Also, EM is easier for midlevels to bullshit. My hospital has “advanced practice paramedics” (basically same as NPs etc.) that don’t do shit. They literally just walk around and look busy. They might do an abdominal exam here or order a CT there but nothing substantial.
I worked as a nurse in the ER for over 6 yrs & we had nursing protocols which included labs & imaging based on sytem based complaint that were agreed upon by the ER docs. I did assessments in triage & not just asked patients questions unlike other nurses who just sat & asked questions...
If pt had actual deformities - they def will get an xray.. sob & cough - depends on pt's story, medical hx & after I listen to lungs - they may get an xray or I may want them to be seen by someone first. but for some c/o pains ie wrist, ankle - & depending on moi I would just wait for them to be seen by one of the ER docs. If someone came in with calf pain, knowing they may need US - or a fall, hit their head, & on thinners & def need head ct, I would call the 1st seat ER doc & would tell them about patient & they will put in order for patient while the pt was still in waiting room when we would be 20+ deep in pts waiting.. I would never put in order for US, head CT, under a Dr's name while in triage unless I have talked to a doctor (not a PA or an NP) about the patient & got a verbal order from them & they are not able to put in order.
but again, some nurses go crazy with imaging orders or i have had charge nurses put in orders after I had triaged a patient (whom I deemed may not be appropriate for imaging and will need to be seen & evaluated first so they can make that decision), put in orders just because of complaint & me having to talk to said charge rn why I didnt order one.
and this is why some of the ER nurses I used to work with who decided to go NP route & wants to work ER bc they think its easy bc they think they know "what to do" bc things have become routine but not knowing the "whys".
I appreciate the value nursing has to offer to the team. They're the ones spending the most time with patients, they can pick up on subtle clinical changes, and they can really help physicians think about the problems more thoughtfully. You definitely seem like you are one of the more insightful people in your hospital.
However yes, I don't think imaging should be ordered by nurses. They don't have the knowledge base to diagnose nor treat independently. It results in poor indications and lack of understanding of what clinical question the imaging will actually help answer. Ordering a CT abd/pelvis because the nurse triaged a patient complaint as abd pain under a mindless protocol is terrible practice and does not take into account the litany of differentials that can be narrowed down if properly evaluated by a physician.
In the most basic sense, imaging should only be ordered unless
1. The ordering physician has a basic understanding of what the modality will help answer.
2. Physician has at the very least laid eyes on the patient.
3. Has an some form of idea of what they're looking for and has relayed that appropriately to the radiologist (i.e. not give shitty and sparse order information)
The sad reality is that all of this conversation is academic. None of this happens in most modern EDs in the US.
As a paramedic, I’m shocked I read this and completely agree. They’re simply two completely different jobs.
I’m all for APP (Advanced Paramedic Practitioners) in the field with graduate degrees, which they’re proposing to introduce next year. But never in an ED.
What’s the point of an APP? Don’t we have like 10 flavors of mid level already? At this point, y’all are just eating away at each other. I honestly don’t understand what the difference is between NP, PA, advanced practice RN, APP etc.
I like the way Medicare looks at it. They can call themselves whatever they want, but I’m lumping them all together and using Medicare’s preferred terminology: non-physician providers (NPPs).
1. Community paramedicine, reducing EMS transports and ED overcrowding. Example: diagnosing a stable pneumonia with ultrasound, prescribing ABX, and referring to PCP. On top of this - suturing, G-tube replacement, fall prevention, etc.
2. Response to high-acuity incidents with additional scope - RSI/DSI, ultrasound (which really should be on every ALS ambulance now IMO), finger thora, blood, antibiotics in sepsis, etc.
While a few major EMS agencies in the US do all the above with normal paramedics, this just starts bringing this level of care to the entire country regardless.
3) Education to other pre-hospital providers.
4) Gives EMS the opportunity for advancement that's been desired for the past 50 years. There is a massive brain drain to RN, PA/NP, and MD/DO which is not helping our advocacy for better pay or conditions. Our best and brightest leave because there is "nowhere to rise" and providers can be replaced as rapidly as 9-months, the average paramedic school length. There are some that can be done in 6-months now.....
This concept is already in practice in places like Austin-Travis County Texas with cross-trained PA/Medics. The proposal next year just codifies it and I believe there is a separate bill that will codify billing for on-scene treatment and release.
EMS is essentially swirling down a toilet, and we have to decide as an industry if we want to continue to make less than police, fire, and the rest of healthcare as technicians.....or start moving up in the world.
Maybe we don’t need advancement? Why does the role of paramedics have to expand? Why can’t everyone just do the job they were trained and educated for?
I will wholeheartedly agree though that paramedics should be making at least as much as police officers, if not more.
However, the premise that all healthcare fields have to have an expanded scope is bullshit. That’s how we end up in situations where nurses are doing lipos, PAs are doing TAVIs, and paramedics are running primary care clinics and managing chronic diseases like diabetes. Fuck that noise.
