NP-MD model

Well, I've returned and thought I'd share a bit about my trip to another trauma job. I think it is always interesting to see how other hospitals run their business compared to what you're used to. I know my hospital has been interested in the idea of an NP-MD practice model, but not sure how to approach it. I can see why. When you sit in your own bubble, used to the problems and bureaucracy of your institution, it's hard to envision it different. But when you visit another place, you see what they've tried. The difficulty in going to an NP-MD model is what happens to the residents? Obviously they need to train and need to be there. But then how can you run a service with only the NPs and an attending physician?

So what I saw at this other hospital was that they separate the residents from the NPs right out of the gate. They have an entirely different set-up, where the trauma patients are on one floor and that floor is covered by the NPs. Somewhere else the residents are off managing other patients, trauma patients I assume that didn't get a bed on the trauma floor. The way I'm used to is I meet up with the resident/intern every morning and we divide all of the trauma patients, no matter what floor they are on. I see and interact with the residents all day. By all appearances, the NPs at the other hospital never see the resident, except for sign out at night to the on-call resident. There the NPs completely manage the floor almost entirely alone and round only with the attending, and there are no layers of residents. It's a more autonomous situation I think for those NPs. But every method has ups and downs. Just as they are downsides of less autonomy where I am, there are upsides of consulting the chief resident on specific issues and the opportunity to do more teaching.

So what's my take on the whole experience? I think it's a great job....but I'm not sure if I'm willing to leave what I have for it. Maybe had I actually been looking for a job, I'd be inclined to make all the sacrifices to go for it. But like I said, I already love my job and why leave it for an unknown? It may have worked well with school, but I'll just have to sort out that situation later if school opens up.