Physician Shortage a Growing Concern In Emergency Medicine

Patients in the United States visit a physician approximately 1 billion times a year, according to the Centers for Disease Control. Of these visits, some 120 million, or 12 percent, take place at hospital emergency rooms. Yet only 4 percent of the nation’s physicians are emergency medicine specialists.

These numbers add up to a serious physician shortage in emergency medicine that is having an impact on both healthcare delivery and on the healthcare reform debate.

Physician leaders with the American College of Emergency Physicians (ACEP) recently released a statement challenging the idea that an increase in the number of primary care physicians will ease the strain of overcrowding now experienced in many hospital emergency rooms nationwide. They are questioning the idea that bolstering primary care, as current healthcare reform proposals call for, will significantly reduce long wait times and overcrowding in the nation’s emergency rooms.

In the statement made to reporters, Nick Jourlies, M.D., president of ACEP, said, “We know we need more primary care physicians. But even with primary care being beefed up, patients will still be getting sick and injured, and they will still be coming to the emergency room.” ACEP is urging the Obama administration and policymakers to include increased resources for hospital emergency rooms as part of the overall healthcare reform effort.

Jourlies’ concern about the supply of emergency medicine specialists is echoed by a study of the national emergency physician workforce published earlier this year in Annals of Emergency Medicine. The study notes that of the nation’s 39,000 clinically active emergency medicine physicians, 69 percent are emergency medicine trained and/or emergency medicine board certified, while the majority of the remainder are family physicians or general internists. These numbers are deemed insufficient to meet the nation’s needs, and, according to the study, “the shortage of emergency medicine-trained physicians will persist for decades.” The study further indicates that shortages of emergency medicine physicians are most pronounced in the Midwest and in rural areas throughout the United States.

Some studies indicate that the steep rise in emergency room visits is not being driven by uninsured patients, but by insured patients who lack ready access to a primary care doctor. A Center for Studying Health Systems Change report showed that the 16 percent rise in hospital emergency room visits between 1997 and 2001 was caused largely by insured patients. During that time, emergency room visits by insured patients increased by 24 percent, whereas ER visits by uninsured patients increased by only 10 percent. Many policymakers argue that primary care physicians would absorb many of these visits if there were more of them. Jourlies challenges this idea and notes that “even if patients call primary care doctors first, their doctors will just tell them to go to the emergency room anyway.”

However this debate is resolved, it is clear that new staffing resources and methods will be needed to address physician shortages in the emergency department. According to Timothy Boes, president of Staff Care, a leading temporary physician staffing firm and a company of AMN Healthcare, an increasing number of hospitals are turning to temporary (locum tenens) physicians to maintain services and revenue while permanent physicians are being sought.

“The locum tenens option fits nicely in emergency medicine because emergency medicine physicians and locum tenens doctors practice in a similar manner,” Boes observes. “Both work on shifts and both see patients in a short-term setting, where continuity of care generally is not an issue.”

According to Staff Care’s 2009 Review of Temporary Physician Staffing Trends, approximately two-thirds of hospitals used locum tenens doctors in the last 12 months. The review asked over 200 hospital executives to rate the skill sets of locum tenens physicians. Eighty-two percent of those surveyed rated locum tenens’ physicians to be either good or excellent.

Even with locum tenens doctors supplementing permanent emergency physician staffs, emergency departments will require alternate staffing models, the Annals of Emergency Medicine study suggests. Recommendations include “the increased utilization of midlevel providers and enhanced collaboration with primary care physicians who often staff smaller, rural emergency departments.” The study notes that physician assistants and nurse practitioners have become a more frequently utilized resource in emergency medicine, with midlevel providers participating in the care of 13 percent of all U.S. emergency department visits in 2005.