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MDs without EM Training Better than Nonphysicians

Schenden, Lawrence W. MD

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doi: 10.1097/01.EEM.0000359178.37488.90


    I am a residency trained, board certified veteran emergency physician. I recently read the article “TeamHealth Recruiting Letter Riles Tennessee EPs” in the February issue. (EMN 2009; 31[2]:1.)

    Leaders in emergency medicine really do not understand the manpower problem. Quite simply, there is a massive shortage of emergency physicians. Many emergency departments are now employing midlevel providers as a major part of their ED workforce. This practice occurs in urban and rural areas.

    I have worked in such situations. These midlevel providers often are right out of school. They frequently have no defined scope of practice, and they are undertrained to see the problems they face in the ED.

    These midlevel providers “attend” the patient with an EP who is working. They will often tell the doctor about two or three patients at a time. The doctor is simply too busy to see these patients, but he must sign their charts. In my experience, this is substandard care. Worse yet, it is substandard care with my name on the chart.

    The argument about whether to staff EDs with doctors without emergency medicine training is ridiculous. The reality is these EDs are already being staffed with nonphysicians. Some midlevel providers are better than others, but all are undertrained compared with any medical school graduate. Midlevel providers are different animals from physicians.

    Leadership in emergency medicine really needs to wake up. We are grossly understaffed. We need a lot more physicians, not midlevel providers. We need these physicians, even if they are not residency trained in emergency medicine. Patient care is suffering.

    Lawrence W. Schenden, MD

    Grand Rapids, MI

    © 2009 Lippincott Williams & Wilkins, Inc.