Why Emergency Medicine? Tracy R. Rahall, MD, FACEP - PowerPoint Presentation

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Why Emergency Medicine?

Tracy R. Rahall, MD, FACEP

Professional Emergency Physicians

EM Fellowship Director

AAFP Position

Family Physicians are an essential part of the emergency medicine safety net and without them large areas of the country would be without adequate emergency medical care

The Future of Family Medicine Project

This project is “looking at a transformation of the U.S. health care system, in partnership with other organizations, including emergency medicine”

AAFP

Family physicians can provide high quality and cost effective care. Look at history:

The birth of emergency medicine occurred because of the perceived need for physicians who were better trained in the care of critically ill or multiple trauma patients

1979: Emergency medicine is sanctioned by the American Board of Medical Specialties as the 23

rd

medical specialty

Family Medicine doctors championed the cause and many “grandfathered” into the practice of Emergency Medicine and sat for the Boards in the 1980s

Several charter members of ACEP (American College of Emergency Physicians) were family practitioners who fostered the development of the specialty

ABFP members were involved in the developmental phase of American Board of Emergency Medicine with their executive director serving on the ABEM board for several years

The Controversy

Although many family physicians currently provide emergency medicine care in a several different settings, their abilities to do so have been called into question within certain emergency medicine professional societies and organizations

ACEP even had a national media campaign promoting ABEM board certification as the only standard for emergency physician quality verification

The Controversy

In contrast, AAFP has supported its members who practice emergency medicine and have published a set of core curricular guidelines on acute and emergency care for residents in family medicine residency programs and developed a policy in 1995 which stated to the effect that family physicians are qualified to provide emergency care services

The Reality

33% of family physicians provide emergency medical services with many making life-long careers in emergency medicine

There are not enough board-certified emergency medicine physicians to fill the emergency department staffing needs nationwide

Institute of Medicine Report

Conclusion: the ““Department of Health and Human Services…partner with professional organizations (to) develop national standards for core competencies…(in emergency and trauma care)…using an evidence based, multi-disciplinary process”

AAFP position paper

New Standards

“The Future of Emergency Medicine Care in the United States Health System” is a recent IOM report

Poor prognosis of emergency medicine in our nation unless significant changes occur

The system is fragmented with inconsistencies in the quality of care provided

It promotes the fundamental need for family physicians providing emergency care particularly in the rural setting

The Reality

AAFP position paper

“Not withstanding the changes in family medicine residency requirements” (more emphasis on emergency care) “trainees in family medicine who plan to practice predominantly in an emergency care setting may need to further expand their clinical training. This would include additional skills in emergency procedures and trauma care, and more familiarity with the rapid, algorithmic approach that typifies advanced resuscitations”

Critical Challenges for Family Medicine: Delivering Emergency Medical Care - “Equipping Family Physicians for the 21st Century” (Position Paper)

2015

The most important objective of the physician must be the provision of the highest quality of care. Quality patient care requires that all providers should practice within their degree of ability as determined by training, experience and current competence.

The AMA, AAFP and most medical specialties have adopted the policy that medical practice privileges be based on “training, experience and demonstrated competence,” not arbitrary specialty. The IOM report emphasizes that high quality, efficient, and reliable patient care can best be achieved through integrative approaches. Core competencies in emergency medicine should be evidenced based and multi-disciplinary.

Family physicians are trained in the breadth of medical care, and as such are qualified to provide emergency care in a variety of settings. In rural and remote settings, family physicians are particularly qualified to provide emergency care.

Finances

FP

$231K

Male vs Female

$258K vs $207K

42% female

EM

$353K

Male vs Female

$368K vs $311K

26% female

Why a Fellowship?

The Goal: providing the highest quality of care

IOM report cites that high quality, efficient, and reliable care for the emergency patient is best achieved through integrative approaches such as the following:

2006: joint training programs in FP and EM are approved by ABEM and ABFM

1990s: Emergency Medicine fellowships

Do a second residency

Benefits of Emergency Medicine

Set hours

Set schedule

No call

Overhead

Typical Family Medicine practice overhead is 60% of revenues

Fam

Pract

.

Manag

.

2010 Mar-Apr.; 17 (2):38-43.

Typical Emergency Medicine practice overhead is 46% of revenue

American College of Emergency Physicians. June 2009.

Family Practitioner Hours

The average family practice doctor will spend about 47 hours “at work”

This includes billing, reading mail, call, etc.

Most do 33 hours direct patient care with at least 1-1.5 additional hours after clinic each night completing charts/paperwork

Depending on whether they do evening clinic they may typically do at least 3-5 additional hours one night per week

Those that do deliveries may be on call one 24-7 shift every other week depending on the call schedule

Emergency Physician Hours

Department of Health and Human Services 2008 Report

Emergency medicine and critical-care doctors work fewer hours than any other specialty

The largest percentage (47%) of EM physicians work 30-40 hours per week

Medscape Emergency Medicine Compensation Report 2012

Pay

Medscape Physician Compensation Report 2017

Family Medicine = $209K

Emergency Medicine = $339K

The Deceptive Income of Physicians

Ben Brown, MD

“Physicians spend about 40,000 hours training and over $300,000 on their education, yet the amount of money they earn per hour is only a few dollars more than a high school teacher. Physicians spend over a decade of potential earning, saving, and investing time training and taking on more debt, debt that isn’t tax deductible. When they finish training and finally have an income – they are taxed heavily and must repay their debt with what remains. The cost of tuition, the length of training and the U.S. tax code places physicians into a deceptive financial situation.”

benbrownmd.wordpress.com/

Is Emergency Medicine Right For Me?

Look at your objectives

Define your career goals

Appraise your unique personal characteristics

Examine whether these characteristics mesh with the unique aspects of practicing Emergency Medicine

Develop your plan to maximize long-term career satisfaction

What do you want?

Schedule flexibility

Earning potential

Social prestige

Time with family

Scholarship

Independence

Organizational power

Academic

vs

community practice

Procedural expertise

Constant stimulation

Challenging clinical environment

Problem solving

Wide spectrum of illness and injury

Serve the public

Treat social ills

Why PEP?

Democratic, well-managed group interested in and motivated to provide excellent patient care

Emphasis in ongoing education with free CME provided

Excellent facilities

Paid benefits

Competitive stipend

Equal pay for men and women

Indiana in top 10 states for

physician salaries

Loan repayment opportunity

Post-fellowship employment opportunities

PEP Contact Information

PEP = Professional Emergency Physicians, PC

https://www.professionalemergencyphysicians.com/

260-482-5091

pepfellowship@pep-em.com