A study of the workforce in emergency medicine: 2007

Counselman, Francis L.; Marco, Catherine A.; Patrick, Vicki C.; McKenzie, David A.; Monck, L; Blum, Frederick C.; Borg, Keith; Coppola, Marco Morelli; Gerard, W. Anthony; Jorgenson, Claudia; Lazarus, Jo Ann; Moorhead, John C.; Proctor, John H.; Schmitz, Gillian; Schneider, Sandra

doi:10.1016/j.ajem.2009.05.014

Cited by 36 publications

(26 citation statements)

References 18 publications

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“…[1][2][3]12,13 Lower patient volumes in rural areas make staffing EDs with multiple providers financially difficult, and increasing PA staffing may improve department cost-efficiency. 7 As our data suggest, these issues have likely influenced the reported higher scopes of practice and less physician supervision among rural EM PAs.…”

Section: Discussionmentioning

confidence: 99%

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Scope of Practice and Autonomy of Physician Assistants in Rural Versus Urban Emergency Departments

Sawyer

Ginde

2014

Acad Emerg Med

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Objectives: This was a study of the scope of practice and autonomy of emergency medicine (EM) physician assistants (PAs) practicing in rural versus urban emergency departments (EDs).Methods: Using the American Academy of Physician Assistants (AAPA) Masterfile, a random sample of 200 U.S. EM PAs were surveyed, with oversampling of an additional 200 rural PAs. Location was classified by zip code-based rural-urban commuting area codes, and responses were compared about conditions managed, procedures performed, and physician supervision between rural versus urban groups.Results: A total of 237 responses were received from PAs in 44 U.S. states, of which (201) were valid responses (105 rural, 96 urban) from PAs currently practicing in EDs (59.3% exclusion-adjusted response rate). Compared to urban PAs, rural PAs more frequently managed cardiac arrest (67% vs. 44%), stroke (86% vs. 72%), multisystem trauma (83% vs. 70%), active labor (44% vs. 23%), and critically ill children (82% vs. 65%) in the past year. They were more likely to have performed intubation (65% vs. 44%), needle thoracostomy (21% vs. 8%), and tube thoracostomy (46% vs. 26%). Rural PAs more often reported never having a physician present in the ED (38% vs. 0%) and less often reported always having a physician present (50% vs. 98%). Rural PAs were also less likely to report that a physician evaluates more than 75% of their patients (8% vs. 18%) and more likely that a physician never evaluates all of their patients (19% vs. 7%).Conclusions: Rural PAs reported a broader scope of practice, more autonomy, and less access to physician supervision than urban PAs.ACADEMIC EMERGENCY MEDICINE 2014;21:520-525

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Section: Discussionmentioning

confidence: 99%

“…T here are not enough emergency medicine (EM) board-certified emergency physicians (EPs) available to staff our emergency departments (EDs) in the United States, [1][2][3] particularly in rural areas. [4][5][6] Furthermore, the limited access to medical care in rural settings mandates that providers be comfortable with increased levels of care.…”

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confidence: 99%

Scope of Practice and Autonomy of Physician Assistants in Rural Versus Urban Emergency Departments

Sawyer

Ginde

2014

Acad Emerg Med

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“…33 However, we were able to capture a broad range of characteristics typical of U.S. EPs; compared to prior estimates of the demography of the U.S. EP workforce, our sample was similar, although not identical, in terms of age, sex, length of clinical practice, and proportion of board-certified respondents. [34][35][36][37] Because there is no reason to suspect our sample was extremely atypical, we believe that the sentiments expressed may resonate with, at the very least, a nontrivial amount of EPs.…”

Section: Limitationsmentioning

confidence: 99%

Emergency Physician Perceptions of Shared Decision‐making

Kanzaria

Brook

Probst

et al. 2015

Academic Emergency Medicine

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Objectives: Despite the potential benefits of shared decision-making (SDM), its integration into emergency care is challenging. Emergency physician (EP) perceptions about the frequency with which they use SDM, its potential to reduce medically unnecessary diagnostic testing, and the barriers to employing SDM in the emergency department (ED) were investigated.Methods: As part of a larger project examining beliefs on overtesting, questions were posed to EPs about SDM. Qualitative analysis of two multispecialty focus groups was done exploring decision-making around resource use to generate survey items. The survey was then pilot-tested and revised to focus on advanced diagnostic imaging and SDM. The final survey was administered to EPs recruited at four emergency medicine (EM) conferences and 15 ED group meetings. This report addresses responses regarding SDM.Results: A purposive sample of 478 EPs from 29 states were approached, of whom 435 (91%) completed the survey. EPs estimated that, on average, multiple reasonable management options exist in over 50% of their patients and reported employing SDM with 58% of such patients. Respondents perceived SDM as a promising solution to reduce overtesting. However, despite existing research to the contrary, respondents also commonly cited beliefs that 1) "many patients prefer that the physician decides," 2) "when offered a choice, many patients opt for more aggressive care than they need," and 3) "it is too complicated for patients to know how to choose."Conclusions: Most surveyed EPs believe SDM is a potential high-yield solution to overtesting, but many perceive patient-related barriers to its successful implementation.ACADEMIC EMERGENCY MEDICINE 2015;22:399-405

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“…Several recent studies suggest that EM workforce demand will not be met by the current training and certification methods. [6][7][8] This problem is even more severe in rural areas where the percentage of residencytrained physicians is considerably less. A recent study from Iowa 9 reported that only 12% of EDs there were staffed exclusively by emergency medicine residencytrained ⁄ board-certified emergency physicians, while 23% of hospitals were staffed exclusively by family medicine physicians.…”

Section: Physician Workforcementioning

confidence: 99%