The Future of Emergency Medicine

Schneider, Sandra; Gardner, Angela F.; Weiss, Leon; Wood, Joseph P.; Ybarra, Michael; Beck, Dennis; Stauffer, Arlen R.; Wilkerson, Dean; Brabson, Thomas; Jennings, A.M.C.; Mitchell, Mark; McGrath, Roland B.; Christopher, Theodore A.; King, Brent R.; Muelleman, Robert L.; Wagner, Mary Jo; Char, Douglas; McGee, Douglas L.; Pilgrim, Randy; Moskovitz, Joshua B.; Zinkel, Andrew R.; Byers, Michelle; Briggs, William T.; Hobgood, Cherri; Kupas, Douglas F.; Krueger, Jennifer; Stratford, Cary J.; Jourıles, Nicholas

doi:10.1016/j.jemermed.2010.06.001

Cited by 12 publications

(12 citation statements)

References 7 publications

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“…Implementation of the Affordable Care Act legislation is expected to increase the demand for health care services, including emergency department (ED) utilization 1 . Despite the growth of training programs, there are not enough residency‐trained and board‐certified emergency physicians (EPs) to accommodate this increase in demand 2,3 . Midlevel providers (MLPs) have been utilized to help fill this workforce gap and increase efficiency at a lower provider cost 4 .…”

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confidence: 99%

Update on Midlevel Provider Utilization in U.S. Emergency Departments, 2006 to 2009

Wiler

Rooks

Ginde

2012

Academic Emergency Medicine

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Objectives: Previous studies have noted a sharp increase in utilization of physician assistants (PAs) and nurse practitioners (NPs), up to 13% of all U.S. emergency department (ED) visits in 2005. The authors sought to reevaluate utilization and visit acuity for these midlevel providers (MLPs) in U. data for arrival by ambulance (6.5% vs. 6.0%), urgent ⁄ emergent triage acuity (33% vs. 37%), and hospital admission (3.3% vs. 3.0%). From 2006 through 2009, 64% of EDs utilized MLPs, with higher utilization in urban (72%, 95% CI = 64% to 78%) compared to nonurban EDs (51%, 95% CI = 39% to 63%). However, among EDs that did utilize MLPs, nonurban EDs had MLPs without physician involvement see a median 27% of all ED visits, compared to 7.5% for urban EDs.Conclusions: Despite a rapid expansion of MLP utilization in U.S. EDs, recent growth appears to have plateaued. The scope of practice of MLPs in EDs does not appear to be rapidly expanding. Urban EDs use MLPs more than nonurban EDs, but among EDs that use MLPs, nonurban EDs had MLPs see a larger proportion of overall ED visits.ACADEMIC EMERGENCY MEDICINE 2012; 19:986-989 ª

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confidence: 99%

Update on Midlevel Provider Utilization in U.S. Emergency Departments, 2006 to 2009

Wiler

Rooks

Ginde

2012

Academic Emergency Medicine

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“…18,58,59 Additional efforts should focus on expanding access to expert care by using less traditional methods, including certification or postresidency training programs for physicians who will be providing care in EDs from non emergency medicine backgrounds and the continued examination of how technology based solutions, including telemedicine, can expand the traditional reach of medical expertise into rural areas. 60–62 …”

Section: Discussionmentioning

confidence: 99%

Safety in Numbers: Are Major Cities the Safest Places in the United States?

