Emergency Medicine Physician Assistant (EMPA) Post-Graduate Training Programs: Program Characteristics and Training Curricula

From eScholarship (hat tip: Dr. Menadue):

Introduction: A growing number of formal postgraduate training programs have been established to provide emergency medicine physician assistants (EMPA) with the unique skills and knowledge to work in the emergency department (ED). The objective of this study was to provide an overview of the current state of EMPA postgraduate training and to describe program characteristics and curriculum components.

Methods: We conducted a cross-sectional study of EMPA postgraduate training programs using data from websites and contacting individual programs to provide program characteristics and curriculum components. Variables collected included length of program, curriculum (e.g., clinical rotations, didactic experience, and research opportunities), size of program/number of trainees, affiliation with emergency medicine (EM) residency, geographic location, and salary.

Results: We identified 29 EMPA postgraduate training programs in 17 states, with at least one additional program in development. The mean length of EMPA training programs is 15 months (range 12-24 months). The most common non-ED/elective rotations are orthopedics, ultrasound, anesthesiology, and trauma. The mean number of trainees per class is 3.46 (median 3, range 1-16 trainees); 27 of 29 (93%) programs were in institutions that also had an EM residency program. The mean annual salary is $58,566 (range $43,000-90,000).

Conclusion: EMPA postgraduate training programs have common characteristics and curriculum components despite a lack of a specialty-specific accrediting organization or certifying examination. The overall growth and current number of these programs merits further research focusing on whether standardized curricula, formal recognition, and accreditation should be developed.


Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children

From JAMA Pediatrics:

Importance  Mild traumatic brain injury (mTBI), or concussion, in children is a rapidly growing public health concern because epidemiologic data indicate a marked increase in the number of emergency department visits for mTBI over the past decade. However, no evidence-based clinical guidelines have been developed to date for diagnosing and managing pediatric mTBI in the United States.

Objective  To provide a guideline based on a previous systematic review of the literature to obtain and assess evidence toward developing clinical recommendations for health care professionals related to the diagnosis, prognosis, and management/treatment of pediatric mTBI.

Evidence Review  The Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control Board of Scientific Counselors, a federal advisory committee, established the Pediatric Mild Traumatic Brain Injury Guideline Workgroup. The workgroup drafted recommendations based on the evidence that was obtained and assessed within the systematic review, as well as related evidence, scientific principles, and expert inference. This information includes selected studies published since the evidence review was conducted that were deemed by the workgroup to be relevant to the recommendations. The dates of the initial literature search were January 1, 1990, to November 30, 2012, and the dates of the updated literature search were December 1, 2012, to July 31, 2015.

Findings  The CDC guideline includes 19 sets of recommendations on the diagnosis, prognosis, and management/treatment of pediatric mTBI that were assigned a level of obligation (ie, must, should, or may) based on confidence in the evidence. Recommendations address imaging, symptom scales, cognitive testing, and standardized assessment for diagnosis; history and risk factor assessment, monitoring, and counseling for prognosis; and patient/family education, rest, support, return to school, and symptom management for treatment.

Conclusions and Relevance  This guideline identifies the best practices for mTBI based on the current evidence; updates should be made as the body of evidence grows. In addition to the development of the guideline, CDC has created user-friendly guideline implementation materials that are concise and actionable. Evaluation of the guideline and implementation materials is crucial in understanding the influence of the recommendations.

Rural ACOs that received loans from the CMS succeeded

From Modern Healthcare:

Accountable Care Organizations that were launched in part through loans from the CMS saved Medicare $82 million after just one year of operations, according to a federal report released Friday. The CMS spent just $58 million in loans to qualifying ACOs.

The ACO Investment Model (AIM) program was created to help rural providers who joined the Medicare Shared Savings Program.

After subtracting $22.6 million in earned shared savings earned by ACOs, Medicare netted about $82.8 million in the first year of the ACOs performance which ended in 2016. These ACOs will repay the upfront cash they received from earned shared savings at the end of their second contract period. Each contract period is three years.

Emergency Room Visits Decrease As Urgent Cares Become More Popular

From US News:

According to a study published in JAMA Internal Medicine on Tuesday, emergency department visits from 2008 to 2015 for low-acuity conditions dropped by 36 percent, while visits to non-emergent care facilities, such as urgent care centers or calls in to telemedicine services, grew by 140 percent.

The researchers examined 20.6 million visits of Aetna insurance members from 2008 to 2015 for “low-acuity” conditions, which include ailments such as sore throats, urinary tract infections, rashes and respiratory infections.

They discovered that visits to urgent care centers increased by 119 percent. Visits to retail clinics increased by 214 percent and the use of telemedicine increased from zero visits in 2008 to six visits per 1,000 members in 2015.

New bill saves Medicare ambulance reimbursements for ESRD

From the Intelligencer:

Congressman Darin LaHood has introduced new legislation that aims to ensure proper Medicare funding for scheduled, non-emergency end-stage renal disease ambulance services.

Alongside Congressman Terri Sewell, a Democrat from the 7th district of Alabama, LaHood introduced House Resolution 6269, which would change the Bipartisan Budget Act of 2018 to restructure the payment adjustment of non-emergency ESRD ambulance transports under Medicaid.

“This is a bill within the Ways and Means Committee that would help ensure that our ambulance services in rural areas aren’t jeopardized,” LaHood said. “Our bill makes sure that Medicare fully funds ambulance services. If you live in a small community, you’ll need these ambulance services. This bill ensures they’re fairly reimbursed for those services. “

Under the current law, ground ambulance providers face a 23 percent cut in reimbursement for ESRD ambulance transports if the patient is a Medicare beneficiary.

Diagnostic Imaging in Emergency Medicine: How Much Is Too Much?

From the Annals of Emergency Medicine:

Few topics are as pertinent to the current emergency medicine climate as the debate surrounding the overuse of diagnostic imaging. Use of advanced diagnostic imaging has increased in the United States exponentially since the advent of computed tomography (CT) and magnetic resonance imaging (MRI). CT use has increased from 3 million scans in 1980 to greater than 60 million in 2005, and is still increasing. Although this growth stretches across the care continuum, it includes the emergency department (ED).

Texas doctor sorry for saying gender pay gap fair as women ‘do not work as hard’

From The Guardian:

A doctor from Plano, Texas has apologised for saying the gender pay gap in medicine is fair because female physicians “do not work as hard and do not see as many patients” as men.

Dr Gary Tigges’ remarks were published by the Dallas Medical Journal, in a section entitled “Big and Bright Ideas”. Women did not work as hard as men, he said, because “they choose to, or they simply don’t want to be rushed, or they don’t want to work the long hours. Most of the time, their priority is something else … family, social, whatever.”

He added: “Nothing needs to be ‘done’ about this unless female physicians actually want to work harder and put in the hours. If not, they should be paid less. That is fair.”