Be Careful What We Wish for!
One ‘hot button’ topic in EM circles remains an ongoing debate about a perceived need to increase residency training requirements to four full years. A recent article provides insights and clinical arguments on differing sides of this issue.
But, at ‘management’ and legislative levels, would the new “real bosses” agree with this need? Are we, in actuality, proposing to train ourselves out of a career and a future?
An Evolving Issue:
in some of the hospitals in which I work, I am now more frequently hearing directly or indirectly, from some of those in management at all levels, that they prefer nurse practitioners (or other mid-levels) to doctors. I have even heard it said, now more than once, that some in management propose a time when there might be Nurse Practitioner-only primary hospitals.
We already now have nurse practitioner-only clinics in many sectors. I also hear that, in some jurisdictions, there may be ED’s, and urgent care centers allowed to operate without an EM physician (or any physician) supervising?
Healthcare as “Big Business” – New ‘Bosses’ – Different Goals & Drivers:
We have entered an era where healthcare is now a Big Business enterprise (projected to shortly become the 5th largest economic market sector in the U.S. economy), increasingly run by Corporate Business Managements with no healthcare backgrounds and with corporate business values dominating.
Business success and survival drivers, focused on issues such as economic realities, profit demands, cost containments, now dominate senior management decision making and development. Increasingly, clinically-practicing physicians (or other clinicians) find themselves unwelcome and with no seat at these senior corporate decision-making levels, thus no voice for patients or workplaces.
More Training Versus Less – and for Whom?
So, in an era when those who increasingly control the purse strings, and those who make the rules (increasing numbers of states and jurisdictions are allowing independent NP practice) now seem to be preferentially seeking “providers” with less training, while we doctors may be, with all the “best intentions”, recommending more training, will we be in reality, training ourselves into oblivion and out of a career?
A Bottom Line?
We can pontificate all we want to that clinics and hospitals have to have doctors to function. But it appears that increasingly those who control the purse strings, and those who make the rules may no longer think so!
Disclaimer:
Opinions expressed are mine alone, and do not necessarily represent opinions or stances of my employers or affiliates.
References:
Dhimitri A Nikolla. DO, et al, How Long Should EM Residency Be? New Studies Shed Light’. ACEPNow, June 21, 2025, How Long Should EM Residency Be? New Studies Shed Light – ACEP Now
Harry W Severance, A Manager’s Perspective on Healthcare Unionization, – Her response was not at all what I expected.’ MEDPAGE Today, June 11, 2023, A Manager’s Perspective on Healthcare Unionization | MedPage Today
Harry W Severance, The ‘Oppositional’ Conundrum Disrupting our Current Healthcare System. Emergency Physician’s Monthly, Dec 16, 2024, The ‘Oppositional’ Conundrum Disrupting our Current Healthcare System | Emergency Physicians Monthly
Peter G. Peterson Publication, ‘Healthcare Spending Will be One-Fifth of the Economy within a Decade. ‘Sept `16, 2024, Healthcare Spending Will be One-Fifth of the Economy within a Decade
Harry W Severance, Top Disruptors within Our Healthcare Systems Part 2. Emergency Physician’s Monthly, Nov 1, 2023, Top Disruptors within Our Healthcare Systems Part 2 | Emergency Physicians Monthly
Jakob Emerson, ‘Most board members at the nation’s top hospitals have no healthcare background: Study’ Becker’s Hospital Review, Feb `4, 2023, Most board members at the nation’s top hospitals have no healthcare background: Study – Becker’s Hospital Review | Healthcare News & Analysis
Harry W Severance, Suits vs Scrubs: The Evolving Healthcare Workplace – The patient pays the ultimate price’. MEDPAGE Today, April 19, 2024, Suits vs Scrubs: The Evolving Healthcare Workplace | MedPage Today
Patsy Newitt, Harry Severance, Physicians have become marginalized. Here’s how young physicians can change this. Becker’s ASC Review, July 21st, 2023, Physicians have become marginalized. Here’s how young physicians can change this. – Becker’s ASC
