Emergency Medicine Workforce Research Articles

Improving Rural Access to Emergency Physicians

The recent Institute of Medicine report entitled The Future of Emergency Care in the United States Health System acknowledges workforce issues in rural America but does not adequately address the current shortage of emergency medicine residency-trained and board-certified emergency physicians in rural America. Areas worthy of further attention to ameliorate this threat include 1) government and hospital support of emergency medicine resident educational debt load, 2) modification of residency review committee for emergency medicine guidelines to permit modified training programs that are rural focused, and 3) support of pilot projects designed to modify the delivery of rural emergency care under remote supervision by academic medical center-based practitioners. The authors discuss these potential solutions to help guide policy makers seeking to enhance rural emergency care delivery through a stronger emergency medicine workforce.

Training emergency medicine doctors for rural and regional Australia: can we learn from other countries?

Australia is a country with a relatively small rural population dispersed over an enormous area. Issues similar to how best to deliver health services and recruit health professionals to rural areas exist in other countries. For professional and lifestyle reasons, most specialist doctors (including emergency medicine specialists), choose to live and work in major metropolitan centres. Outside the major Australian cities, most presentations to emergency departments are dealt with by 'non-specialist' doctors, often with limited specialist back up. Recruitment of suitably trained medical staff is increasingly difficult. There is increasing reliance on overseas trained doctors from widely varying backgrounds. In Canada and New Zealand, family medicine trained emergency medicine doctors are a significant proportion of the workforce in rural and regional emergency departments. To undertake a detailed investigation of the non-specialist emergency medicine doctors in Australia, and examine strategies to secure a more highly trained emergency medicine workforce for rural and regional Australia. A survey was undertaken of 230 doctors working in 57 rural and regional Australian emergency departments. Consultations and interviews were held with 53 key clinicians, educators and administrators. There were no training or education standards for doctors working in smaller Australian emergency departments. There was considerable instability in the workforce with many planning to leave their current position or reduce their involvement in emergency medicine. The vast majority felt a need to undertake further emergency medicine training. There was little agreement among stakeholders as to how emergency medicine should be taught, or services delivered in rural and regional Australia. There is need in Australia to offer a specific postgraduate qualification in emergency medicine for doctors wishing to practise emergency medicine outside major city hospitals. Ideally, such a course would be largely taught in rural and regional hospitals and would contain additional elements relevant to rural practice. The Canadian and New Zealand emergency medicine qualifications may be useful models.

Emergency Medicine Workforce

Emergency Medicine Workforce

Workforce projections for Emergency Medicine in Puerto Rico: A five-year follow-up of an evident demand

In this study, two mathematical equations were used to calculate and establish the actual Emergency Medicine workforce needed in Puerto Rico (PR) and project the time frame to meet the actual demand. 1) Supply equals the number of existing Emergency Physicians (EPs) plus residency-trained graduates in EM per year minus the annual attrition rate (3%); and 2) Demand equals six (6) full time equivalent positions per Emergency Department (ED) times the total number of EDs in PR. Under both scenarios tested, the significant EP shortage in PR will continue until 2044. The actual calculated shortage is 287 EPs. There is an actual significant shortage in the Puerto Rico EP workforce. It will take a long time to make leaders understand the positive impact of having residency-trained EPs in every ED, on quality patient care and the whole health care system.