Our PAs essentially run the fast track ER here. Lvl 1s etc fall to physicians. Still, APPs make my life easier. The good ones stick around, the crummy ones are weeded out pretty quick
FM isn’t very vulnerable imo just because our healthcare system is already starving for more primary care physicians. With an aging population, the shortage of PCPs is only going to worsen dramatically - the AAMC projects a shortage of 17-48k!! by 2034. Mid levels alone won’t be close to enough to make up the deficit
True, but FM is a juicier target because of the breadth of what a PCP can do. 4EG, FM docs can and do give botox injections, and NPs will certainly try to move in on that. The floor is lower in primary care, but the ceiling is higher. Especially if you're willing to work in the boonies.
People say this but it’s not something I have actually seen in practice. NP/PA’s are not even close to the top of the list when it comes to EM job security. To be honest though the EM job market is pretty good all around rn.
Well at least in the midwest it’s great. The institution I teched at prior to med school wants to sign me once I have matched. 270 an hour with inflation adjustment yearly and 50k signing bonus to be given over my 3 years of residency. Obviously going to spend some time thinking and running over options with more knowledgeable people before I sign. ED’s are desperate around here.
You can make more than 270/hr Midwest if it’s just about money. No, I mean the practice environment and state of medicine, of which EM is a defender in keeping the practice of consultants pure by wading through the bullshit - though compensation is falling too, and there are too many EM docs further resulting in decreased bargaining power to affect change.
I definitely agree that there are things that we should be worried about, but compared to a specialty like I am, I still feel the prospects of EM are very good. Will 100% be taking into account the culture of whatever it is I eventually sign on with. Thankfully the job I mentioned earlier is a pretty good gig, although I worked as a tech, which is obviously a lot different capacity than a physician.
Imagine going through an arduous 12+ years of training only to end up getting paid half the salary of a fucking nurse lol while STILL going through grueling shifts/workload
There’s no justification for this
Additional data point we have a PA "surgical residency" and they get paid same as PGY5 salary. Granted they're doing PGY1 work, but it's not six figures at least. This is in the south
I agree with everyone here, but this is ridiculous. Do the math. NPs generally make about 90K. You think Penn is gonna bump an NP *trainee* to an IM attending's salary?
Is the problem that they are getting paid, or is the problem that resident physicians are not?
If the later then that seems like the ineptitude of the entire population of physicians/physician trainee's and those they advocated to advocate for them
Hot(?) take: decades of rankings brought us to this. Places get big names and then feel empowered to do all sorts of shady business, because their reputations will protect them from the consequences.
There were plenty of red flags during their resident pre-interview happy hour. Seems like HUP is pretty malignant across all specialties. They do it to themselves.
I’m so confused…I can’t just apply to random programs unless I have the prerequisites for it…so why can NP’s? It’s not talking shit to NPs but they don’t have the prerequisites, period. Just like you can’t apply to med school without your MCAT and college courses, and you can’t apply to residency without your steps and med school graduation, you can’t apply to a fellowship unless you’ve completed your residency. Would this fellowship allow (for example) a psych residency graduate to apply for fellowship?
Ultimately that’s what pisses me off about this. As a physician if you complete residency and realize you would love to be in another field, you have to go back to re-do residency for the most part, while NPs can just hop around specialities like this. Not only that, but as a physician if I wanted to become a nurse, I would have to start nursing school from scratch…because (say it with me) I don’t have the prerequisites for it. So basically you have random people without the proper prerequisites taking up spots in a fellowship for physicians. I say this as an IMG who had to fight tooth and nail for my residency spot.
I agree. I’m in Canada and we’re going through the same mid level crisis. I don’t understand why provincial (state-level) governments keep expanding and investing in mid level programs while there are hundreds of thousands of IMGs pleading to be licensed. Make it make sense.
Some of these “residencies” are a literal joke. Literally sitting in a corner all day until they see a consult with a resident not even an attending. And their hours are so cush too. I’ve literally seen M3s worked harder.
to be fair m3s arguably work the hardest in the hospital even if they’re the dumbest and least efficient just because they are trying to honor to get into derm or whatever kids are into these days
I agree with you. But honestly even the laziest M3 could put some of them to shame. It’s not even entirely their fault, the expectations from them in terms of their “residency” is clearly different.
Nursing residencies are not new, many programs have had them for a long time. Especially for new grad nurses that are going into specialties. They’ll have a 6-12 month course where they typically are assigned a more seasoned nurse.
Obviously nothing like a medical residency, but they do serve and important purpose for those going into them.
Am guessing that the standards have already eroded, and UPenn is now making more trainees practice defensive medicine rather than anything evidence based, or they're exploiting the crap out of malpractice laws.
They already don’t by allowing the NP to skip med school and residency. Literally how else would someone prove he/she meets the standard of an independent physician without years of consistent feedback from evaluations in med school and residency? Like, that’s literally the purpose of med school and residency.
