Bilateral Queckenstedt's sign

When you are on call it seems that all too often you are called in for the dumbest reasons and it is important not to blow up and check from Queckenstedt's sign on the poor sod who called you in. Lately though, it seems that that calls are coming far to often. Rather than just complain I decided to investigate the matter. In my groups case, the vast majority of the calls are from nurse practicioners who are now manning some ERs and many Fast Tracks. These nurse practicioners are nurses with 17 months of extra training. I guess the idea is that they can replace a MD or DO who has 4 years of medical education and then 3 to 4 years of speciality emergency medical training. Anyway, stuff that usually could be seen in the ER that is treated and streeted can not be taken care of because the NPs either can't do it or don't know how to do it so you get called in. What is even worse is many times that I am called in I find that there is something totally different going on with the patients. Then I wonder, how many of the patients that they have sent home had something bad wrong! I called up one of the hospitals administrators and asked why the NPs are not discussing the patients with their supervising MD and he informed me that all the supervising MD has to do is review their charts later. Further the NPs can act independently. I asked why they dont hire MDs and the answer was easy, MDs cost too much because of their liability insurance. Nurse Practicioners are cheaper and have minimal insurance because they are not held to the same standards! You put EMTALA in the mix and there you are. You get called in for everything.