Why physician-led care is king in the ER

No offense, mid-level providers, but when it comes to care in the ER, patients prefer teams led by physicians. That’s the result of a recent survey from the American College of Emergency Physicians (ACEP) and Morning Consult, which polled over 2,200 American adults on their emergency treatment preferences.^[]

According to the findings, 79 % of adults prefer to have physicians leading their medical care team while in the emergency department. Generational gaps do influence preference: Among people 65 and older, 91% prefer physician-led teams.

Survey shows patient preferences

Among other findings, the survey showed:

• Over half of adults polled (52%) were very familiar with the role of a doctor/physician in the ER.

• Only 35% of adults were very familiar with the role of physician assistants in the ER.

• Slightly more people (37%) were very familiar with the role of nurse practitioners in the ER.

• Of those polled, 72% would be very or somewhat concerned if a doctor/physician was unavailable to oversee the diagnostic and treatment process in medical emergencies.

• After learning more about training requirements for all ER professionals, 76% of adults surveyed still preferred physician-led ER care.^[]

As reported by the American Medical Association in 2020, most patients believe that a physician’s extensive education and training are critical for providing optimum patient care, especially for emergencies or complications.^[]

At the time, 84% of people surveyed said they prefer primary responsibility for diagnosis and treatment rest with a physician. Additionally, 75% said they’d prefer to be treated by a physician, even if it meant longer wait times or greater costs.

Education, training differences are key

Physicians complete anywhere from 10,000 to 16,000 hours of clinical education and training before beginning formal practice. Mid-level providers, however, are licensed after a far less rigorous process.

The American Academy of Physician Assistants lists at least 2 years of courses in basic and behavioral sciences as a prerequisite for entry into most physician assistant (PA) programs.^[] Once a person is accepted to an accredited PA program, they can expect another 26 months, or 3 academic years, of education and training with over 2,000 of clinical hours.

In contrast, nurse practitioners must obtain a Bachelor’s Degree in Nursing and registered nurse (RN) license before enrolling in a nurse practitioner (NP) program.^[] Most accredited NP programs require applicants to work as RNs for at least a year or two before applying.

Currently, nurses can obtain a Master of Science degree in Nursing and work as an NP. This requirement generally takes 1 to 2 years. Some choose to go further, obtaining a Doctor of Nursing Practice degree, which can take up to 6 years. Either way, nurses must focus on one practice specialty throughout their education.

Many states require PAs and NPs to practice under the direct supervision of a licensed physician. In other states, advanced practice providers (AAPs) may collaborate with doctors, and a small number of states let AAPs practice independently. But that could soon change.

Practice laws up for debate in many states

There may be hope for AAPs in the form of legislation that could even the playing field in scope of their duties.

In early 2020, nine states advanced legislation to expand scope of practice for advanced-practice RNs and PAs.^[] Pushback from physician-led organizations led to defeat of eight of those bills. But the conversation continues: By the end of 2021, APP groups continued to lobby against practice models requiring formal supervision, collaboration, or other written agreements with doctors.^[]

They argue that loosening supervision will impact patient care negatively, and patient safety may be compromised because of inadequate education and training.

But as the population of the country ages, and the possibility of a physician shortage emerges, states must decide whether to allow AAPs to practice independent of physician supervision or input.^[]

While the ACEP survey findings only represent a small proportion of the population, it’s worth noting that many patients prefer care from actual doctors. Time will tell if this standard holds as a more medically complex population ages and the number of trained doctors potentially declines.