Sometime this summer, a large non-profit community hospital began something new and terrifying: It delegated medical admissions to Nurse Practitioners and Physician Assistants.
Yes, sick patients in the ER who need admitting to the hospital are now being admitted and cared for by non-Physicians.
The hospital is not located in some under-served community. In fact, the region is doing very well economically.
Pause. Let me repeat that again…
Nurse Practitioners and Physician Assistants are now admitting and managing medical admissions.
This includes complex patients admitted from the ER to the Intensive Care Unit.
We’ve been reassured: “A physician is supervising the NP’s and PA’s.”
Hmmm… we know what that means…
So… What’s the problem?
Physicians spend four years of medical school, moving on to intensive internships and several years of residency.
For most reputable hospitals, the final privilege of admitting patients only occurs after successfully completing a residency and Board Certification.
Many of us look back at our ignorance in early Internship and tremble. There is no substitute for years of experience and bookwork.
Years later, hospital care has gotten more difficult. For even seasoned and knowledgeable doctors, the task is challenging.
In fact, every year, the challenge grows.
Now, though, you don’t even have to be a doctor. As the difficulty increases, we reduce the required skills for the job.
Does this make sense?
Teachers in medical school often told us: You only diagnose what you know. If you don’t know much, you will diagnose it wrong.
Fortunately, even a healthcare provider with limited knowledge can blunder ahead for a while and seem okay.
But, then….there are the tough cases.
There are the cases where the initial ER doctor (or ER Physician Assistant) completely blows the assessment.
These are patients with a care team all charging in one direction, the wrong direction, until someone re-examines the case and says: “WAIT!!! We need to change plans!”
It is not an easy thing to do. It takes experience, courage and an excellent knowledge base.
Rarely is that someone the NP or PA.
Sometimes, one physician consultant has to tell another physician consultant: “I think you are wrong. This is why…..”
Again, that person is almost never the NP or PA.
Taking care of medical admissions is one of the toughest jobs in medicine.
Why are we delegating this to those with lesser knowledge and experience?