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Am Fam Physician. 2006;73(7):1163

Ensuring access to emergency care in rural areas remains a challenge. High costs and low patient volumes make 100 percent staffing of rural emergency departments (EDs) by emergency medicine residency-trained physicians (EPs) unlikely. As rurality increases, so does the dependence on family physicians to provide quality emergent care.

Emergency medical services should be organized to meet the needs of the patient population in the most effective manner. Today, with increased specialization in medicine, many different clinicians provide ED care.1,2 The American Academy of Family Physicians reports that 54 percent of its members provide some form of ED care, and 2.5 percent work full-time in ED care.3

Rural hospitals, because of their smaller and less predictable patient volumes, are less likely to staff an ED with EPs.2 However, the American College of Emergency Physicians’ (ACEP’s) policy states that EPs should be the preferred providers of care in every ED.4

Nationwide analysis from the Area Resource File shows the consistent presence of family physicians, and the decline in EPs, per capita with increasing rurality (see accompanying table).5,6 The percentage of counties with an ED but no EPs increases with rurality. Available data do not account for care provided by physicians across counties.

RUCC*Number of countiesNumber per 10,000 persons of:Percentage of counties with an ED but no EPs
FPsEPsED visits

To succeed, ACEP’s position requiring emergency medicine board certification for credentialing in EDs would require an increase in the number of EPs, a means of inducing their practice in rural areas, and the subsidizing of rural EDs to pay for them. More viable options include designing a system of care that meets emergency care needs with a range of clinicians including family physicians, and supporting combined professional efforts to ensure access to high-quality emergent care for rural populations.

The information and opinions contained in research from the Graham Center do not necessarily reflect the views or the policy of the AAFP.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

A collection of Graham Center Policy One-Pagers published in AFP is available at One-Pagers are also available at

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