Emergency medicine has been plagued in recent years with problems like physician shortages and diversion, or turning away ambulances because of overcrowding. One solution being used in many areas to reduce congestion and cut costs is the employment of nurse practitioners.
Nurse practitioners are master's trained nurses with additional experience in a specific area of practice. These providers may be one solution for the future of emergency medicine – though some caution they won't be a replacement for physicians.
Nurse practitioners treat alongside physicians when patients have serious illnesses. They are also able to provide unsupervised care to patients with minor conditions like an ear infection and can free up doctors by performing more time-consuming services like sewing a laceration.
As with most areas of healthcare, cost is a major driver of the use of nurse practitioners. A 2011 study by Advance Newsmagazine found that nurse practitioners make, on average, about $90,000 a year. Emergency room physicians earn about $250,000 annually, according to CNN Money.
By seeing patients with less serious illnesses, physicians can work with more acute – i.e. higher billing – patients. It also keeps ERs from "boarding" patients – admitting them but not treating them or moving them into the hospital.
"Having nurse practitioners see patients that aren't high acuity helps speed things up and moves them through the emergency department quicker," said Jennifer Wilbeck, an emergency nurse practitioner in Nashville, Tenn.
An article in the Advanced Nursing Journal from 2011 found that the costs of an emergency room nurse practitioner program were justified by the revenue they made. Nurse practitioners were able to move patients through more quickly (the time from arrival to contact with a provider dropped from 75 to 25 minutes), thereby seeing more billable patients. And, the percentage of patients who left the hospital without a medical screening examination (which creates a billable charge even if the patient isn't treated) dropped from 3.6 percent to 0.9 percent.
Nurse practitioners are also more inclined to work in areas where physicians aren't drawn to practice or where hospitals can't afford a physician's salary Wilbeck said.
Vidor Friedman, past chief of staff at Florida Hospital Celebration Health in Orlando, Fla., said nurse practitioners are a valuable part of his team and an answer to one of the industry's biggest challenges.
"Using nurse practitioners is one answer to part of the workforce problem," he said. "There is an overall shortage of emergency physicians and nurse practitioners are less expensive to put in place than a physician."
But Friedman, a board member of the American College of Emergency Physicians, cautioned that nurse practitioners are physician extenders – not a replacement for physicians. The ACEP make clear that the role of these nurses is to augment physicians' care, "Mid-level providers … should not provide unsupervised emergency department care," said a statement by the organization.