Tuesday, February 9, 2010

Emergency Medicine Practitioners

I received an email asking me, “what is an EMP”? I use the term rather frequently in publication to identify emergency medicine practitioners, hence EMPs. An EMP is a physician (MD or DO), Physician Assistant, or Nurse Practitioner who engages in the practice of emergency medicine. Other publications might differentiate between physicians and some term like “Mid-level practitioner” or MLP. I’ve never quite understood the term MLP. Mid-level between what? I understand that an MLP is between a physician and a nurse, hence mid-level. It is mainly a regulatory term and has no application to the clinical practice of medicine so I personally shun the term.

Nursing is nursing. Medicine is medicine. These are two entirely different disciplines. Although the knowledge base of nursing and medical providers overlap to some degree, there is no in-between area of practice. As a PA, I practice medicine, specifically emergency medicine. I practice under the general supervision of a physician, and I am actually providing physician-level services. In a similar fashion, an NP is a nurse, but has advanced education to include the practice of medical acts. NPs also have some type of supervisory arrangement with a physician and they also provide physician services. There is no such thing as a “mid-level practitioner.” The term itself implies that there is some middle, or lower level of acceptable care. The accurate term is, “non-physician practitioner.” All practitioners provide physician services, and there are no studies that demonstrate the superiority of care provided by one type of provider over another (i.e. MD v. NP v. PA).

If you were to compare the work of a PA and a physician resident, you would find many similarities. Both practice in a supervisory arrangement following graduation from their respective training programs. For the resident physician, there is a more structured path of experiences and progressive responsibility leading to completion of the residency program. For the PA (or NP), the educational process is less formal and more self-directed as we learn, “on-the-job.” Like our resident counterparts, we also gain experience and progressive responsibility in our practice. In the end, the physician resident graduates and continues into independent practice. The PA continues to practice in the supervised role, albeit with an ever-increasing level of autonomy within that role. In essence, the PA role is akin to that of being a “permanent resident.”

I am a specialist in emergency medicine. I am a licensed and nationally-certified PA (PA-C) and I am qualified by over 13 years of EM experience, a post-graduate Masters degree with a concentration in my specialty, and I hold all the requisite life-support credentials, ACLS, PALS, ATLS. I have very similar experience to that of an emergency medicine resident and provide physician services to the full spectrum of emergency department patients in my practice. I am an emergency medicine practitioner.

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