Workforce Projections for Emergency Medicine: How Many Emergency Physicians Does the United States Need?

Abstract

Objective: To mathematically model the supply of and demand for emergency physicians (EPs) under different workforce conditions. Methods: A computer spreadsheet model was used to project annual EP workforce supply and demand through the year 2035. The mathematical equations used were: supply = number of EPs at the beginning of the year plus annual residency graduates minus annual attrition; demand = 5 full-time equivalent positions/ED X the number of hospital EDs. The demand was empirically varied to account for ED census variation, administrative and teaching responsibilities, and the availability of physician extenders. A variety of possible scenarios were tested. These projections make the assumption that emergency medicine (EM) residency graduates will preferentially fill clinical positions currently filled by EPs without EM board certification. Results:Under most of the scenarios tested, there will be a large deficit of EM board-certified EPs well into the next century. Even in scenarios involving a decreasing "demand" for EPs (e.g., in the setting of hospital closures or the training of physician extenders), a significant deficit will remain for at least several decades. Conclusions:The number of EM residency positions should not be decreased during any restructuring of the U.S. health care system. EM is likely to remain a specialty in which the supply of board-certified EPs will not meet the demand, even at present levels of EM residency output, for the next several decades.

Qualification discrepancies between urban and rural emergency department physicians

“…The reasons for the discrepancy in qualifications between rural and urban ED physicians may result from inadequate supply of EPs entering the workforce, a lack of demand for EPs in the rural ED, or both. Recent emergency medicine workforce studies project a relative shortage of emergency physicians in the United States as a whole and suggest that the supply of boardcertified EPs will not meet the demand for several decades with the current graduation rate of existing EM residency programs (5,6). A description of the EM workforce in rural areas for EDs with an average annual census of just over 10,000 found that 72% of physicians lacked both EM residency training and board certification (7).…”

Nonemergency Medicine‐Trained Physician Coverage in Rural Emergency Departments

“…Like most nonprimary care providers, emergency physicians are geographically concentrated in urban areas, which is partly due to rural areas lacking the patient volume and the economic base to support them. Specifically, it is estimated that a population of 18,000 is required to support 1 emergency physician, 30 and further, because 5 full‐time physicians are needed to staff an emergency department, 31 it is unreasonable to expect only emergency physicians to staff rural emergency departments. The provision of emergency department care in America should be patient oriented, not provider oriented and, in concert their own policies 11,24,25 and with the Institute of Medicine recommendations, 23 medical specialties need to work together to ensure that high‐quality emergency department care is readily available from a competent and qualified provider everywhere in the United States.…”

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

“…A computer spreadsheet model described by Holliman et al was used to establish the EP workforce supply vs. demand (9). Factors considered that could affect both supply and demand were established by available literature and by communication with hospitals, public health organizations, and health care executives, professors, and medical directors.…”