Prehospital Physicians

[Obstructions]

It might actually be cheaper to staff the helicopter with EM residents as they are paid similar to a paramedic. I've heard that the change is a result of a new program director who thinks that residents should be in the ED more and that the helicopter should be optional and not a requirement (also, some docs don't want to fly... I know I wouldn't). Supposedly his decision to do away with that part of their program was very controversial among faculty and residents.

I bet...I'd like to become a EM physician, and I thought being a HEMS Physician would be really cool. But after messing around and hanging out with some local flight nurses and paramedics....eek. :unsure: Keep me away from those death machines. Physicians are extremely expensive cargo.

But I still thinking geting that HEMS education would have been beneficial. All the level II and level I trauma centers around here have their own HEMS service, so I don't see why understanding the system and roles could be that bad...just for a few months.

 

[Summit]

Maybe I could be a Prehospital CRNA and anesthetize patients for a comfy ride to the Hospital.

I got a good laugh ^_^

 

[EMDispatch]

Where I grew up in PA, there is a system of hospital based ALS chase units. One of them in a more remote area was kept at the home of one doctor and he would respond in it. I was pretty young, so I don't remember much about him, but I'm sure he was certified as an EMT-P, especially since the same organization requires PhRNs to also be EMT-P, and probably acted almost exclusively in that role.

 

[Shishkabob]

My medical directors (plural) often respond to calls.



Our local Level 1 also requires all their EM residents to do a month riding on the ambulance with us to get not only a greater appreciation for what we do, but also understand the limitations that we have to work with in the field.

 

[medicsb]

My medical directors (plural) often respond to calls.
Our local Level 1 also requires all their EM residents to do a month riding on the ambulance with us to get not only a greater appreciation for what we do, but also understand the limitations that we have to work with in the field.

Pretty much every EM residency does this, usually its a small handful of shifts over 2 weeks in the first year. I think it'd be better if they required one week in first year and then another in third year where they're expected to actually treat patients with the medic as opposed to observing as most do since they still new.

 

[jrm818]

It might actually be cheaper to staff the helicopter with EM residents as they are paid similar to a paramedic. I've heard that the change is a result of a new program director who thinks that residents should be in the ED more and that the helicopter should be optional and not a requirement (also, some docs don't want to fly... I know I wouldn't). Supposedly his decision to do away with that part of their program was very controversial among faculty and residents.

Ah...I didn't realize the director changed. What you said does make intuitive sense to me, so that may well be it. My information may have been junk...

As to money, I only heard rumor and innuendo....something about needing to pay more doctors to fill the shifts left open by residents jetsetting around. I could see it going either way, since hiring EP's is much more expensive than hiring medics, if they actually needed to hire more. Administrative and training costs probably add to that. Maybe insurance too?

Maybe it was just a pain in the rear to organize and they didn't want to see their residents crashing....

 

[medicsb]

Ah...I didn't realize the director changed. What you said does make intuitive sense to me, so that may well be it. My information may have been junk...

As to money, I only heard rumor and innuendo....something about needing to pay more doctors to fill the shifts left open by residents jetsetting around. I could see it going either way, since hiring EP's is much more expensive than hiring medics, if they actually needed to hire more. Administrative and training costs probably add to that. Maybe insurance too?

Maybe it was just a pain in the rear to organize and they didn't want to see their residents crashing....

If they had to hire board certified EM docs to staff the helicopter when residents weren't available, then yeah, it'd be REALLY REALLY expensive (probably 100-200$ an hour). But, residents are paid in the range of 45-60k per year, typically, which is probably more than medics in Worcester make, but it is probably comparable to nursing pay, if not less. Realistically speaking, the residents were probably functioning similar to medics and I'm sure that they were required to call an attending for every patient contact to go over their assessment and plan. They really would be better off in the ED since EMS is not part of a EM docs job like it is in other parts of the world.

 

[platon20]

I bet...I'd like to become a EM physician, and I thought being a HEMS Physician would be really cool. But after messing around and hanging out with some local flight nurses and paramedics....eek. :unsure: Keep me away from those death machines. Physicians are extremely expensive cargo.

But I still thinking geting that HEMS education would have been beneficial. All the level II and level I trauma centers around here have their own HEMS service, so I don't see why understanding the system and roles could be that bad...just for a few months.

