Integration of Nurse Practitioners and Physician Assistants in Emergency Departments
To the editor: I read the recent CJEM publication by Ducharme and colleagues1 on the impact of nurse practitioners (NPs) and physician assistants (PAs) in Ontario emergency departments (EDs) with great interest. The authors concluded that "the addition of PAs or NPs to the ED team can improve patient flow in medium-sized community hospital EDs. Given the ongoing shortage of physicians, use of alternative health care providers should be considered."1 Similarly, a 1996 publication by Hooker and McCaig2 in the American Journal of Emergency Medicine concluded, "Recruitment and use of PAs and NPs may be a cost-effective strategy for improved delivery of emergency services."2 Indeed, the use of alternative care providers seems to be an effective solution for physician shortage not only in EDs but also in other departments. However, there are issues to be considered with a change of this nature. First, there must be a systematic training, evaluation and certification program for such personnel. Second, the responsibility of the physician as team leader must increase. Physician control and oversight of all procedures that such health care workers perform is particularly important. These issues necessitate expansion of the roles emergency physicians play to include those of administrator, collaborator and facilitator.
Viroj Wiwanitkit, MD
Wiwanitkit House, Bangkhae,
Ducharme J, Alder RJ, Pelletier C, et al. The impact on patient flow after the integration of nurse practitioners and physician assistants in 6 Ontario emergency departments. CJEM 2009;11:455-61.
Hooker RS, McCaig L. Emergency department uses of physician assistants and nurse practitioners: a national survey. Am J Emerg Med 1996;14:245-9.