Rural Emergency Medicine: The 2004 West Virginia Emergency Medicine Workforce

Rural Emergency Medicine: The 2004 West Virginia Emergency Medicine Workforce

Emergency medicine workforce study in israel: 2003

Study objectives: Emergency medicine was officially recognized as a specialty in Israel in 1999. In November 2003, the first class of 9 Israeli trained and examined emergency physicians were certified as specialists. We undertake this survey to assess current staffing of emergency departments (EDs) in Israel and attempt to estimate the need for emergency physicians in the future. Methods: A survey instrument was sent to all ED directors in general hospitals having EDs in Israel. The ED directors were informed that the information would be kept anonymous and only used in the aggregate. We asked questions relating to ED staffing by number of physicians, type of specialty, resident or specialist, and differential staffing by time of the day and week. In addition, we inquired as to the census, structure, hospital resources available, and size of the ED. Results: We had a response rate of 96% (23 of 24 hospitals). There are 59 certified emergency medicine specialists working in EDs in Israel, caring for a total of 1,872,500 visitors annually. A minority are residency trained. There are currently 37 emergency medicine residents enrolled in 19 programs in Israel. Emergency care is otherwise given by specialists and residents in other fields and by nonspecialist physicians. Presence of emergency medicine specialists is not evenly distributed by hospital type or time of day. During the day shift at large hospitals, there is an average of 2.25 emergency medicine specialists and another 4 specialists of other types on duty. From midnight to 8 am in large hospitals, there is an average of less than 1 specialist of any kind (typically not emergency medicine) on duty in the ED. Evenings and nights in most EDs, care is given by nonspecialists (residents in various specialties and others nonspecialists) working 16-hour shifts. The shortage of emergency physicians is greatest in medium-sized hospitals (average ED census 88,000 visits per year) where there is an average of only 5.3 full-time physicians (of all types) employed, which is in contrast to large hospitals (average ED census 104,000) where there is an average of 9.3 full-time ED physicians (of all specialties). Nineteen of 23 responding hospitals have been recognized as potential training sites for emergency medicine residents. Conclusion: The recognition of the need for emergency medicine as a specialty in Israel by the medicopolitical establishment has not as yet translated into care of emergencies by emergency physicians for most patients. It is apparent that to adequately staff the existing EDs in Israel around the clock full time, there is a need for a large increase in the number of emergency specialists. This increase will require a policy emphasis on funding positions for emergency medicine staff and a concentrated effort directed at emergency medicine resident education.

Health Care Disparities in Emergency Medicine

AbstractThe Institute of Medicine's landmark report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” documents the pervasiveness of racial and ethnic disparities in the U.S. health care delivery system, and provides several recommendations to address them. It is clear from research data, such as those demonstrating racial and ethnic disparities in emergency department (ED) pain management, that emergency medicine (EM) is not immune to this problem. The IOM authors describe two strategies that can reduce disparities in EM. First, workforce diversity is likely to result in a community of emergency physicians who are better prepared to understand, learn from, and collaborate with persons from other racial, ethnic, and cultural backgrounds, whether these be patients, fellow clinicians, or the larger medical and scientific community. Given the ethical and practical advantages of a more diverse EM workforce, continued and expanded initiatives to increase diversity within EM should be undertaken. Second, the specialty's educational programs should produce emergency physicians with the skills and knowledge needed to serve an increasingly diverse population. This cultural competence should include an awareness of existing racial and ethnic health disparities, recognition of the risks of stereotyping and biased treatment, and knowledge of the incidence and prevalence of health conditions among diverse populations. Culturally competent emergency care providers also possess the skills to identify and manage racial and ethnic differences in health values, beliefs, and behaviors with the ultimate goal of delivering quality health services to all patients cared for in EDs.

Health Care Disparities in Emergency Medicine

The Institute of Medicine's landmark report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care," documents the pervasiveness of racial and ethnic disparities in the U.S. health care delivery system, and provides several recommendations to address them. It is clear from research data, such as those demonstrating racial and ethnic disparities in emergency department (ED) pain management, that emergency medicine (EM) is not immune to this problem. The IOM authors describe two strategies that can reduce disparities in EM. First, workforce diversity is likely to result in a community of emergency physicians who are better prepared to understand, learn from, and collaborate with persons from other racial, ethnic, and cultural backgrounds, whether these be patients, fellow clinicians, or the larger medical and scientific community. Given the ethical and practical advantages of a more diverse EM workforce, continued and expanded initiatives to increase diversity within EM should be undertaken. Second, the specialty's educational programs should produce emergency physicians with the skills and knowledge needed to serve an increasingly diverse population. This cultural competence should include an awareness of existing racial and ethnic health disparities, recognition of the risks of stereotyping and biased treatment, and knowledge of the incidence and prevalence of health conditions among diverse populations. Culturally competent emergency care providers also possess the skills to identify and manage racial and ethnic differences in health values, beliefs, and behaviors with the ultimate goal of delivering quality health services to all patients cared for in EDs.