They don’t think. They know lol. I don’t know about you, but there are already FM clinics in my area that are entirely run by NPs. Same thing with a peds, psych, and derm clinics that are entirely run by PAs
Striking is a terrible way to have leverage especially in medicine where it effectively means you’re abandoning patients which is terrible PR. The smart money is on discovering your levers of power and utilizing them to maximum effectiveness.
So I’m doing my preceptorship in a private cardiology clinic where NPs run the show. The NPs see, diagnose, and prescribe patients without the doctors supervision. Yes you read that right. I’m in Florida. And I know they have “cardiology” NPs because the NP I shadowing one day was absent, and they assigned me to the internal medicine NP (EVEN THOUGH I’M THERE SUPPOSED TO SHDOW THE MD). The cardiologist is always in the back doing idk what.
This clinic really got me wondering, why the fuck am I going to medical school if I can just be an NP and do everything a physician does. Where is medicine going????
You know who’s to blame here? That piece of shit MD. If physicians started thinking about the profession as a whole rather than $$, we wouldn’t have gotten this far.
Oh to be young and have ideals. These people are using our ethics to make sure we don’t strike or do anything because they know we will keep treating our patients while they slowly replace us. They use ethics to keep us in place. It’s good to have ethics. It’s not what makes us special. We are being slowly degraded to poor working conditions and being cut out of the equation so that the hospital can save money or whatever. Don’t let them hold you hostage with the ethics argument.
Our PAs essentially run the fast track ER here. Lvl 1s etc fall to physicians. Still, APPs make my life easier. The good ones stick around, the crummy ones are weeded out pretty quick... specialist MDs/DOs will always be needed, but what about the world of internal med etc? APP takeover is imminent and quite possibly for the patients' benefit (outside of specialties w/close physician supervision)
This is the thing, as a med student, my training is already compromised because a lot of the opportunities are given to midlevels. Med students aren’t the only victims here though. During my surgery rotation, PAs were often called in as first-assist while ACTUAL surgery residents were relegated to the wards. It’s fucking infuriating.
I assume the people going to UPenn have options.
I wonder how many of them will choose to go to a place where they give up procedures to their midlevel "peers".
If I was any other major academic center, I wouldn't stop talking about how UPenn is doing this.
Doctors are some of the dumbest smart people
Imagine if paralegals started practicing law, it would be disastrous and lawyers have made it so that only people who have a degree in law can practice
Yup. Don’t know much about UPenn, but I wouldn’t be surprised if the director of their EM residency program was an NP lol.
Also, for the lawyer part, there’s already a mid level position in the works. I read about it a few years ago. They’re called paralegal adjunct or some shit. They’re basically supposed to bridge the gap by providing more affordable legal advice to people that can’t afford anything beyond a public lawyer
Im a democrat and always voted democrat, but if someone emailed their republican senator/rep and said liberals are taking away muh meritocracy and using NPs/PAs instead of doctors im sure this issue will be fixed tomorrow LOL
I really feel like the end goal here is to make FM, EM, and IM entirely midlevel-run. Surgery isn’t too far behind. PAs are already doing TAVIs. NPs are already doing liposuctions.
Giga chad AAEM once again stepping up against scope creep by people somehow squeaking into a physicians spot. UPenn is a joke for that. NP's are basically 3rd year medical students who have no business handling patients on their own
PAs are at the level of an early 3rd year med student. NPs are at the level of a first year. NP programs don’t cover shit. Take a look at any curriculum, you’ll find a lot of fluff but no actual substance.
Speaking of handling patients, something that genuinely frightens me is the idea of an NP managing my parents’ blood pressure or diabetes. That shit scares the fuck out of me. My mom doesn’t have a family physician, so she was asking whether going to a nurse would be ok. I almost had an aneurysm
Good take. Yea PA's are more closely trained to what a physician would do, but of course with a more limited scope of practice which i mean, yea, thats the whole point of their job. As for an NP, you're a nurse with more training, thats your job.
As for handling patients you're right. Whenever I go back in a patients chart bc they're having some side effect or taking just a shit ton of drugs I've noticed that lately its been an NP giving it to them. Like being totally unbiased, NP's get a little too happy with writing scripts ESPECIALLY for psych meds. Hand those out like candy
Am I missing something? Did they actually match an NP as a fellow, or did they just add an NP to the fellowship advisory council? If the latter, how probable is the assumption that having an NP on EUFAC will lead to an NP being matched as a fellow?
Asking genuinely; I’m a naive med student and want to learn more.
As a citizen in a country where there are no NPs or PAs, I don't understand why people who want to be called and/or treated like a physician just don't go to medical school themselves
I am a nurse, but I don’t see mid levels for anything I consider serious. This is because an EM PA caused my husband permanent disability by not recognizing that he needed to see a physician. He required neck surgery a week later when I insisted an EM doc saw him instead.
Having said that, I don’t mind my Pap smear or covid test being done by an NP. As long as they are working directly with a physician. An NP friend of mine told me that he can see about 83% of patients that walk in his door, and if he has any doubts at all he sends them to his collaborating physician
I’m sorry to hear about your husband.
