I've been an ER nurse for an eternity. Seen a lot of changes. Seen a lot of changes with our doctor group.
When I started in the ER our docs weren't board certified ER docs, they were internal medicine. As a nurse group, we had a great relationship with them. They respected us, valued our opinion and because of that we gave really great care. The doctors back then worked for the hospital.
Down the road they decided to form a group and contract with the hospital. Thats when the changes began. Eventually they started hiring only board certified ER docs which is as it should be.
These two changes - the group separating and contracting with the hospital, hiring ER docs only, changed our ER.
This is only my perspective but when they formed their own group, it changed them. It seemed to become more about the money. When you contract with someone, you have to make the contractee happy.
What makes the hospital happy? Happy patients. Getting them to come back. Making money for the hospital. Using the hospitals high tech equipment.
What makes a patient happy? Obviously, they want to feel better. They want you to calm their fears that something awful is wrong with them. They expect you to do things for them: run tests, relieve their pain, reassure them.
Now in this day and age, making them feel better takes the form of relieving any kind of discomfort RIGHT NOW. Pain 4/10 here's some dilaudid. Hint of nausea, zofran. IV for everybody. The days of giving you an ODT zofran, a vicodin and letting you drink water are gone. More complex interventions make the patient happy, the more interventions the higher the level of care, the higher payment for the doctor and the hospital. There is a money incentive to do excessive testing, over the top treatment. Thats what our doctor group does these days. I realize that this is the norm in ERs across the country. Is this kind of care good for the patient?
The other change, the coming of board certified ER docs changed it too. Having worked in a hospital on call that trains ER docs, I saw the difference from our ER. The docs separated themselves into their own area, having little interaction with the nurses other than around patient care. There wasn't the collaboration like at my hospital. Basically the nurses were task monkeys. They were there to carry out the doctors orders, their opinion wasn't sought out.
So that happened at our hospital too. The docs and nurses no longer collaborate with each other like we used to. It has affected patient care.
Then in the last couple of years, anticipating decreased reimbursement, our docs decided to start hiring PAs and went with the pit boss model. The PAs see all the patients and collaborate with the staff doc. PAs are a lot cheaper to employ, allowing that profit and salary to be maintained by the docs.
The introduction of the PAs has had a negative impact on our ER. PAs, at least in our ER, are not collaborators. They collaberate with the doctor and thats about it. They have not been receieved well by the nurses, further alienating the relationship between the docs and nurses. Once again, all of this has affected patient care. Not in a positive way.
The point of this blog post: As money becomes more and more the center of medicine, the best care for the patient falls by the wayside, replaced by the pursuit of profit.