Study Suggests Family Physicians Can Help Stem Future ER Staffing Shortfall

A recent study in Academic Emergency Medicine surmises that a mismatch between future demand for emergency physicians, or EPs, and the number of EPs available will lead to workforce shortages. But according to Perry Pugno, M.D., M.P.H., director of the AAFP Division of Medical Education and a physician workforce expert, family physicians are well-prepared to practice in the emergency medicine setting, especially in rural areas, and could fill those gaps.

"Assessment of Emergency Physician Workforce Needs in the United States, 2005" (4-page PDF; About PDFs) concludes that the number of board-certified EPs is unlikely to meet the future staffing needs of U.S. emergency departments, or EDs. However, Pugno said that although some family physicians might need more training in critical care procedures or new diagnostic tools, they already are working very well in suburban and rural EDs.

In fact, family physicians may be the preferred emergency care providers in rural areas, Pugno told AAFP News Now, because the programs where emergency medicine residents train tend to be in urban trauma centers with lots of technology and consultants. That means the physicians coming out of these residencies may not be prepared to practice in rural areas, where such resources are scarce, he said.

"Emergency medicine needs family physicians, and others, to meet current service needs -- and perhaps future needs, too, for quite a while," Pugno said.

"The need for emergency services is large and growing; and even if existing programs graduated more physicians, there is little reason to think more of those graduates would move to the rural areas that are particularly short on physicians with this specialized training," said the study's lead author Carlos Camargo Jr., M.D., Dr.P.H., an associate professor at Harvard Medical School and the Harvard School of Public Health in Boston, in a Dec. 17 news release from Massachusetts General Hospital, where he practices.

"We probably should explore alternatives, such as giving the family physicians who currently staff many U.S. emergency departments extra training in key emergency procedures," he continued. "We might also increase our reliance on nurse practitioners and physicians assistants, who can help emergency physicians of any training background better handle the continually rising number of patients."

Camargo's study analyzed data from the 2005 National Emergency Department Inventory-USA on 4,828 EDs in the United States, defined as emergency care facilities that are open 24 hours a day, seven days a week.

In 2005, the study said, there were about 22,000 board-certified EPs, with an additional 1,350 newly board-certified, residency-trained EPs expected to enter the workforce in the following year. After estimating ED staffing needs based on usage statistics, the study authors concluded that this supply of physicians was sufficient to meet only 55 percent of the current EP demand.

The study looked at different scenarios to project changing conditions in the EP workforce: a best-case scenario, in which there was no attrition; a worst-case scenario, in which attrition was high; and an intermediate scenario, in which the attrition rate was based on best available data.

According to the study, even in the best-case scenario, in which no board-certified EP died or retired, it would take until the year 2019 to staff all EDs with board-certified EPs. In the intermediate scenario, which assumed a 2.5 percent annual attrition rate, workforce needs would be met by 2038, almost 30 years away. In the worst-case scenario, which assumed a 12 percent annual attrition rate, supply would never meet demand.

The study also noted that workforce estimates have to address the big disparities in EM physician staffing in urban and rural areas. Fewer board-certified EPs practice in rural emergency departments than in urban ones. Rural emergency departments have difficulty recruiting and retaining any physicians who perform ED duties, let alone board-certified EPs, the study said.

The study authors said that based on their estimates, they "anticipate that the demand for EM residency-trained, board-certified EPs will remain high for decades to come and outlast the professional careers of current EM trainees."

The conclusions Camargo and his colleagues reached are strikingly similar to those contained in a 2006 Institute of Medicine report, "Hospital-based Emergency Care: At the Breaking Point," which stated that "although ideally, all EDs would be staffed by residency-trained, board certified EPs, this is highly unlikely to occur in the near to middle term, if ever."

All the more reason to welcome family physicians and their unique skills set into emergency rooms across the nation, according to Pugno.

"Family doctors are trained in evaluating and diagnosing the undifferentiated patient," he said. "Some of them could use more experience in high-volume urban trauma centers, since that's a fairly unique environment. But for most emergency settings, family doctors are going to be well-prepared."