State of the National Emergency Department Workforce: Who Provides Care Where?

Hall, M. Kennedy; Burns, Kevin; Carius, Michael; Erickson, Mitchel; Hall, Jane; Venkatesh, Arjun K.

doi:10.1016/j.annemergmed.2018.03.032

Cited by 49 publications

(39 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A 2014 study evaluating Medicare data found that EPs comprise 63.9% of the emergency clinician workforce in urban counties versus only 44.8% of the workforce in rural counties where a greater proportion of nonemergency physicians and APPs practice . The study identified several factors driving this disparity, including location of residency programs, which tend to be more concentrated in urban areas . Additional factors reported by EM residency graduates as strongly influencing the decision to practice in urban versus rural environments include lifestyle, access to amenities/recreation, ED volume/acuity, and family/spouse .…”

Section: Implications Of Workforce Projectionsmentioning

confidence: 96%

“…Although the current data presented in this article do not support an impending overall shortage of EPs, rural areas do continue to see a shortage of EPs when compared to urban and suburban settings . A 2014 study evaluating Medicare data found that EPs comprise 63.9% of the emergency clinician workforce in urban counties versus only 44.8% of the workforce in rural counties where a greater proportion of nonemergency physicians and APPs practice . The study identified several factors driving this disparity, including location of residency programs, which tend to be more concentrated in urban areas .…”

Section: Implications Of Workforce Projectionsmentioning

confidence: 98%

See 1 more Smart Citation

Too Big Too Fast? Potential Implications of the Rapid Increase in Emergency Medicine Residency Positions

Haas

Hopson

Zink

2019

AEM Education and Training

View full text Add to dashboard Cite

Emergency medicine (EM) has expanded rapidly since its inception in 1979. Workforce projections from current data demonstrate a rapid rise in the number of accredited EM residency programs and trainee positions. Based on these trends, the specialty may soon reach a point of saturation, particularly in urban areas. This could negatively impact future trainees entering the job market as well as the career plans of medical students. More time and resources should be devoted to obtaining accurate projections, assessing the distribution of emergency physicians in rural versus urban settings, and implementing central workforce planning to protect the future of graduating trainees.

show abstract

Section: Implications Of Workforce Projectionsmentioning

confidence: 96%

Section: Implications Of Workforce Projectionsmentioning

confidence: 98%

Too Big Too Fast? Potential Implications of the Rapid Increase in Emergency Medicine Residency Positions

Haas

Hopson

Zink

2019

AEM Education and Training

View full text Add to dashboard Cite

show abstract

“…Estimates from prior studies showed that the number of emergency medicine-trained physicians increased from 26,826 in 2008 to 35,856 in 2014, while physicians who were not trained in emergency medicine decreased from 12,235 to 8,397. 28,29 Physician assistants and nurse practitioners are increasingly prevalent among all ED clinicians, up to 14,360 in 2014. 29 To accurately measure changes in work intensity, patient volume, patient complexity, and care intensity these changes should be benchmarked by changes in total clinician hours in the ED in future studies.…”

Section: Limitationsmentioning

confidence: 99%

Changes in Emergency Department Care Intensity from 2007-16: Analysis of the National Hospital Ambulatory Medical Care Survey

Chou

Baker

Schuur

2020

WestJEM

View full text Add to dashboard Cite

Introduction: Emergency departments (ED) in the United States (US) have increasingly taken the central role for the expedited diagnosis and treatment of acute episodic illnesses and exacerbations of chronic diseases, allowing outpatient management to be possible for many conditions that traditionally required hospitalization and inpatient care. The goal of this analysis was to examine the changes in ED care intensity in this context through the changes in ED patient population and ED care provided. Methods: We analyzed the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2007-2016. Incorporating survey design and weight, we calculated the changes in ED patient characteristics and ED care provided between 2007 and 2016. We also calculated changes in the proportion of visits with low-severity illnesses that may be safely managed at alternative settings. Lastly, we compared ED care received and final ED dispositions by calculating adjusted relative risk (aRR) comparing ED visits in 2007 to 2016, using survey weighted multivariable logistic regression. Results: NHAMCS included 35,490 visits in 2007 and 19,467 visits in 2016, representing 117 million and 146 million ED visits, respectively. Between 2007 and 2016, there was an increase in the proportion of ED patients aged 45-64 (21.0% to 23.6%) and 65-74 (5.9% to 7.5%), while visits with low-severity illnesses decreased from 37.3% to 30.4%. There was a substantial increase in the proportion of Medicaid patients (22.2% to 34.0%) with corresponding decline in the privately insured (36.2% to 28.3%) and the uninsured (15.4% to 8.6%) patients. After adjusting for patient and visit characteristics, there was an increase in the utilization of advanced imaging (aRR 1.29; 95% confidence interval [CI], 1.17-1.41), blood tests (aRR 1.16; 95% CI, 1.10-1.22), urinalysis (aRR 1.22; 95% CI, 1.13-1.31), and visits where the patient received four or more medications (aRR 2.17; 95% CI, 1.88-2.46). Lastly, adjusted hospitalization rates declined (aRR 0.74; 95% CI, 0.64-0.84) while adjusted discharge rates increased (aRR 1.06; 95%CI 1.03-1.08). Conclusion: From 2007 to 2016, ED care intensity appears to have increased modestly, including aging of patient population, increased illness severity, and increased resources utilization. The role of increased care intensity in the decline of ED hospitalization rate requires further study.

show abstract

“…Locum jobs for the Fellows of the Australasian College for Emergency Medicine (FACEMs) and registrars are advertised daily. There is an obvious shortage of permanent, qualified doctors servicing the EDs of regional and rural Australasia . But the question must be asked: if ACEM's role as an organisation is to turn trainees into EM specialists, what benefit does a rural term provide to accomplish that?…”

Section: Competing Interestsmentioning

confidence: 99%

Rural terms should be mandatory for ACEM trainees: No

Khoury

2019

Emerg Medicine Australasia

View full text Add to dashboard Cite

State of the National Emergency Department Workforce: Who Provides Care Where?

Cited by 49 publications

References 7 publications

Too Big Too Fast? Potential Implications of the Rapid Increase in Emergency Medicine Residency Positions

Too Big Too Fast? Potential Implications of the Rapid Increase in Emergency Medicine Residency Positions

Changes in Emergency Department Care Intensity from 2007-16: Analysis of the National Hospital Ambulatory Medical Care Survey

Rural terms should be mandatory for ACEM trainees: No

Contact Info

Product

Resources

About