In its 2022 annual review of adverse events at U.S. health care facilities, The Joint Commission—America’s oldest and largest health care standards-setting and accrediting body—reported an alarming trend at emergency departments and hospitals: a 19% increase in negative outcomes over the previous year. Many factors contributed to the rise; a worsening staffing shortage likely numbers among them.
Emergency health care facilities are shorthanded, resulting in longer patient wait times and higher rates of patients’ leaving against medical advice (LAMA). Physician assistants (PAs), medical professionals who provide many of the same services as medical doctors, can help mitigate the shortage of emergency room (ER) personnel, providing essential services to patients in need.
The public imagination most often associates physician assistants with primary care, but PAs serve across varied specializations, including surgery, mental health and emergency medicine. Approximately one in nine PAs practices emergency medicine; critical care and emergency medicine rank second and third among PA fields with the sharpest increases in clinical opportunities (cardiothoracic and vascular surgery ranks first).
This article examines the role of PAs in emergency care and how these professionals are driving change in the industry. It also discusses how University of Pittsburgh’s Physician Assistant Studies Hybrid (PAS-Hybrid) program prepares students to embrace and effect innovation in emergency medicine.
The Evolving Landscape of Emergency Care
Emergency care facilities face mounting challenges as increased patient loads stress resources. According to a study of more than 400 general acute care hospitals in California, emergency department (ED) visits increased by 7.5% between 2011 and 2021. ED capacity has not kept up with the growth in emergency care utilization.
Meanwhile, mental health-related ED visits by children, teenagers and young adults soared from 2011 to 2020, according to a report published in the Journal of the American Medical Association. In 2020, mental health issues accounted for 7.5 million ER visits by people 6 to 24 years old, up from 4.8 million in 2011. The Substance Abuse and Mental Health Services Administration (SAMHSA) predicts that substance use disorders could account for three million annual ED visits by 2025.
Amid the rising demand for ED services, fewer doctors are choosing to go into emergency medicine. Budget cuts are curtailing services as private equity investors take over ERs and look for ways to save money and increase profits, compounding the problem. With fewer physicians entering emergency care, critical services are increasingly being provided by nurse practitioners and PAs—”advanced practice providers”—who can perform many of the same duties as MDs.
The Role of Emergency Medicine Physician Assistants
Emergency medicine is the third-most-popular specialty chosen by board-certified PAs, outranked only by surgical specializations and family medicine. PAs play a critical role in emergency medicine.
Emergency medicine PAs work in various settings. Some serve as solo providers in rural EDs, others on teams in community hospitals and Level I Trauma Centers. PAs’ scope of practice in EDs comprises a range of tasks, including:
- Performing medical exams and procedures
- Taking patient histories
- Ordering and performing diagnostic tests
- Diagnosing conditions
- Ordering medications
- Counseling patients
- Referring patients to appropriate specialists
- Writing admission orders
- Participating in service quality improvement activities
How PAs Drive Change in the ED
The Society of Emergency Medicine Physician Assistants asserts that employing ED PAs is cost-effective and efficient. PAs provide many of the same services as physicians, but at a substantially lower cost. Adding PAs to EDs also accelerates patient processing, reducing wait times and improving satisfaction.
ED PAs do more than provide essential services. They also actively drive change in emergency medicine by:
- Facilitating interprofessional collaboration in emergency care teams: Emergency room crowding is a growing problem, leading to increased patient risk due to delayed care. Studies have shown that interprofessional teamwork can reduce patients’ time in the ER. PAs are well-placed to lead the way in maximizing interprofessional teams that improve patient outcomes and reduce stress levels among staff.
- Providing additional patient engagement: PAs typically have more time than physicians to engage directly with patients, enabling patients to convey questions and concerns. As a result, patients leave the ED better informed about their conditions and treatment, promoting better health care outcomes.
- Streamlining ED processes: PAs’ expertise and training enable them to assume critical roles that expedite patient processing. A CEP America case study of a California hospital that assigned PAs to triage ED patients found wait times cut in half and the number of patients who left without being seen reduced by 80%.
- Using telehealth to drive positive and efficient patient care outcomes: Telehealth is slowly entering emergency medicine. According to Telehealth.HHS.gov, possible telehealth applications in EDs include remote patient screening to determine what care is needed and e-consults for providers to receive recommendations from other doctors with specialty expertise. Telehealth holds many potential benefits for emergency care, including lower costs, reduced hospital overcrowding and improved access to care in rural communities.
Looking Ahead: How Pitt Prepares PAs for the Future
The Pitt PAS-Hybrid program prepares PAs to leverage the latest technologies and clinical methods to transform patient care and improve outcomes. Upon completing the program, students should be able to demonstrate competencies in patient-centered care, society and population health, health literacy and communication, interprofessional collaborative practice and leadership, professional and legal aspects of health care and health care finance. These skills—especially communication and teamwork—are crucial for PAs to thrive in emergency care settings. Pitt students participate in eight clinical rotations during the program’s second year, equipping them to work in various health care settings, including the dynamic environment of emergency medicine.
Improve Patient Outcomes in a Top Health Care Setting
Changes in the ways emergency medicine is delivered are creating opportunities for mid-level health care providers like PAs and nurse practitioners. The Pitt PAS-Hybrid program offers a clear pathway for aspiring providers who want to shape the future of emergency health care to reach their goals.
If you are ready to take the next step in your patient care career, schedule a one-on-one call with an enrollment advisor for more information. Alternatively, review these application best practices if you’re ready to apply to become a Pitt PAS-Hybrid student.