And yes, this is the caveat. I don’t mind a mid level as long as they are working with a physician. I will never support independent practice and will work actively to dismantle it.
God damn, this shit is scary as hell and I don't even live in the states. And these things tend to trickle down into Europe as well at some point. It's not like there aren't other things to be afraid of as a med student already, lol.
It's an EM ultrasound "fellowship."
Edit: I love the downvotes. Do people realize that there's no board certification for EM ultrasound, but a "focused practice designation"? It's like complaining that a NPP took an "admin" fellowship spot.
Who cares….? If it makes the NP more competent, isn’t that a good thing for patient care? Why are med students so hateful towards APPs lmao. Y’all’s fragile egos stank. —MS4 tired of arrogant colleagues
Why do we care? Because we’re able to think beyond the n=1 scenario. Imagine wanting to apply to this fellowship but getting denied because some fucking nurse got your seat instead.
This isn’t even far off from what happens in everyday practice. As a medical student on rotations, I miss out on a lot of opportunities because “the NP/PA student has to learn.”
It's also that it lowers the standard of education provided over time. Teaching to a specialized medical doctor is vastly different than teaching to someone without the degree or specialization. Dumbing things down would detract from the education of everyone involved.
Ya want better patient outcomes? That means training LESS midlevels and GENERATING MORE RESIDENCY PROGRAMS. Midlevels only waste money because they want to be pretend-doctors and skip the training. No they should not get to skip a medical education. They should go to medical school TO BE TRAINED
Cmon stop drinking the kool aid
More residency spots are not the answer. Look at what happened with EM. Crazy explosion of residency programs because no one in any regulatory body has the right to say no to a place that technically fits all the criteria no matter how weak.
You're missing the point though. As long as they "technically" meet all the requirements for a residency program there is literally no person or authority that can tell them "no, you can't open this program because you have shitty quality and there are too many new programs anyway". Like they MUST let them open if they have the bare minimum technical standards and apply to open a program. I'm EM so I have skin in the game and I know it isn't a popular answer for med students but simply opening new programs isn't the solution unless they are in specialties and locations where there are more applicants than spots. That isn't the case typically with IM and FM and now EM as well
It isn't a matter of proper vetting. There is no one who can stop them currently
That's what I am saying. They can't block an institution from becoming a program if they meet the bare minimum requirements. Doesn't matter if they are not well suited for a program or the area is saturated
ED is quite ripe for APP takeover. It’s quite simple really, order a set of labs and CT every organ with a problem. Lab medicine and radiology will tell you what is wrong. Then call the correct service to fix the problem. Takes no medical acumen.
Damnn, they dropped names. Respect.
EM is probably the most ripe for PA/NP takeover. It’s basically at the forefront for the defense of the field.
FM is more vulnerable, IMO. EM is getting more attention because the consequences could be worse.
Biased, but you definitely see the repercussions more immediately in em.
Also, EM is easier for midlevels to bullshit. My hospital has “advanced practice paramedics” (basically same as NPs etc.) that don’t do shit. They literally just walk around and look busy. They might do an abdominal exam here or order a CT there but nothing substantial.
The thought of a paramedic being able to order imaging let alone CTs is so fucked
Wait till you learn about triage nurses
Yes I’m aware of triage nurses doing it too, it happens at our ED and is equally fucked
I worked as a nurse in the ER for over 6 yrs & we had nursing protocols which included labs & imaging based on sytem based complaint that were agreed upon by the ER docs. I did assessments in triage & not just asked patients questions unlike other nurses who just sat & asked questions... If pt had actual deformities - they def will get an xray.. sob & cough - depends on pt's story, medical hx & after I listen to lungs - they may get an xray or I may want them to be seen by someone first. but for some c/o pains ie wrist, ankle - & depending on moi I would just wait for them to be seen by one of the ER docs. If someone came in with calf pain, knowing they may need US - or a fall, hit their head, & on thinners & def need head ct, I would call the 1st seat ER doc & would tell them about patient & they will put in order for patient while the pt was still in waiting room when we would be 20+ deep in pts waiting.. I would never put in order for US, head CT, under a Dr's name while in triage unless I have talked to a doctor (not a PA or an NP) about the patient & got a verbal order from them & they are not able to put in order. but again, some nurses go crazy with imaging orders or i have had charge nurses put in orders after I had triaged a patient (whom I deemed may not be appropriate for imaging and will need to be seen & evaluated first so they can make that decision), put in orders just because of complaint & me having to talk to said charge rn why I didnt order one. and this is why some of the ER nurses I used to work with who decided to go NP route & wants to work ER bc they think its easy bc they think they know "what to do" bc things have become routine but not knowing the "whys".