Myers

Branas

French

et al. 2013

Annals of Emergency Medicine

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Study objectives Many US cities have experienced population reductions, often blamed on crime and interpersonal injury. Yet the overall injury risk in urban areas compared with suburban and rural areas has not been fully described. We begin to investigate this evidence gap by looking specifically at injury-related mortality risk, determining the risk of all injury death across the rural-urban continuum. Methods A cross-sectional time-series analysis of US injury deaths from 1999 to 2006 in counties classified according to the rural-urban continuum was conducted. Negative binomial generalized estimating equations and tests for trend were completed. Total injury deaths were the primary comparator, whereas differences by mechanism and age were also explored. Results A total of 1,295,919 injury deaths in 3,141 US counties were analyzed. Injury mortality increased with increasing rurality. Urban counties demonstrated the lowest death rates, significantly less than rural counties (mean difference=24.0 per 100,000; 95% confidence interval 16.4 to 31.6 per 100,000). After adjustment, the risk of injury death was 1.22 times higher in the most rural counties compared with the most urban (95% confidence interval 1.07 to 1.39). Conclusion Using total injury death rate as an overall safety metric, US urban counties were safer than their rural counterparts, and injury death risk increased steadily as counties became more rural. Greater emphasis on elevated injury-related mortality risk outside of large cities, attention to locality-specific injury prevention priorities, and an increased focus on matching emergency care needs to emergency care resources are in order.

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“…Therefore, alternative staffing models must be developed.” 6 Largely in response to the IOM report, representatives of all major EM organizations accepted an invitation from ACEP and met in July 2009 to discuss the future of EM, with a major emphasis on workforce. After reviewing the literature, there was broad consensus that an insufficient EP workforce represents a potential threat to patient safety and that it is likely that EM board certified EPs will not be able to completely fill the workforce demand for several decades, if ever 7 . The report emphasized the importance of timely access to adequately trained emergency care providers as an important public health goal.…”

Section: The Ep Workforcementioning

confidence: 99%

“…Potential solutions to increasing the total number of clinically active EPs are aimed at increasing the supply of physicians, while decreasing the attrition. As of 2009, there were 149 allopathic and 43 osteopathic EM residency programs with approximately 1,500 graduates per year 7 . Given that nearly all existing EM residency slots are filled, one potential solution to increase the supply of EPs would be to increase the number of EM residency positions.…”

Section: The Ep Workforcementioning

confidence: 99%

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Regionalization of Emergency Care Future Directions and Research: Workforce Issues

Ginde

Rao

Simon

et al. 2010

Academic Emergency Medicine

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The provision of emergency care in the United States, regionalized or not, depends on an adequate workforce. Adequate must be defined both qualitatively and quantitatively. There is currently a shortage of emergency care providers, one that will exist for the foreseeable future. This article discusses what is known about the current emergency medicine (EM) and non-EM workforce, future trends, and research opportunities.ACADEMIC EMERGENCY MEDICINE 2010; 17:1286-1296 ª 2010 by the Society for Academic Emergency Medicine A well-trained, efficiently distributed workforce is critical to provide for the nations' emergency care needs. This includes any regionalized system of emergency care. The cognitive and technical skills of emergency care providers are vital resources in ensuring delivery of timely, high-quality emergency care to all Americans. Currently, 120 million patients go to our nation's emergency departments (EDs) each year. Historic trends have shown that the demand for emergency care continues to rise, 1 even with health care reform and a push toward universal insurance coverage.2 This reflects a growing, aging population with many chronic diseases. This rising demand is likely to increase the need for emergency care providers. There is currently a shortage and mal-distribution of emergency medicine (EM) residency-trained and board-certified physicians (emergency physicians [EPs]). 3-7The 2010 Academic Emergency Medicine consensus conference on regionalization of emergency care focused on getting the right care to the right patient at the right time. We describe the current state of the emergency care workforce, potential solutions, and a vision for the future. Our discussion looks at EPs, non-EM-trained physician providers, and nonphysician providers. We identify gaps in knowledge that form the basis of an emergency care workforce research agenda. Our discussion focuses on the goal of improved access to high-quality emergency care for all acutely ill or injured patients across the entire United States. Under any regionalization plan, an efficiently distributed, qualified workforce will ensure a sufficient number of providers with appropriate training for their practice environments and will be distributed according to patient need throughout the system.

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The Future of Emergency Medicine

Cited by 12 publications

References 7 publications

Update on Midlevel Provider Utilization in U.S. Emergency Departments, 2006 to 2009

Update on Midlevel Provider Utilization in U.S. Emergency Departments, 2006 to 2009

Safety in Numbers: Are Major Cities the Safest Places in the United States?

Regionalization of Emergency Care Future Directions and Research: Workforce Issues

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