Larkin G L, Kantor W, Zielinski J J
Department of Surgery, Division of Emergency Medicien, University of Texas Southwest Medical Center, Dallas, TX 75390-8579, USA.
Acad Emerg Med. 2001 Sep;8(9):886-92. doi: 10.1111/j.1553-2712.2001.tb01149.x.
Contentious moonlighting policies and the proliferation of nonphysician clinicians (NPCs) in academic emergency departments (EDs) send conflicting messages to emergency medicine (EM) residents regarding appropriate ED staffing patterns. The objective was to assess EM resident (EMR) views on the ED utilization of unsupervised residents and NPCs from their perspectives as both physicians and prospective patients.
A survey was mailed to a random sample of senior EMRs (sampling fraction, 68%) from the Emergency Medicine Residents Association membership list. Respondents were instructed to assume the role of patient when presented with hypothetical clinical scenarios of increasing severity; outcomes included provider preferences and the impacts of medical urgency, time delays, costs, and supervision on those preferences. Survey items asked about willingness to see residents, nurse practitioners (CRNPs), and physician assistants (PAs), and perceived impact of NPCs on professional identity.
A total of 251 EMRs responded. Senior EMRs are more willing to have their care handled by residents as opposed to mid-level providers. For a moderate illness or injury scenario, 54% agreed to be seen by a resident alone compared with only 17% and 24% willing to be seen by a CRNP and PA, respectively. Only a small fraction of the residents (22.7%) would allow another resident to treat them for a major injury or illness. Residents are more willing to be seen by mid-level providers if a savings in time can be realized but showed little interest in using NPCs to save money. Approximately one-third (34%) of the residents view mid-level providers as a professional threat, but logistic regression reveals this perception to be 2.25 (1.3, 4.0) times higher in male EMRs and 1.94 (1.1, 3.4) times higher in those with higher household incomes (> or =$75,000).
When assuming the patient role, senior EMRs have preferences for ED care that are consistent with restrictive EMR moonlighting and NPC staffing policies.
学术急诊科（ED）中存在争议的兼职政策以及非医师临床医生（NPC）的增加，给急诊医学（EM）住院医师传达了关于适当的急诊部人员配备模式的相互矛盾的信息。目的是从急诊医学住院医师作为医生和潜在患者的角度，评估他们对急诊部使用无监督住院医师和NPC的看法。
从急诊医学住院医师协会会员名单中随机抽取高级急诊医学住院医师样本（抽样比例为68%），并邮寄调查问卷。要求受访者在面对严重程度不断增加的假设临床场景时，扮演患者的角色；结果包括提供者偏好以及医疗紧急程度、时间延迟、成本和监督对这些偏好的影响。调查项目询问了受访者是否愿意让住院医师、执业护士（CRNP）和医师助理（PA）看病，以及NPC对职业认同的感知影响。
共有251名急诊医学住院医师回复。与中级提供者相比，高级急诊医学住院医师更愿意由住院医师提供护理。对于中度疾病或损伤的情况，54%的人同意由住院医师单独看病，而愿意由CRNP和PA看病的分别只有17%和24%。只有一小部分住院医师（22.7%）会允许另一名住院医师治疗他们的重伤或重病。如果能节省时间，住院医师更愿意由中级提供者看病，但对使用NPC省钱兴趣不大。约三分之一（34%）的住院医师认为中级提供者是职业威胁，但逻辑回归显示，男性急诊医学住院医师的这种看法高2.25（1.3，4.0）倍，家庭收入较高（≥75000美元）的住院医师的这种看法高1.94（1.1，3.4）倍。
在扮演患者角色时，高级急诊医学住院医师对急诊护理的偏好与限制性的急诊医学住院医师兼职和NPC人员配备政策一致。
