Last month, I wrote about provider satisfaction. In that article, which you can read here, I discussed factors that affect provider satisfaction. Professional development was one extrinsic factor that I wrote about in that article. Soon after publication, I received an email from Doximity surveying professional development satisfaction, specifically among ER PAs. To my surprise, 60% of respondents indicated dissatisfaction. This hit a little too close to home for me.

I enjoyed my time in the ER, and it was not easy to leave the ER group I worked for and go back to Urgent Care, as I did last summer. So, what leads to such a high rate of dissatisfaction for APPs in the ER? What trends in Emergency Medicine could be contributing to this survey result? In this article, I will discuss my answers to these questions and give my advice to current and aspiring ER APPs as they experience these issues firsthand.

The Draw of the ER

If you have spent any time in the ER during rotations or as a nurse, you know the ER is not for everyone. From the moment I finished my last ER rotation, I knew I wanted to be an ER provider. My personality thrives in chaos, so I naturally loved the fast pace the ER provided. I loved the challenge of managing acutely ill patients and how this made me a stronger and more confident provider. Most providers I know that thrive in ER have similarities: The desire to improve their skills, the ability to tolerate a flexible shift-work schedule, and an appreciation for the increased compensation that comes with it.

High acuity

Inside Look at the ER

ER layouts will differ based on location and patient volume. Larger ERs will have several different areas where patients are seen. Areas will be a variation of these: A fast-track area with lower acuity patients staffed with a Nurse Practitioner or a Physician Assistant, a section for high-acuity and trauma cases, and a step-down area responsible for patients requiring intermediate care and smaller workups.

Every ER runs a slightly different operation. I have worked at two places with differing staffing models. The private ER group I worked with staffs their APPs on a rotational schedule, allowing them to work shifts across fast-track, step-down, and higher acuity areas. The smaller corporate hospital I worked for did not have a designated fast-track area. Still, the APPs were expected to see the lower acuity patients, primarily level 4s and 5s, with occasional level 3s slipping onto my board. The two experiences were drastically different, and I doubt it will surprise you that I only worked at the corporate hospital for six months before giving that up.

ER Trends

My experience and opinion of being an ER provider may be skewed because I worked for a small, private ER group. Although I ultimately left because there was no room for continued growth, I appreciated other parts of the job and still enjoy working shifts there occasionally.

In my opinion, the utilization of APPs directly relates to job satisfaction. In emergency medicine, the two trends I have seen increasing are at two different ends of the spectrum. At one end, rural hospitals are moving to staff their ERs solely with APPs and do not require a physician to be present 24/7. On the other end, many larger hospital systems are moving to utilizing APPs in high-traffic, low-acuity areas like fast-track. What role would you prefer? Could pushing APPs to fast-track areas contribute to lower satisfaction and a lack of professional development among ER providers?

The Fast Track Experience

To answer these questions, let’s talk about what working fast-track as an APP is like. It is no secret that busy ERs need a fast-track area because 30-50% of the patients who end up in the ER could have their needs met in an Urgent Care. However, the Emergency Medical Treatment and Labor Act (EMTALA) mandates that all individuals seeking emergency care must be attended to, leading to a need to quickly move patients in and out who do not require extensive workups.

It makes financial sense for hospitals and ER groups to use APPs in these areas as “meat movers” over physicians. Although this is not the most glorious part of the ER to work in, it does have some advantages.

Advantages of Fast Track
I’ve never met an ER provider who is happy seeing coughs and colds day in and day out, but working in t