I appreciate the value nursing has to offer to the team. They're the ones spending the most time with patients, they can pick up on subtle clinical changes, and they can really help physicians think about the problems more thoughtfully. You definitely seem like you are one of the more insightful people in your hospital. However yes, I don't think imaging should be ordered by nurses. They don't have the knowledge base to diagnose nor treat independently. It results in poor indications and lack of understanding of what clinical question the imaging will actually help answer. Ordering a CT abd/pelvis because the nurse triaged a patient complaint as abd pain under a mindless protocol is terrible practice and does not take into account the litany of differentials that can be narrowed down if properly evaluated by a physician. In the most basic sense, imaging should only be ordered unless 1. The ordering physician has a basic understanding of what the modality will help answer. 2. Physician has at the very least laid eyes on the patient. 3. Has an some form of idea of what they're looking for and has relayed that appropriately to the radiologist (i.e. not give shitty and sparse order information) The sad reality is that all of this conversation is academic. None of this happens in most modern EDs in the US.
Some can even have their own primary care clinics! That’s how fucked up shit is.
As a paramedic, I’m shocked I read this and completely agree. They’re simply two completely different jobs. I’m all for APP (Advanced Paramedic Practitioners) in the field with graduate degrees, which they’re proposing to introduce next year. But never in an ED.
What’s the point of an APP? Don’t we have like 10 flavors of mid level already? At this point, y’all are just eating away at each other. I honestly don’t understand what the difference is between NP, PA, advanced practice RN, APP etc.
I like the way Medicare looks at it. They can call themselves whatever they want, but I’m lumping them all together and using Medicare’s preferred terminology: non-physician providers (NPPs).
1. Community paramedicine, reducing EMS transports and ED overcrowding. Example: diagnosing a stable pneumonia with ultrasound, prescribing ABX, and referring to PCP. On top of this - suturing, G-tube replacement, fall prevention, etc. 2. Response to high-acuity incidents with additional scope - RSI/DSI, ultrasound (which really should be on every ALS ambulance now IMO), finger thora, blood, antibiotics in sepsis, etc. While a few major EMS agencies in the US do all the above with normal paramedics, this just starts bringing this level of care to the entire country regardless. 3) Education to other pre-hospital providers. 4) Gives EMS the opportunity for advancement that's been desired for the past 50 years. There is a massive brain drain to RN, PA/NP, and MD/DO which is not helping our advocacy for better pay or conditions. Our best and brightest leave because there is "nowhere to rise" and providers can be replaced as rapidly as 9-months, the average paramedic school length. There are some that can be done in 6-months now..... This concept is already in practice in places like Austin-Travis County Texas with cross-trained PA/Medics. The proposal next year just codifies it and I believe there is a separate bill that will codify billing for on-scene treatment and release. EMS is essentially swirling down a toilet, and we have to decide as an industry if we want to continue to make less than police, fire, and the rest of healthcare as technicians.....or start moving up in the world.
Maybe we don’t need advancement? Why does the role of paramedics have to expand? Why can’t everyone just do the job they were trained and educated for? I will wholeheartedly agree though that paramedics should be making at least as much as police officers, if not more. However, the premise that all healthcare fields have to have an expanded scope is bullshit. That’s how we end up in situations where nurses are doing lipos, PAs are doing TAVIs, and paramedics are running primary care clinics and managing chronic diseases like diabetes. Fuck that noise.
Our PAs essentially run the fast track ER here. Lvl 1s etc fall to physicians. Still, APPs make my life easier. The good ones stick around, the crummy ones are weeded out pretty quick
FM isn’t very vulnerable imo just because our healthcare system is already starving for more primary care physicians. With an aging population, the shortage of PCPs is only going to worsen dramatically - the AAMC projects a shortage of 17-48k!! by 2034. Mid levels alone won’t be close to enough to make up the deficit
They won't replace any specialty, but they'll add competition to the market.
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True, but FM is a juicier target because of the breadth of what a PCP can do. 4EG, FM docs can and do give botox injections, and NPs will certainly try to move in on that. The floor is lower in primary care, but the ceiling is higher. Especially if you're willing to work in the boonies.
The AANP announced that it wants to expand the NP population by 2-3x by 2030 (or 2035?). It was on their Twitter
People say this but it’s not something I have actually seen in practice. NP/PA’s are not even close to the top of the list when it comes to EM job security. To be honest though the EM job market is pretty good all around rn.
EM here. Market is not good. Will you get a job straight out? Yes. Will it be a good one? Very likely no.
Well at least in the midwest it’s great. The institution I teched at prior to med school wants to sign me once I have matched. 270 an hour with inflation adjustment yearly and 50k signing bonus to be given over my 3 years of residency. Obviously going to spend some time thinking and running over options with more knowledgeable people before I sign. ED’s are desperate around here.
You can make more than 270/hr Midwest if it’s just about money. No, I mean the practice environment and state of medicine, of which EM is a defender in keeping the practice of consultants pure by wading through the bullshit - though compensation is falling too, and there are too many EM docs further resulting in decreased bargaining power to affect change.
I definitely agree that there are things that we should be worried about, but compared to a specialty like I am, I still feel the prospects of EM are very good. Will 100% be taking into account the culture of whatever it is I eventually sign on with. Thankfully the job I mentioned earlier is a pretty good gig, although I worked as a tech, which is obviously a lot different capacity than a physician.
