Advanced Practice Clinicians and the Scribe Advantage
EPPA’s Director of Quality and head of the APC training program, Dr. Peter Currie, discusses how EPPA is incorporating Advanced Practice Clinicians (APCs) into EPPA’s Emergency Medicine practice and the advantage scribes have when starting clinical practice.
What is EPPA’s APC-T Program?
The APC-T (Advanced Practice Clinician Training) program was developed to facilitate new PAs and nurse practitioners integration into how EPPA practices Emergency Medicine. Right now, it’s an 8-10 month clinical training program. In the emergency setting, patient care is happening in real time and APCs need to make decisions ‘right now.’ Questions remain about how to most effectively and safely integrate APCs into an emergency practice and I can’t say we have them all figured out, but the program has been going very well.
What types of practice models are available to APCs?
There are some emergency departments (EDs) in town that utilize APCs similar to the way that they utilize interns (recent medical school grads starting their residency training). This mainly happens in academic centers where medical students and residents are constantly rotating through. In these settings, APCs who stay in their job awhile will see many classes of residents come and go. While the education and training can be very good, despite their years of experience, these APCs are often supervised by an ever-changing rotation of residents and many don’t find that very satisfying in the long-term.
Other EDs utilize APCs in ‘fast track’ or triage areas where they’ll only see low-acuity patients; ankle sprains, cold symptoms, etc. or they’ll simply intake the patient and pass them off to the MD. While some APCs enjoy this type of work, others may find that it lacks variety or challenge. At EPPA and some other EDs, APCs can work in both fast track and the main department under the supervision of board-certified Emergency Physicians. This model provides APCs with a variety of patient types in a supported environment and, we believe, provides a level of professional satisfaction and growth.
What distinguishes an APC when they apply with EPPA?
There’s a variety of factors but the first two I typically look at are: did they scribe and did they rotate with us? /p> APCs, particularly newly graduated PAs, who’ve rotated in the ED and especially those who’ve taken additional elective rotations in the ED, show they’re dedicated to Emergency Medicine. If they rotated with us, they show dedication and an understanding of who we are at EPPA. Rotations are one month long – some of our former scribes have worked in the Emergency Department for over a year. A scribe background tells me that the candidate has seen hundreds, if not thousands of patients, understands what emergency medicine is all about, and has remained dedicated to the profession.
What are the specific advantages to a scribe background?
The PA programs are always telling me that scribes come in and leave as the best students. They tend to be more comfortable in front of patients, are better at synthesizing clinical information and, even if they don’t yet understand the pathophysiology, they’ve seen this stuff before, experienced it in context and are familiar with the language of medicine. For our APC-T program, students with a scribe background hit the ground running, they know how to build a patient history and are familiar with the technical aspects of documentation – a skill which should not be undervalued.
What’s the future of APCs at EPPA?
I believe the program will continue to grow. It’s both necessary to manage the growing patient population and I believe emergency medicine is a very attractive choice for new providers. Emergency medicine, in some practices, allows APCs to go from a very minor complaint to something a lot more complicated or urgent. You can see an obstetrics issue, followed by a trauma, or medical problem. There’s the opportunity to perform procedures and work with your hands – I think that kind of variety is attractive. There are certainly some lifestyle considerations; emergency providers work nights and weekends, but I think the pluses outweigh the minuses. The derogatory term for emergency providers is “glorified triage” – we stabilize and admit or discharge. I actually see that as a compliment. Emergency providers are the “jack of all trades” – they’re the kind of provider you want around if you need help.