10 Emerging Trends in Emergency Medicine
Emergency departments remain prime places for patients to obtain medical attention, making emergency medicine physicians critically important in their care.
“There is still a good market for emergency medicine physicians in the current and near future,” said William Jaquis, MD, FACEP, president-elect of the American College of Emergency Physicians (ACEP). In fact, career opportunities for emergency physicians and advanced practitioners are likely to feel the impact of a number of emerging trends in the field.
10 Key Trends in Emergency Medicine
1. Growth in Patient Volume
A study of emergency department (ED) visits, reported in JAMA Internal Medicine in December 2018, found an 18.4 percent increase from 2006 through 2014. ED visits increased more than population growth, and the authors predicted ED visits will continue to increase as care shifts from inpatient to outpatient settings.
A 2017 study by researchers at the University of Maryland School of Medicine in Baltimore found that nearly half of U.S. medical care is delivered in EDs. And in recent years, the percentage of care delivered by EDs has grown.
As long as patient use of EDs remains strong, emergency medicine jobs will remain in demand.
2. Rising Salaries
With the need for emergency medicine physicians strong, salaries remain high. ACEP reported in September 2018 that the national average salary for ED physicians increased 3.5 percent from 2017, but that reflects a 34.5 percent increase from 11 years ago. Sign-on bonuses are growing as well, with $50,000 being the norm.
Similarly, Merritt Hawkins’ latest annual review of recruiting incentives found that average starting salaries for emergency physicians increased from $349,000 in 2016/2017 to $358,000 in 2017/2018, not including bonuses and benefits.
Emergency medicine also offers opportunities for locum tenens assignments across the country and is one of the most in-demand specialties. ACEP reported locum tenens offers are some of the most lucrative in terms of average salary.
3. Care in Alternative Settings
Jaquis reported retail and urgent care clinics and longer physician office hours are reducing the number of lower-acuity patients seeking ED care. However, many hospitals offer fast-track options. Toward the end of 2018, the Mount Sinai Health System opened a new Express Care location, for minor injuries and illnesses on the hospital’s New York campus. Emergency medicine physicians staff the location, creating another opportunity for those seeking emergency medicine jobs.
Additionally, some urgent care centers, such as GuideWell Emergency Doctors in Central Florida, employ emergency physicians. As Florida Blue expands those centers, it will open up more emergency medicine jobs.
4. More Older Adult Patients
While emergency medicine physicians are trained to care for patients of all ages, a growing number of their patients are aging baby boomers. Patients age 65 and older have higher utilization of the emergency department for care, Jaquis said.
EDs specializing in the care of older adults are opening across the country. UC San Diego Health opened California’s first accredited senior emergency care unit in January 2019. This creates opportunities for emergency medicine physicians who want to work with older adults.
“The GeriED is an exciting trend,” said Jaquis, suggesting an opportunity to enhance older adults’ care.
5. Freestanding Emergency Departments
Many health systems are building freestanding EDs, depending on state laws.
“They provide a way to extend emergency care to areas that otherwise would not have access to high-quality emergency care,” Jaquis said.
These freestanding locations create opportunities for emergency medicine physicians wanting to “cut down on the frustrations of working in a bigger hospital and to focus on the patient,” Jaquis said.
6. Consolidation of Emergency Medicine Physician Groups
A fair number of emergency medicine practice groups are consolidating, Jaquis reported. Smaller groups are joining larger groups, making them even bigger.
Jeff Swearingen, the co-founder of Edgemont Capital Partners in New York, wrote in Emergency Physicians Monthly about the trend in emergency practice consolidation, citing “regulatory uncertainty, cost-containment and negotiating leverage pressures” as reasons.
7. Revenue Concerns
Increasing concerns exist with an increase in high-deductible health plans, out-of-network providers, and balanced billing leaving patients with more of their bills to pay themselves, Jaquis said.
Patients may go to a hospital in their plan’s network, only to find that the physicians that treat them may not be in the network, leaving the patient to pay the charges or whatever the insurer denied.
“It comes from a shift of cost to the patient who is caught in the middle,” Jaquis said. This leaves some physicians wondering if they are going to get paid.
8. Rural Shortages of Emergency Physicians
“There is always a trend of not enough emergency physicians in rural markets,” Jaquis reported.
A 2018 study from the University of Iowa found that rural EDs using telemedicine save money and make it easier to recruit new physicians. ED physicians in rural areas can use telemedicine to consult with specialists in larger facilities, which may let the patient be treated in place or be transferred to the appropriate facility. Reimbursement, however, remains a challenge, Jaquis said.
“As hospitals across the country continue to be shuttered, access to care is a growing necessity for many, especially those in rural areas,” said Heather Dumas, senior vice president of human resources at Air Methods in Englewood, Colorado. “Today, more than one-quarter of the American population, 85 million residents, can only access a Level 1 or 2 Trauma Care facility within one hour if they are flown by air medical missions. Collectively, this means that our services are more necessary than ever before.”
9. Concerns about violence
Violence in the ED remains a problem. At Mercy Hospital in Chicago in November 2018, emergency department physician Tamara O'Neal, MD, and two other people were killed by a gunman in the ED.
“There is a considerable concern for violence, whether workplace, domestic, or gun violence,” Jaquis said.
10. Access to care
Emergency medicine physicians remain concerned about the ability of patients to access care, an ongoing challenge.
“We broadly work for access in all settings including emergency care,” Jaquis said. “We have to make sure of the ability of patients to continue to access the care they need.”
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