Crash Cart: APPs with full practice authority in the VA, complex scheduling, and adding humanities to med school curriculum

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This week: The VA proposes solving physician shortages with advanced practice providers by giving them full practice authority. Plus, can adding literature study to medical training reduce burnout? Join in as our editors discuss the week’s headlines.


Is your schedule overflowing? We know why.

New research shows emergency physicians schedules are the most complex due to low staffing and high patient demand. Original Article by HIT Consultant.

William Sullivan, DO, JD: When I was the director of a smaller ED, scheduling wasn’t that difficult for me, but I’ve heard others describe the process as “herding cats.” The biggest problem with scheduling is having the right balance of docs. If you have too few, then the docs get overworked, get frustrated, and leave. If you have too many, then the docs don’t get all the shifts they want, get frustrated, and leave. I downloaded this “study” and it doesn’t give much data at all. It just talks about “rules” and “schedule requests,” but doesn’t discuss what the “rules” involve. And when you think about emergency department schedule requests versus pulmonary or cardiology schedule requests, there are more emergency physicians at a typical hospital versus pulmonologists or cardiologists, so naturally there will be more schedule requests. The “study” was done by a physician scheduling company, so I think it ends up being more of a sloppy infomercial than a “study.”

Jyoti Mahapatra, MD: “Physicians can’t work two 12-hour shifts in a row”?! We can’t? Can I receive retroactive time off for the 12 hour weekends I have been working for the past decade?! Since I recently started making the schedule for our free-standing ED, apparently I can also call myself a rocket scientist. I am going to add this to my ID badge, not that it will stop everyone from calling me nurse anyways. With a mostly part-time and casual staff, putting together the schedule is like playing Jenga in reverse. Work-life balance and preventing burnout would be much easier if I just had more physicians to help maintain a circadian schedule and work less of those mythical 12 hour shifts.


The VA proposes solving physician shortages with advanced practice providers

Some physician groups disagree, they believe replacing docs with non-physicians would sacrifice quality care. Original Article by MD Magazine.

William Sullivan, DO, JD: One could easily get into a argument about whether the word “replace” should be used, but arguing about semantics doesn’t change the fact that the VA is planning to hire more midlevel providers to provide care with “full practice authority” in VA facilities. So whether we say that the VA is just going to hire more midlevel providers and hire fewer physicians or whether we say that the VA is going to replace physicians, the underlying theme from the article is that the VA doesn’t seem to be planning a collaborative approach to medical care. Whether that is in the best interests of VA patients will be the subject of much heated debate, I’m sure.

Jyoti Mahapatra, MD: If the government agreed to the loan forgiveness proposal, maybe midlevel coverage would be a moot controversy. That sounds like an incredible solution to two huge problems, which is why it would never be considered. And of course, because it is not the cheapest option. So much of our national budget is spent on defense, it is truly shameful that more of that money is not directed towards those actually providing defense. Those are the ‘providers’ whose interests matter the most.


Medical students turn to literature to combat detachment

Burnout and depression is widespread in the medical community, but reading novels lessens the pain. Original Article by The New York Times.

William Sullivan, DO, JD: This seems like a strange combination. Being better able to “reflect” about things is fine and dandy, but I’m not sure how reading poetry and novellas contributes to the practice of medicine to the point that four years of education should focus upon doing so. Looking forward to reading about an electrical engineering and medicine track at Georgetown in the future.

Jyoti Mahapatra, MD: With all due respect to Dr. Sullivan, I couldn’t disagree more. Self-reflection should be a skill as developed as critical and analytical thinking. ‘Practiced detachment’ is not an effective means to emotional self-preservation. Medical student and physician depression, substance abuse, and suicide demonstrate this. Plenty of students would abhor anything that takes time away from studying and memorizing. But for many of them, burying reactions to death, suffering, and self-sacrifice will manifest as burnout instead of tenacity. A humanities program should be one of many curriculum changes to medical school, and self-reflection is an integral step towards a less dehumanizing medical education.


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