Louisiana Program Brings Family Docs to the Field

Emergency medicine residents must complete EMS rotations as part of their training, but this is not typical for family medicine residents, and few medical schools require it of their students. Yet per the American Academy of Family Physicians, family medicine physicians represent up to a third of the emergency care workforce in larger cities, and two-thirds of all the medical claims filed in 2012 from emergency departments nationwide were filed by family medicine physicians. Training family medicine residents in emergency medicine is essential to keep both urban and rural emergency departments running.

East Baton Rouge Parish (La.) Emergency Medical Services offers a unique in-the-field EMS experience to family medicine resident physicians and medical students. Medical director Dan Godbee helped implement the program, motivated by the deficiency in the number of other emergency medicine or EMS rotations offered in standard medical education throughout the U.S.

Since the inception of these programs in 2013, EBRP EMS has hosted up to 16 family medicine resident physicians and five medical students per year. Resident rotations last a month, and medical student rotations last either two or four weeks, in which time participants learn to provide immediate healthcare in the nonhospital setting and develop a better understanding of acute illness.

For the local family medicine program, residents participate in 3–4 12-hour EMS shifts during their emergency medicine month, and medical students rotating with the program have the option of 1–2 EMS ride-alongs over their third- and fourth-year family medicine rotations.

The response to the EMS experience has been overwhelmingly positive. In a promotional video family medicine residents and students describe how beneficial the experience has been to them. Family medicine physician Michelle Duhe, MD, says, “It got us out of the office so we can see how people live at home, how that affects their care and their health, and then how chaotic it can be sometimes on the scene, where it’s much more controlled in our office… I also got to do a lot of hands-on stuff that we don’t really get to do when we’re in in the hospitals.”

In addition to ambulance ride time, students and residents get the chance to participate in the department’s community paramedic program, and there are rotations for medical director experience and quality assurance/continuous quality improvement (QA/CQI). Fourth-year medical student Shannon Altazan participated in the community paramedic program and noted it’s an innovation that “bridges the gap between emergency medical services, the emergency room, and primary care.”

The benefits of physician EMS rides extends to the paramedic teams involved as well. EBRP EMS paramedic Brad Harris explains, “We’re all links in the same chain. We are able to listen to the physician’s line of questioning, see what information is important to them, and see what pertinent details they’re looking for.”

In a time when the ED demand has increased and the number of emergency medicine physicians hasn’t kept pace, the role of family medicine physicians may expand. Residency and medical school programs would do well to increase their students’ exposure to acute care. This program is not limited to the Baton Rouge area, and it is offered as an elective for students in any medical school or residency program. For more information visit the East Baton Rouge Parish EMS website or contact Godbee at DGodbee@brla.gov.

Aarti Attreya, MD, is a family medicine resident with the Baton Rouge General Family Medicine residency program.

Dan C. Godbee, MD, is medical director for East Baton Rouge Parish and the city of Baton Rouge EMS.