Pre-Hospital physicians

[rescue1]

Yeah it really is. It's a super popular specialty now, though, at least in my school. So maybe in the next 5-10 years it'll start to change.

I doubt you'll ever see the CAH's staffed with emergency physicians though, there's just not enough patients to justify it.

 

[VFlutter]

In some of these places the in-house CRNA/NP or PA are running the show and the physician is just there for oversight. Huge demand for CRNAs in rural areas to provide critical care services along with typical OR roles.

 

[E tank]

Yeah it really is. It's a super popular specialty now, though, at least in my school. So maybe in the next 5-10 years it'll start to change.

I doubt you'll ever see the CAH's staffed with emergency physicians though, there's just not enough patients to justify it.

You're right but what is happening in many areas is the idea of e-medicine departments that do remote ER/ICU management. As regional hospital systems suck up these little CAHs and they become part of a wider healthcare network, these e ICU docs have a kind of eye in the sky in what looks like a dispatch center back at the mothership. That's where these PA's and "GP's" would kind of morph their roles.

 

[rescue1]

You're right but what is happening in many areas is the idea of e-medicine departments that do remote ER/ICU management. As regional hospital systems suck up these little CAHs and they become part of a wider healthcare network, these e ICU docs have a kind of eye in the sky in what looks like a dispatch center back at the mothership. That's where these PA's and "GP's" would kind of morph their roles.

At that hospital I mentioned they had a "neuro robot" that was basically a portable video chat/computer so they could consult Jefferson (the regional neuro center) for stroke management in the ED before they were shipped downtown. I could see that happening for rural emergency departments and ICUs who would want a consult from the mothership hospital.

 

[VFlutter]

eICU is a great resource however you still need a competent provider on the other end to provide critical interventions. But Tele consults work great for the stroke population, having an actual neurologist make the decision for TPA.

 

[NomadicMedic]

Sounds like where I work. Our local hospital is a CAH. Let's just say it's interesting seeing what some of the docs decide to do with critical or unstab;e patients.

 

[VFlutter]

Unstable A fib with RVR....P.O. Digoxin it is!

 

[EpiEMS]

Certainly a relatively inexpensive way to staff these CAHs -- a midlevel with a one year EM-residency who can consult in an EM (or other) physician from...heck, anywhere!

I like it.

 

[rescue1]

Certainly a relatively inexpensive way to staff these CAHs -- a midlevel with a one year EM-residency who can consult in an EM (or other) physician from...heck, anywhere!

I like it.

I think the biggest problem is that midlevels, much like physicians, tend to not want to work way out in the boonies. Especially if they've done extra EM training and are likely to be able to grab a job in a more desirable location.

The other issue I could see is that these CAHs tend to have family medicine doctors who simultaneously see patients in the ED, have an outpatient practice, and see inpatients in the hospital. I don't really know about the cost vs. having midlevel support. Though I fear we've gone somewhat off topic haha

 

[EpiEMS]

I think the biggest problem is that midlevels, much like physicians, tend to not want to work way out in the boonies. Especially if they've done extra EM training and are likely to be able to grab a job in a more desirable location.

I suppose so, but let's say you have to pay people, call it, 20% more, to work somewhere "undesirable". As an administrator, I'd rather pay 20% more on a $100,000/year PA (plus the cost of a tele-EM doc) than 20% extra on a $250,000/year EM physician.

that these CAHs tend to have family medicine doctors who simultaneously see patients in the ED, have an outpatient practice, and see inpatients in the hospital

Fair enough - I don't think that the bulk of physicians do this anymore (they have hospitalists for this)...but maybe rural practice is different. That's certainly a consideration.

 

[NomadicMedic]

The majority of ER docs at the CAHs in my area are staffed by a Physician's Group, usually the docs have some ER background, but there's a fair number of family practice physicians running the show at the local ED. Sadly, many of the EMS providers don't have any idea how this works.

 

[E tank]

I think the biggest problem is that midlevels, much like physicians, tend to not want to work way out in the boonies. Especially if they've done extra EM training and are likely to be able to grab a job in a more desirable location.

You might be surprised about where those midlevels want to be. The prospects of running your own show independently is pretty attractive to a lot of folks (ie cursory to no physician supervision). The money is very good and the fishing and hunting is even better...

 

[rescue1]

I suppose so, but let's say you have to pay people, call it, 20% more, to work somewhere "undesirable". As an administrator, I'd rather pay 20% more on a $100,000/year PA (plus the cost of a tele-EM doc) than 20% extra on a $250,000/year EM physician.



Fair enough - I don't think that the bulk of physicians do this anymore (they have hospitalists for this)...but maybe rural practice is different. That's certainly a consideration.

Yeah I'm speaking about rural areas specifically, and honestly only from some anecdotal experience (my first EMS experience was in a rural spot where the medical director was also an outpatient doc and an ER doc) and from what I read about. My guess would be that a hospital busy enough to hire a hospitalist service would also be busy enough to warrant to hire physicians in the emergency department, but I don't really know for certain.

As for the midlevels, I would never suggest no one would ever want to live rurally, but there are certainly problems getting enough higher level health care providers out there. It is crazy how much more money you can make by working in rural areas as a physician, and yet places still struggle to attract them away from the big cities, where the pay is less and the cost of living is higher. I don't know about PAs/NPs specifically but my guess is it's the same story.

 

[EpiEMS]

@rescue1 Yeah, you're probably right about the hospitalists - I guess it depends on the hospital's size and how filled up the inpatient beds are at any given time. About the rural living, again, I agree - but there's gotta be some wage that would make people give up urban amenities, you know what I mean?