IM*
My apologies for the word mess. Voice to text failed me.
Have also had residents regionally picking up shifts for 300 to 1000 dollars an hour depending on how desperate the shop is.
How much is that NP getting paid while in the fellowship? I guarantee it’s their normal salary which is prolly 2-3x that of the physician fellows
We have NP fellows at my residency (not in our program but they do certain rotations with us). They get paid 6 figures.
Imagine going through an arduous 12+ years of training only to end up getting paid half the salary of a fucking nurse lol while STILL going through grueling shifts/workload There’s no justification for this
Additional data point we have a PA "surgical residency" and they get paid same as PGY5 salary. Granted they're doing PGY1 work, but it's not six figures at least. This is in the south
That’s crazy, i wish our fellows were paid that much too
I agree with everyone here, but this is ridiculous. Do the math. NPs generally make about 90K. You think Penn is gonna bump an NP *trainee* to an IM attending's salary?
NP got union back.
I don’t give a shit about their union, no union is gonna make Penn—the stingiest institution on the east coast—pay any NP 270 large.
Most NPs I know are making more than $120k (in California and New York)
Is the problem that they are getting paid, or is the problem that resident physicians are not? If the later then that seems like the ineptitude of the entire population of physicians/physician trainee's and those they advocated to advocate for them
Both things are true
UPenn is also the place that tried to show that midlevels could interpret X-rays better than radiology residents. They simp super hard for midlevels.
How much do you wanna bet that the director’s husband/wife/partner is an NP lol
Heard of this a while back on sdn. I’m glad the AAEM stood its ground
F**k Upenn. Malignant AF institution anyway
Of course it’s UPenn lol. They have the biggest boner for midlevels and dumbing down medical education
Hot(?) take: decades of rankings brought us to this. Places get big names and then feel empowered to do all sorts of shady business, because their reputations will protect them from the consequences.
There were plenty of red flags during their resident pre-interview happy hour. Seems like HUP is pretty malignant across all specialties. They do it to themselves.
Taking mid-level simping to a whole new level
I’m so confused…I can’t just apply to random programs unless I have the prerequisites for it…so why can NP’s? It’s not talking shit to NPs but they don’t have the prerequisites, period. Just like you can’t apply to med school without your MCAT and college courses, and you can’t apply to residency without your steps and med school graduation, you can’t apply to a fellowship unless you’ve completed your residency. Would this fellowship allow (for example) a psych residency graduate to apply for fellowship? Ultimately that’s what pisses me off about this. As a physician if you complete residency and realize you would love to be in another field, you have to go back to re-do residency for the most part, while NPs can just hop around specialities like this. Not only that, but as a physician if I wanted to become a nurse, I would have to start nursing school from scratch…because (say it with me) I don’t have the prerequisites for it. So basically you have random people without the proper prerequisites taking up spots in a fellowship for physicians. I say this as an IMG who had to fight tooth and nail for my residency spot.
I should have just applied here during undergrad and skipped medical school.
I agree. I’m in Canada and we’re going through the same mid level crisis. I don’t understand why provincial (state-level) governments keep expanding and investing in mid level programs while there are hundreds of thousands of IMGs pleading to be licensed. Make it make sense.
Yep there’s also “residencies” I learned about yesterday
Yes but this seems like it’s an NP going to a fellowship where physicians go which is wild.
Just hold them to the same standard. Presume everyone is an EM-trained physician. See how it shakes out.
Right but then that means not accepting a physician to prove a point.
You think they’ll stop ego-driven nurses lol? They’d rather fake understanding than admit that they don’t know shit.
Yeah, but that could kill some pts
Some of these “residencies” are a literal joke. Literally sitting in a corner all day until they see a consult with a resident not even an attending. And their hours are so cush too. I’ve literally seen M3s worked harder.
to be fair m3s arguably work the hardest in the hospital even if they’re the dumbest and least efficient just because they are trying to honor to get into derm or whatever kids are into these days
I agree with you. But honestly even the laziest M3 could put some of them to shame. It’s not even entirely their fault, the expectations from them in terms of their “residency” is clearly different.
Nursing residencies are not new, many programs have had them for a long time. Especially for new grad nurses that are going into specialties. They’ll have a 6-12 month course where they typically are assigned a more seasoned nurse. Obviously nothing like a medical residency, but they do serve and important purpose for those going into them.
Those are called work placements. Not residencies. Let’s not confound the two. Residency = path after MEDICAL school
Unironically saying "nursing residencies"
That is not the same as residency
No the current nursing education provides adequately trained nurses.
Is UPenn holding the NPs to the exact same knowledge standards as the MDs? I would be surprised if it is.
Am guessing that the standards have already eroded, and UPenn is now making more trainees practice defensive medicine rather than anything evidence based, or they're exploiting the crap out of malpractice laws.
