Family physicians are expected to provide comprehensive care while also accommodating the diverse care needs of their particular patient populations. In the nation's rural areas, that can mean spending more time in emergency care settings, a recent data analysis(www.jabfm.org) suggests.
Overall, about one out of every 15 family physicians devotes at least 80 percent of his or her time to emergency or urgent care, according to researchers at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, with those in remote areas taking on a higher percentage of these patients compared with their urban peers.
The findings were published in the July/August issue of the Journal of the American Board of Family Medicine.
Using data routinely collected from Maintenance of Certification for Family Physicians examination applications completed between 2008 and 2012, the researchers categorized physicians according to the geographic setting in which they worked, ranging from urban to small rural to frontier.
In frontier areas, more than 8 percent of family physicians reported devoting 80 percent or more of their time to the ER or urgent care. In urban areas, the figure dropped to slightly more than 3 percent.
One analyst said the results were expected, given the relative scarcity of physicians of any kind in rural areas.
"It makes sense in that physicians located in more isolated areas have a broader scope of practice than in urban/metropolitan areas," said Kathleen Klink, M.D., medical director for health policy at the Graham Center, in an interview with AAFP News. "We also have evidence that more rurality is associated with emergency departments being staffed with fewer board-certified emergency medicine physicians and more family physicians."
Klink wrote a commentary on the research(www.jabfm.org) that was published in conjunction with the researchers' findings. As experts in behavioral and social issues related to health, she noted, family physicians are prepared to deal with the variety of cases that occur in emergency settings, a significant percentage of which involve ambulatory care-sensitive conditions.
However, Klink added, when the same or similar care is provided episodically rather than in the primary care setting, opportunities to develop the patient-physician relationship may be missed. Thus, coordination of care between emergency/urgent care centers and primary care facilities needs to be emphasized to preserve and enhance the patient-physician relationship.
"With evidence that coordination of services between emergency and primary care such as health centers improves accessibility, it is essential to ensure that all physicians, in both isolated as well as urban environments, are supported by referral and communication systems to enhance patient outcomes. Policies that support patient-centered medical home activities within urgent care settings may ameliorate some of the disadvantages of urgent visits," she noted in the commentary.
Overall, Klink told AAFP News, "We know that family physicians are providing a service in some emergency care settings that other specialties are not available to provide and enhancing access to care for patients."
Furthermore, because the ER often serves as a stopgap form of health coverage among low-income individuals, the presence of family physicians in such settings offers another advantage.
"We know that uninsured and underinsured, women, children and minorities are disproportionately represented in emergency settings, and this population faces barriers to other sources of care, including primary care. So family physicians providing care in emergent settings are, in all likelihood, filling a needed gap in care," Klink explained.