A study of the workforce in emergency medicine: 1999

Study objective: We estimate the total number of physicians practicing clinical emergency medicine during a specified period, describe certain characteristics of those individuals to estimate the total number of full-time equivalents (FTEs) and the total number of individuals needed to staff those FTEs, and compare the data collected with those data collected in 1997. Methods: Data were gathered from a survey of a random sample of 2,153 hospitals drawn from a population of 5,329 hospitals reported by the American Hospital Association as having, or potentially having, an emergency department. The survey instrument addressed items such as descriptive data on the institution, enumeration of physicians in the ED, and the total number of physicians working during the period from June 6 to June 9, 1999. Demographic data on the individuals were also collected. Results: A total of 940 hospitals responded (a 44% return rate). These hospitals reported that a total of 6,719 physicians were working during the specified period, or an average of 7.85 persons scheduled per institution. The physicians were scheduled for a total of 347,702 hours. The average standard for FTE was 40 clinical hours per week. This equates to 4,346 FTEs or 5.29 FTEs per institution. The ratio of persons to FTEs was 1.48:1. With regard to demographics, 83% of the physicians were men, and 82% were white. Their average age was 42.6 years. As for professional credentials, 42% were emergency medicine residency trained, and 58% were board certified in emergency medicine; 50% were certified by the American Board of Emergency Medicine. Conclusion: Given that there are 5,064 hospitals with EDs and given that the data indicate that there are 5.35 FTEs per ED, the total number of FTEs is projected to be 27,067 (SE=500). Given further that the data indicate a physician/FTE ratio of 1.47:1, we conclude that there are 39,746 persons (SE=806) needed to staff those FTEs. When adjusted for persons working at more than one ED, that number is reduced to 31,797. When the 1999 data are compared with those collected in 1997, we note a statistically significant decline in the number of hospital EDs, from 5,126 in 1997 to 5,064 in 1999 (P =.02). The total number of emergency physicians remained the same over the 2-year period, whereas the number of FTEs per institution increased from 5.11 to 5.35. The physician/FTE ratio remained unchanged. [Moorhead JC, Gallery ME, Hirshkorn C, Barnaby DP, Barsan WG, Conrad LC, Dalsey WC, Fried M, Herman SH, Hogan P, Mannle TE, Packard DC, Perina DG, Pollack CV Jr, Rapp MT, Rorrie CC Jr, Schafermeyer RW. A study of the workforce in emergency medicine: 1999. Ann Emerg Med. July 2002;40:3-15.]

The emergency medicine workforce study: More questions than answers

[Augustine JJ, Kellermann AL. The emergency medicine workforce study: more questions than answers. Ann Emerg Med. July 2002;40:16-18.]