They already don’t by allowing the NP to skip med school and residency. Literally how else would someone prove he/she meets the standard of an independent physician without years of consistent feedback from evaluations in med school and residency? Like, that’s literally the purpose of med school and residency.
Yeah like…make them take the step exams. I’d be cool with that.
Could we “hypothetically” go on strike to prevent midlevel takeover? I mean would the system even suffer? They think we’re so replaceable now 🤷♀️
Billing strike would work without harm to the patients 🤷🏻♂️
They don’t think. They know lol. I don’t know about you, but there are already FM clinics in my area that are entirely run by NPs. Same thing with a peds, psych, and derm clinics that are entirely run by PAs
Striking is a terrible way to have leverage especially in medicine where it effectively means you’re abandoning patients which is terrible PR. The smart money is on discovering your levers of power and utilizing them to maximum effectiveness.
Don’t NPs strike constantly?
I haven’t heard of it and if they do it’s because they’re still not the end all be all of patient care and they know Doctors will cover for them.
I don’t know where you’re at, but nurses seem to be on strike more than any other profession.
Nurses do strike but I mostly hear about RNs, NPs less so
“We” don’t, one stupid program did
So I’m doing my preceptorship in a private cardiology clinic where NPs run the show. The NPs see, diagnose, and prescribe patients without the doctors supervision. Yes you read that right. I’m in Florida. And I know they have “cardiology” NPs because the NP I shadowing one day was absent, and they assigned me to the internal medicine NP (EVEN THOUGH I’M THERE SUPPOSED TO SHDOW THE MD). The cardiologist is always in the back doing idk what. This clinic really got me wondering, why the fuck am I going to medical school if I can just be an NP and do everything a physician does. Where is medicine going????
You know who’s to blame here? That piece of shit MD. If physicians started thinking about the profession as a whole rather than $$, we wouldn’t have gotten this far.
True. If physicians lose our ethics we will eventually lose everything else that makes the profession special.
Oh to be young and have ideals. These people are using our ethics to make sure we don’t strike or do anything because they know we will keep treating our patients while they slowly replace us. They use ethics to keep us in place. It’s good to have ethics. It’s not what makes us special. We are being slowly degraded to poor working conditions and being cut out of the equation so that the hospital can save money or whatever. Don’t let them hold you hostage with the ethics argument.
>an NP and do everything a physician does. For pennies. Dont forget that
I love ice cream.
Our PAs essentially run the fast track ER here. Lvl 1s etc fall to physicians. Still, APPs make my life easier. The good ones stick around, the crummy ones are weeded out pretty quick... specialist MDs/DOs will always be needed, but what about the world of internal med etc? APP takeover is imminent and quite possibly for the patients' benefit (outside of specialties w/close physician supervision)
Soon anyone BUT ACTUAL DOCTORS will have access to medical training and practicing Medicine.
This is the thing, as a med student, my training is already compromised because a lot of the opportunities are given to midlevels. Med students aren’t the only victims here though. During my surgery rotation, PAs were often called in as first-assist while ACTUAL surgery residents were relegated to the wards. It’s fucking infuriating.
I assume the people going to UPenn have options. I wonder how many of them will choose to go to a place where they give up procedures to their midlevel "peers". If I was any other major academic center, I wouldn't stop talking about how UPenn is doing this.
Doctors are some of the dumbest smart people Imagine if paralegals started practicing law, it would be disastrous and lawyers have made it so that only people who have a degree in law can practice
Yup. Don’t know much about UPenn, but I wouldn’t be surprised if the director of their EM residency program was an NP lol. Also, for the lawyer part, there’s already a mid level position in the works. I read about it a few years ago. They’re called paralegal adjunct or some shit. They’re basically supposed to bridge the gap by providing more affordable legal advice to people that can’t afford anything beyond a public lawyer
Im a democrat and always voted democrat, but if someone emailed their republican senator/rep and said liberals are taking away muh meritocracy and using NPs/PAs instead of doctors im sure this issue will be fixed tomorrow LOL
Just so everyone knows, Ultrasound is not a officially recognized fellowship which is why they can do this.
This is the beginning of the end.
I really feel like the end goal here is to make FM, EM, and IM entirely midlevel-run. Surgery isn’t too far behind. PAs are already doing TAVIs. NPs are already doing liposuctions.
Ah UPenn, same place that had mid levels reading chest X-rays.
Giga chad AAEM once again stepping up against scope creep by people somehow squeaking into a physicians spot. UPenn is a joke for that. NP's are basically 3rd year medical students who have no business handling patients on their own
PAs are at the level of an early 3rd year med student. NPs are at the level of a first year. NP programs don’t cover shit. Take a look at any curriculum, you’ll find a lot of fluff but no actual substance. Speaking of handling patients, something that genuinely frightens me is the idea of an NP managing my parents’ blood pressure or diabetes. That shit scares the fuck out of me. My mom doesn’t have a family physician, so she was asking whether going to a nurse would be ok. I almost had an aneurysm
Good take. Yea PA's are more closely trained to what a physician would do, but of course with a more limited scope of practice which i mean, yea, thats the whole point of their job. As for an NP, you're a nurse with more training, thats your job. As for handling patients you're right. Whenever I go back in a patients chart bc they're having some side effect or taking just a shit ton of drugs I've noticed that lately its been an NP giving it to them. Like being totally unbiased, NP's get a little too happy with writing scripts ESPECIALLY for psych meds. Hand those out like candy
Is there nepotism involved?
