets more so than before. There are efforts to bring more healthcare capabilities to rural areas. The historic model of rural patients traveling long distances for healthcare is outdated. Many patients don’t make those long trips. They just stay home, not receiving adequate care while their medical conditions get worse.
PA Pay, PA Burnout
PA’s work in over 20 specialties. The National Commission on Certification of Physician Assistants recently released a report listing average incomes by specialty. Compare that with the NCCPA report on PA burnout by specialty. While you’re at it, check out this Bureau of Labor Statistics list that compares pay for NPs, PAs, and RNs by each state.
Hospitals, health systems, and more
Trying To Weather Storms
Financial challenges continue for hospitals and health systems. Hospital continues to claim bankruptcy while others close up shop. Mutiple contributing factors are citied. Some of them include declining populations, declining utilization, and declining admissions. Other factors are closely tied to payer mix and reimbursement rates.
A minority of US Chief Financial Officers believe a recession is coming. Historically, healthcare has been considered a recession proof industry. However, that doesn’t mean there are not impactful effects on healthcare when the general economy falters.
The Good stuff
PA Joshua Johnson of Hawaii has been awarded the title of “Distinguished Fellow of the American Academy of Physican Assistants.” He’s been an orthopedics PA for 13 years and has been a notable contributor to his community. This title is not given out easily, nor frequently. Congratulations, Josh!
Read about Kansas NP, Amy Siple who recently received an award for excellence. She’s dedicated to caring for our geriatric population and increasing access to quality care by NPs. There’s lots of debate about full practice authority for NPs/PAs. Amy is leading by building coalitions, listening, and being patient. Amy is showing how her profession contributes to patient care, but also how to productively work together with other stakeholders. Great job, Amy!
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