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Emergency Medicine Turf War Heats Up

Tensions have risen in the ongoing clash between emergency medicine physicians and the advanced practice professionals (APPs) who specialize in their discipline over the latter group’s use of terms like “residency” and “fellowship” in postgraduate training programs.

Last month, nearly all professional organizations representing emergency physicians issued a joint statement calling for those terms to be reserved solely for physician graduates of medical schools.

“The terms “resident,” “residency,” “fellow,” and “fellowship” in a medical setting must be limited to postgraduate clinical training of medical school physician graduates within GME training programs,” the statement said. “Hospitals or employers should not create or advertise post-graduate training of nurse practitioners or physician assistants in the emergency department without explicit involvement and approval of the emergency medicine departmental and residency leadership.”

Over the next few weeks, societies representing physician assistants (PAs) and nurse practitioners (NPs) shot back. The Society of Emergency Medicine Physician Assistants (SEMPA) issued a statement that it was “disappointed that, once again, postgraduate EMPAs find themselves the target of a divisive and paternalistic position statement from emergency medicine physician representative organizational leaders and colleagues,” and garnered a statement of support from the American Academy of Physician Assistants.

A joint statement from the American Association of Nurse Practitioners (AANP) and several other NP organizations said the groups “strongly oppose the view that emergency care is solely ‘physician-led’ or that physicians should dictate education and practice standards for advanced practice registered nurses (APRNs).”

Loaded Terminology

The controversy centers around a rise in PA and NP postgraduate training programs, which usually incorporate terminology like “residency” and “fellowship.” This has raised questions in resident physicians’ minds about whether an overall increase in trainees will have an impact on caseloads and, ultimately, threaten programs’ accreditation.

“If the hospital insists on having NP or PA trainees, that is going to dilute the caseloads available to residents,” Lisa Moreno, MD, president of the American Academy of Emergency Physicians, told MedPage Today. “If caseloads are diluted, number one a program can lose its accreditation. Two, if residents get less supervised training, they may be less prepared to take good care of patients when they graduate.”

The dispute picked up steam this February when the University of North Carolina at Chapel Hill announced a residency program in emergency medicine for advanced practice professionals (APPs).

Sources told MedPage Today that the emergency medicine physician residency program director had not been made aware of the program before it was launched. They also said APP residents would earn $60,000 annually, higher than a physician residency salary of $57,000.

In a statement posted Feb. 23, the director, Nikki Binz, MD, said the school’s announcement was “very premature”; Binz also wrote that “UNC does not have an APP EM education pathway, and no pathway will be introduced this year.” She also stated that the salary information was “not true and would never be true.” Binz did not return a recent request for comment.

EM physician professional societies met not long afterward to respond to