AAPA Responds to AAEM Resident Student Association Advocating for End of PA and NP Fellowships

Letter from AAPA President Beth R. Smolko, DMSc, MMS, PA-C, DFAAPA

April 16, 2021

On behalf of the PA profession, we are writing to oppose the open letter to the specialty of emergency medicine recently issued by the AAEM Resident Student Association.[i] This letter advocates for the end of all PA and NP “fellowships” and the replacement of non-physicians with physicians. This letter and these actions are based on a not-yet-published ACEP report, which is currently in publication review.

Your student organization asserts that these actions are necessary for the safety of patients – but in reality, this position is not in the best interest of patients and is out of touch with how medicine is practiced today.

This open letter claims that PAs and NPs have been “physician extenders” during physician shortages, but without a shortage, there is no longer a need for this “extension” and instead, “the most qualified individual to care for patients should do so.” The letter also states that graduating EM physicians are “significantly more qualified to fill these patient care roles.”

These claims are simply untrue. Nearly 10% of the nation’s approximately 150,000 PAs practice in emergency medicine and are a crucial part of the timely delivery of high-quality care to patients – especially during the COVID-19 pandemic. In fact, an April 9 ACEP presentation reviewing the EM workforce report states, “Physician assistants and nurse practitioners play a valuable role in the ED.”[ii] Importantly, PA practice has been extensively studied and evaluated, and PAs have been found to provide high-quality patient care similar to that of physicians.[iii]

Despite a possible EM physician surplus, a 2020 study published in the Annals of Emergency Medicine found that the rural emergency physician shortage is expected to worsen in the coming years, and that just 8% of clinically active emergency physicians practice in rural communities.[iv] The same study found that the rural emergency physician workforce is closing in on mid-career or retirement, with more than 70% having completed their medical training more than 20 years ago.

The COVID-19 pandemic has been a challenge for all medical providers, including PAs, NPs, and physicians. Three in five PAs have tested, treated, and diagnosed COVID-19 patients, and one in seven PAs became infected with COVID-19.[v] Like physicians, PAs have experienced furloughs, layoffs, and reduced hours. Advocating for patients should not include removing advanced practice providers like PAs and NPs from the equation. As the healthcare workforce moves forward, our professions must work together to ensure that every patient receives high-quality care from the appropriate provider, at the right place, and at the right time.

More Resources
AAPA Responds to AAEM Position Statement on Advanced Practice Providers
AAPA Response to EM Physician Groups’ “Joint Statement Regarding Post-Graduate Training for Nurse Practitioners and Physician Assistants”

[i] https://www.aaemrsa.org/about/position-statements/specialty-of-em

[ii] https://www.acep.org/globalassets/sites/acep/media/workforce/emphysicianworkforceofthefuture_4920.pdf

[iii] https://www.aapa.org/download/39029/

[iv] https://www.annemergmed.com/article/S0196-0644(20)30501-1/fulltext

[v] 2021 AAPA Salary Survey