A Study of the Workforce in Emergency Medicine

Study objective: Emergency medicine has progressed significantly since its initial recognition as a medical specialty. Relatively little factual information is known, however, regarding who or how many physicians practice emergency medicine. The purpose of this study is to determine the total number of physicians practicing clinical emergency medicine during a specified period, to describe certain characteristics of those individuals, and to estimate the total number of full-time equivalents (FTEs), as well as the total number of individuals needed to staff those FTEs. Methods: Data were gathered from a survey of a random sample of 2,062 hospitals drawn from a population of 5,220 hospitals reported by the American Hospital Association as having, or potentially having, an emergency department. The survey instrument addressed items such as descriptive data on the institution, enumeration of physicians in the ED, as well as the total number working during the period June 1, 1997, through June 14, 1997. Demographic data on the individuals were also collected. Results: A total of 942 hospitals responded (a 45.7% return rate). These hospitals reported a total of 5,872 physicians were working during the specified period, or an average of 7.48 persons scheduled per institution. The physicians were scheduled for a total of 297,062 hours. The average standard for FTE was 40 clinical hours per week. This equates to 3,713 FTEs or 4.96 FTEs per institution. The ratio of persons to FTEs was 1.51:1. With regard to demographics, 83% of the physicians were men and 81% were white. Their average age was 42 years. As to professional credentials, 58% were emergency medicine–residency trained and 53% were board certified in emergency medicine; 46% were certified by the American Board of Emergency Medicine. Conclusion: Given that there are 4,945 hospitals with EDs and given that the data indicate there are 4.96 FTEs per ED, the total number of FTEs is projected to be 24,548 (standard error=437). Given further that the data indicate a physician/FTE ratio of 1.51:1, we conclude that there are 36,990 persons (standard error=683) needed to staff those FTEs. When adjusted for persons working at more than one ED, that number is reduced to 32,026. [Moorhead JC, Gallery ME, Mannle T, Chaney WC, Conrad LC, Dalsey WC, Herman S, Hockberger RS, McDonald SC, Packard DC, Rapp MT, Rorrie CC Jr, Schafermeyer RW, Schulman R, Whitehead DC, Hirschkorn C, Hogan P: A study of the workforce in emergency medicine. Ann Emerg Med May 1998;31:595-607.]

The EM Work Force Profiled

Projections of future requirements for trained emergency physicians in the U.S. have been hampered by a lack of good data on the current emergency medicine work force. ACEP and a consultant group provide the first-ever national description. The authors surveyed 2,062 hospitals randomly …

Key Issues in Emergency Medicine Workforce Planning

The goal of workforce planning should be to match the supply of providers with the nation's demand. Whatever workforce planning process evolves, it will be necessary for the specialty to portray accurately our workforce needs. Because this portrait requires a clear understanding of the development of and funding mechanisms for graduate medical education and specific data describing both the supply and demand for emergency physicians, we address these issues. [Moorhead JC, Schafermeyer RW, Rorrie CC Jr: Key issues in emergency medicine workforce planning. Ann Emerg Med December 1997;30:765-772.]

Analysis of factors affecting U.S. emergency physician workforce projections. SAEM Workforce Task Force.

To use existing data sources to refine prior estimates of the U.S. emergency medicine (EM) workforce and to estimate effects of proposed changes in the U.S. health care system on the EM workforce. Relevant data were extracted from the American College of Emergency Physicians (ACEP) 1995 Membership Activity Report, the American Medical Association (AMA) publication "1995/96 Physician Characteristics and Distribution in the U.S.," the American Hospital Association (AHA) 1994 hospital directory, a written survey of each state's medical licensing board and state medical society, and the American Board of Emergency Medicine (ABEM) annual activity report for 1995. These data were used to project workforce supply and demand estimates applicable to workforce models. None of the available information sources had complete data on the number and distribution of emergency physicians (EPs) currently practicing in the United States. Extrapolating the limited reliable statewide EP numbers to make nationwide projections reveals a shortage of EPs needed to fully staff the nation's existing EDs. At least 22 states had an average ratio of < 5 EPs per existing ED. Additional national projections incorporating a decreasing number of U.S. EDs indicate that the current annual number of EM residency graduates will not eliminate the deficit of EPs for at least several decades, given that projected numbers of retiring EPs annually will soon equal the total annual EM residency graduate production. Although the current data on EPs in practice in the United States are incomplete, the authors project a relative shortage of EPs. More accurate and complete information on the numbers and distribution of EPs in America is needed to improve workforce projections.