Many ED patients are evaluated by advanced practice providers (APPs) instead of emergency physicians (EPs), regardless of whether they know it. “Patients seeking immediate medical care trust and prefer emergency physicians,” says Christopher Kang, MD, FACEP, president-elect of the American College of Emergency Physicians (ACEP).
More than 80% of adults reported they most trusted an EP to lead their medical care in the ED as opposed to a nurse practitioner, physician assistant, or nurse, according to an ACEP poll of 2,200 adults.1 “An overwhelming number of [respondents] entrust the emergency physician to lead their medical care as compared to a nurse practitioner [9%] or physician assistant [7%], especially as the severity of their injury or condition increases,” Kang notes.
However, many patients do not realize they never saw an EP. To figure it out, ACEP survey respondents indicated they use mostly subjective criteria. “There are numerous unreliable ways by which patients may presuppose the credentials of the members of their emergency department care team, including individual partialities [and] personal and cultural experiences,” Kang says.
Some of the quirky criteria survey respondents named included the color of scrubs, titles on badges, whether the provider is wearing a stethoscope, and how the provider interacts with colleagues. Respondents also reported confusion over knowing the difference between an EP and a PA (16% were unsure) and the difference between an EP and a nurse practitioner (17% were unsure). “The most consistent way to identify whether you are being treated by an emergency physician, physician assistant, or nurse practitioner is to confirm their full title, qualifications, and role,” Kang offers.
Considering the broad range, acuity, and severity of injuries and conditions seen in the ED, physicians are the most highly educated, trained, and qualified to make diagnostic and treatment decisions for ED patients, Kang argues. “However, despite the substantial differences in education and specialty training, there are circumstances where hospitals increasingly utilize physician assistants and nurse practitioners to provide a wider range of care, including complex medical decisions and procedures,” Kang says.
Every member of the emergency care team is a qualified professional, and should be respected and recognized for their respective roles, training, and credentials. “Each member of the emergency care team should introduce themselves or confirm their role and qualifications,” Kang suggests. “Patients should know the identities and qualifications of the team members caring for them.”
The use of APPs in the ED is becoming common, according to Annie E. Howard, JD, a partner in the Johnson City, TN, office of Hancock, Daniel & Johnson. The EP and APPs should stay in constant communication throughout the shift. “But this does not mean advanced practice clinicians cannot act independently, within the scope of their license,” Howard adds.
Understandably, patients often are confused by all these nuances, credentials, and job titles. “It’s not appropriate for a physician extender to represent herself as a ‘physician,’ but to represent herself as a ‘provider’ is perfectly appropriate,” Howard says.
If a bad outcome occurs, patients might allege they should have been seen by an EP, or that they did not even realize they had not seen an EP. Howard says this kind of allegation is unlikely to result in a successful lawsuit. “As long as the provider was seeing the patient within the scope of his or her practice and consistent with the hospital’s practice or policy, there’s ultimately little weight to this misunderstanding,” Howard says.
REFERENCE
- American College of Emergency Physicians. Public opinion on the value of emergency physicians. August 2021.
Many patients do not realize the type of medical professional who handled their care. There are numerous unreliable, subjective ways patients may presuppose the credentials of the members of their care team, including individual partialities, along with personal and cultural experiences.
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