Rural emergency departments struggling with physician shortages, analysis finds

Workforce challenges persist in rural emergency departments amid physician shortages, according to a study in Annals of Emergency Medicine.

For the study, researchers examined the 2014 Medicare Public Use Files dataset of 932,243 physicians to identify emergency physicians, nonemergency physicians or advanced practice providers. They narrowed the study to clinicians paid for evaluation and management services to Medicare fee-for-service Part B patients in the emergency department. To determine urbanicity, they examined data from the National Bureau of Economic Research.  

The study identified 58,641 unique emergency medicine clinicians, with 35,856 (61.1 percent) classified as emergency physicians, 8,397 (14.3 percent) as nonemergency physicians, and 14,360 (24.5 percent) as advanced practice providers. The identified nonemergency physicians were primarily family practice and internal medicine emergency medicine clinicians, at 41.7 percent and 19.9 percent, respectively. Advanced practice providers primarily included nurse practitioners (31.5 percent) and physician assistants (68.4 percent).

Among the identified unique emergency medicine clinicians, 58,565 were mapped to 2,291 U.S. counties or equivalents. Nearly 64 percent of emergency physicians were in urban counties, while nearly 45 percent were in rural counties, according to the study. More than 27 percent of counties did not have emergency medicine clinicians and 41.4 percent of counties did not have any emergency physicians reimbursed by Medicare fee-for-service Part B.

"Our analysis revealed that more than one third of emergency department clinicians are someone other than an emergency physician," said the study's lead author, M. Kennedy Hall, MD, assistant professor in the department of emergency medicine at the University of Washington School of Medicine in Seattle. "This points to the need for a broader approach to emergency care training. Health systems have unique needs, and hospitals, particularly in rural areas, will continue to be challenged to harness the provider mix in their regions."

He added: "Our EM workforce is broad-based with a variety of ambulatory care skillsets in addition to emergency medicine experience. It is important to provide additional emergency medicine-specific training when needed, as well as examine standards for APPs and nonemergency physicians, especially in locations where access to trained emergency physicians is limited."


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