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Dreamingthelive's post in the academic vs. community thread about the supervisory role of academic attendings raised some interesting points when dovetailed with the current discussion regarding the soul of EM. Right now the majority of us work at places with an attending/midlevel ratio >1. Anesthesia is frequently cited as a model for future staffing and the ACT model seems to be most commonly 1:4. Given that it's harder for midlevels to make the leap to solo practice in EM due to inability to risk-stratify our patients prior to arrival, what do you think the predominant staffing model will look like in 5 years (or what should it look like)?
Birdstrike has voted for independent practice for midlevels (without possibility of transfering liability) or to have absolute control over the HR aspects of midlevels if they are not independently practicing. While I think he outlines the two medicolegally safest paths for EPs, I don't think either will be common.
I think we are going to start seeing jobs where the ratio is <1, although my thought is that providing anything resembling real supervision to 4 midlevels isn't logistically possible (although I'm sure there will be some CMG jobs that offer higher pay for the risk to your license). I could definitely see stable jobs with a 1:2 or 1:3 ratio where the attending is present to provide that extra 15% for a physician assessment and to provide technical assistance/political cover for the midlevels. In essence, rather than being a fast-track or low-acuity provider the midlevels would be essentially permanent residents.
Birdstrike has voted for independent practice for midlevels (without possibility of transfering liability) or to have absolute control over the HR aspects of midlevels if they are not independently practicing. While I think he outlines the two medicolegally safest paths for EPs, I don't think either will be common.
I think we are going to start seeing jobs where the ratio is <1, although my thought is that providing anything resembling real supervision to 4 midlevels isn't logistically possible (although I'm sure there will be some CMG jobs that offer higher pay for the risk to your license). I could definitely see stable jobs with a 1:2 or 1:3 ratio where the attending is present to provide that extra 15% for a physician assessment and to provide technical assistance/political cover for the midlevels. In essence, rather than being a fast-track or low-acuity provider the midlevels would be essentially permanent residents.