Sure you could do that, but you'd be taking a MASSIVE paycut to do so.

Emergency physicians get paid based on the RVUs they provide in the ER environment. A busy ER shift can have a doctor seeing 5 patients an hour. The cash flow you generate from that will be MUCH, MUCH higher than flying around on a helicopter or going in an ambulance.

ER docs get paid anywhere between 250-350k, if they spent all their time on choppers they'd be lucky to break 100k

 

[platon20]

If they had to hire board certified EM docs to staff the helicopter when residents weren't available, then yeah, it'd be REALLY REALLY expensive (probably 100-200$ an hour). But, residents are paid in the range of 45-60k per year, typically, which is probably more than medics in Worcester make, but it is probably comparable to nursing pay, if not less. Realistically speaking, the residents were probably functioning similar to medics and I'm sure that they were required to call an attending for every patient contact to go over their assessment and plan. They really would be better off in the ED since EMS is not part of a EM docs job like it is in other parts of the world.

ER residents are basically supplied at zero cost to the hospital. Medicare pays their entire wages and benefits. In fact most hospitals get more money from Medicare than what it takes to actually pay the resident's salary/malpractice/healthcare etc. I think last year Medicare paid about 150k for each resident slot.

 

[Summit]

On the helicopter front: Air crew are far more than medical providers; they are flight crew. Helicopters are dangerous and specialized. You want long term permanent flight crew. I don't think you want residents as the standard staffing for helicopters. For safety, you want experienced helicopter crew more so than you want a resident who flies three times a month for a year before the next guy pops in.

 

[the_negro_puppy]

Not from the US but...

We have pre-hospital doctors on fly cars and Helicopters, they do stuff like:

RSI
Packed red blood cell infusion
Tranexamic acid
FAST Scan

 

[ExpatMedic0]

there a common sight in much of Europe. In Copenhagen an M.D. with a Paramedic respond in a fly car behind the ambulance on some calls.

 

[jlw]

Here in Ohio the University of Cincinnati AirCare heli's fly with a Doc and Flight RN/Medic.

 

[EpiEMS]

The implementation of a prehospital physician program is an interesting one. I'm sure it's great to have, and works wonders for some patients, but from an administration/business perspective, it's really tough to justify (I would think) in most locales, no?

I don't have any data on prehospital physician costs versus benefits, though. Anybody have anything?

 

[Veneficus]

The implementation of a prehospital physician program is an interesting one. I'm sure it's great to have, and works wonders for some patients, but from an administration/business perspective, it's really tough to justify (I would think) in most locales, no?

I don't have any data on prehospital physician costs versus benefits, though. Anybody have anything?

You are not going to be able to compare costs and savings across systems for this.

If there was money to be made doing it in the US, physicians would be doing it.

In European countries where there are physicians prehospital, they fulfil a role within their systems that would not easily correlate to the US.

But from working in it, the system here saves considerable hospital resources putting physicians on the ambulance. But those hospitals are not private ventures. The goal is to save money, not to make it.

 

[ExpatMedic0]

Ya I am not sure how it works here in Denmark %100. I have done some ride a longs with them but there healthcare system is free for everyone and this is a "wellfair state" Although the doctors respond to emergency calls all day I believe they probably reduce transports and ED admission by a large percentage. I have no data on this and its just an assumption. Also the docs are the only ones allowed to intubate here.

 

[DrParasite]

As was mentioned earlier, Jersey has a few docs that go out into the field. They are scattered around various projects.

As for it they help or not, it all depends. Some doctors are awesome, will help out, bring their bag of toys in on calls, while other docs will walk with not even a stethoscope, and generally get in the way of everyone else.

But if you get a knowledgeable doctor who is comfortable working in the field, who doesn't mind getting dirty, and works with the prehospital providers, that's it's a huge asset.

 

[Clare]

I believe we are getting doctors on the helicopter permanently now.

 

[rescue1]

I believe we are getting doctors on the helicopter permanently now.

Are they residents or full attendings?
(sorry, I forget the Commonwealth terms for those)

 

[JPINFV]

Are they residents or full attendings?
(sorry, I forget the Commonwealth terms for those)

House officers (still used on occasion over here) vs consultants?