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My Experience Matters: There’s No Replacement for an Emergency Physician

I began my medical career as a physician assistant (PA). Within weeks of completing my PA training, I was participating in major medical decisions. I was told my PA training would prepare me "to do pretty much everything a physician does", but nothing could be further from the truth.

As a PA, I vividly recall the night that changed my career. Four weeks after I completed my PA training, a toddler was brought to my emergency department late at night with a severe head injury.

She had tubes coming out of her that I didn't recognize and a scan of her brain I couldn't interpret. At that hour there was no physician onsite. A child's life was in my hands and quick decisions were necessary, decisions I was not equipped to make.

It was deeply unsettling to assume responsibility for this child without the information or the training to know exactly what needed to be done. That night I vowed never again to be put in that position with the stakes so high. That night I chose to become a physician.

I realize now that the training I completed as a PA was almost comparable to a third-year medical student. That is certainly a helpful amount of medical knowledge. It's just nowhere near what a physician knows by the time their training is done. As a new PA, I remember asking the senior PA on staff why we did certain things.

I was told, "things are done this way, because that is how our physician likes it to be done." I remember how uncomfortable it felt to care for a patient without fully understanding why procedures needed to be done.

Now that I'm a physician, I prioritize educating my team because I know what they don't know. One thing I teach is to get me immediately whenever anything seems wrong.

Recently, paramedics brought in a man who had fallen about 12 feet off a ladder. A PA was the first to see this patient and she promptly ordered x-rays. That would've been appropriate had this patient suffered a minor trauma. But the PA didn't know what she didn't know.

One look told me this patient had a shattered pelvis and heavy internal bleeding. The PA was not trained to recognize the extent of these injuries or realize that this man needed blood, a full body scan and immediate intervention. Moving him in any way, especially to obtain x-rays, may have killed him.

I've seen firsthand that there are patient safety concerns that come with putting somebody without the appropriate training in the position to make life or death decisions.

The distinct roles on an emergency care team are meant to complement each other, and they are not interchangeable. Every PA and nurse practitioner (NP) that I know is qualified and driven, and they play an integral part of the care team, but they are not a replacement for an emergency physician.

Ricki Brown-Forestiere, MD, is an emergency physician in Florida.

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