Problematic policies that increasingly exclude family physicians from emergency departments are contributing to shortages in rural areas and, ironically, accelerating the use of NPs and PAs in these settings.
Fam Pract Manag. 2025;32(6):7-10
Author disclosures: no relevant financial affiliations.
Family physicians have historically played a significant role in delivering emergency care. However, over the last 50 years, policy changes have made it increasingly difficult for family physicians to practice in the emergency department (ED), even in rural areas with workforce shortages. As a result, non-physician clinicians are increasingly being used in these settings to help fill the void.1 Coherent emergency medicine workforce strategies that include family physicians are urgently needed to address these issues.
Our aim in this editorial is to describe what has led to this untenable situation and to offer some potential solutions.
A BRIEF HISTORICAL PERSPECTIVE
After World War II, changing demographics and social conditions as well as dwindling numbers of “general practitioners” led patients to increasingly rely on hospital “emergency rooms” (ERs) for unanticipated medical care. These early ERs were often staffed by junior medical and surgical house officers (i.e., interns or residents) who lacked the necessary clinical skills to manage the growing complexity of cases and had little to no attending supervision.
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