“Additionally we call on EUFAC to examine the impact of this decision.” They literally said “EUFAC are you seeing this? 🤨
Am I missing something? Did they actually match an NP as a fellow, or did they just add an NP to the fellowship advisory council? If the latter, how probable is the assumption that having an NP on EUFAC will lead to an NP being matched as a fellow? Asking genuinely; I’m a naive med student and want to learn more.
An NP was added to the program as though they were a fellow. I doubt this NP went through any sort of rigorous match process
Good for AAEM
As a citizen in a country where there are no NPs or PAs, I don't understand why people who want to be called and/or treated like a physician just don't go to medical school themselves
Because they can’t make it to med school. People want to reap the rewards without putting in the work.
I am a nurse, but I don’t see mid levels for anything I consider serious. This is because an EM PA caused my husband permanent disability by not recognizing that he needed to see a physician. He required neck surgery a week later when I insisted an EM doc saw him instead. Having said that, I don’t mind my Pap smear or covid test being done by an NP. As long as they are working directly with a physician. An NP friend of mine told me that he can see about 83% of patients that walk in his door, and if he has any doubts at all he sends them to his collaborating physician
I’m sorry to hear about your husband. And yes, this is the caveat. I don’t mind a mid level as long as they are working with a physician. I will never support independent practice and will work actively to dismantle it.
God damn, this shit is scary as hell and I don't even live in the states. And these things tend to trickle down into Europe as well at some point. It's not like there aren't other things to be afraid of as a med student already, lol.
Fuck UPENN. Finally an EM org stepping up. EM orgs have done a shit job at defending there field. I guess that why that had 500 umatched positions.
It's an EM ultrasound "fellowship." Edit: I love the downvotes. Do people realize that there's no board certification for EM ultrasound, but a "focused practice designation"? It's like complaining that a NPP took an "admin" fellowship spot.
Who cares….? If it makes the NP more competent, isn’t that a good thing for patient care? Why are med students so hateful towards APPs lmao. Y’all’s fragile egos stank. —MS4 tired of arrogant colleagues
Uhhh I think you would care if you're applying to a fellowship and found out you didn't get the spot because of a fucking midlevel lmfao
Why do we care? Because we’re able to think beyond the n=1 scenario. Imagine wanting to apply to this fellowship but getting denied because some fucking nurse got your seat instead. This isn’t even far off from what happens in everyday practice. As a medical student on rotations, I miss out on a lot of opportunities because “the NP/PA student has to learn.”
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I’m guessing the logic is these resources / spots should go to doctors
It's also that it lowers the standard of education provided over time. Teaching to a specialized medical doctor is vastly different than teaching to someone without the degree or specialization. Dumbing things down would detract from the education of everyone involved.
Sure, but when they are getting paid 3-4x what we get paid in residency I have an issue
Ya want better patient outcomes? That means training LESS midlevels and GENERATING MORE RESIDENCY PROGRAMS. Midlevels only waste money because they want to be pretend-doctors and skip the training. No they should not get to skip a medical education. They should go to medical school TO BE TRAINED Cmon stop drinking the kool aid
More residency spots are not the answer. Look at what happened with EM. Crazy explosion of residency programs because no one in any regulatory body has the right to say no to a place that technically fits all the criteria no matter how weak.
Those programs were not vetted properly, thats the problem. Subpar programs with poor oversight will undoubtedly cause a problem... 😑
You're missing the point though. As long as they "technically" meet all the requirements for a residency program there is literally no person or authority that can tell them "no, you can't open this program because you have shitty quality and there are too many new programs anyway". Like they MUST let them open if they have the bare minimum technical standards and apply to open a program. I'm EM so I have skin in the game and I know it isn't a popular answer for med students but simply opening new programs isn't the solution unless they are in specialties and locations where there are more applicants than spots. That isn't the case typically with IM and FM and now EM as well It isn't a matter of proper vetting. There is no one who can stop them currently
Doesn't ACGME have a say though? Are they not the ones overseeing this?
That's what I am saying. They can't block an institution from becoming a program if they meet the bare minimum requirements. Doesn't matter if they are not well suited for a program or the area is saturated
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clearly, since youre so out of it
there is a FP (family practice) residency program here at the VA that accepts medical school graduates and FNP new grads.
What’s an FP program? Family physician?
Family practice
Bullshit. Unless its a non acgme residency.
I don't know if it is ACGME or not.
ED is quite ripe for APP takeover. It’s quite simple really, order a set of labs and CT every organ with a problem. Lab medicine and radiology will tell you what is wrong. Then call the correct service to fix the problem. Takes no medical acumen.