Emergency Department Coverage by Primary Care Physicians in a Rural Practice‐Based Research Network: Incentives, Confidence, and Training

Lew, Edward K.; Fagnan, Lyle J.; Mattek, Nora; Mahler, Jo; Lowe, Robert A.

doi:10.1111/j.1748-0361.2009.00216.x

Cited by 8 publications

(5 citation statements)

References 13 publications

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“…For populations of 15 000–25 000, there is usually a specialist surgeon supported by one or more GPS (‘mixed’ model). Lew et al [ 80 ] USA 2009 Quantitative study—survey • In rural areas EDs are often staffed by primary care physicians, rather than emergency medicine trained specialists. • More than one third of the respondent physicians currently covering the ED reported that they derive greater than 40% of their income from working in it.…”

Section: Resultsmentioning

confidence: 99%

“…In the USA, one article identified high liability insurance premiums as a threat to viable smaller rural generalist practices, as well as limited technical facilities and the lack of an appropriate support workforce [ 78 ]. In Canada, difficult access to locums, the need for more education and training [ 79 ], low confidence in responding to paediatric emergencies and worsening physician shortages [ 80 ] are seen as the major barriers to developing the rural generalist workforce. In Europe, the pressures of providing the dual-role of primary care practitioner and specialist in rural communities [ 81 ], as well as an increasing centralisation of specialist services to larger centres, are negatively affecting RGM [ 82 ].…”

Section: Resultsmentioning

confidence: 99%

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International approaches to rural generalist medicine: a scoping review

Schubert

Evans

Battye³

et al. 2018

Hum Resour Health

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BackgroundContemporary approaches to rural generalist medicine training and models of care are developing internationally as part of an integrated response to common challenges faced by rural and remote health services and policymakers (addressing health inequities, workforce shortages, service sustainability concerns). The aim of this study was to review the literature relevant to rural generalist medicine.MethodsA scoping review was undertaken to answer the broad question ‘What is documented on rural generalist medicine?’ Literature from January 1988 to April 2017 was searched and, after final eligibility filtering (according to established inclusion and exclusion criteria), 102 articles in English language were included for final analysis.ResultsIncluded papers were analysed and categorised by geographic region, study design and subject themes. The majority of articles (80%) came from Australia/New Zealand and North America, reflecting the relative maturity of programmes supporting rural generalist medicine in those countries. The most common publication type was descriptive opinion pieces (37%), highlighting both a need and an opportunity to undertake and publish more systematic research in this area.Important themes emerging from the review were:DefinitionExisting pathways and programmesScope of practice and service modelsEnablers and barriers to recruitment and retentionReform recommendationsThere were some variations to, or criticisms of, the definition of rural generalist medicine as applied to this review, although this was only true of a small number of included articles. Across remaining themes, there were many similarities and consistent approaches to rural generalist medicine between countries, with some variations reflecting environmental context and programme maturity. This review identified recent literature from countries with emerging interest in rural generalist medicine in response to problematic rural health service delivery.ConclusionsSupported, coordinated rural generalist medicine programmes are being established or developed in a number of countries as part of an integrated response to rural health and workforce concerns. Findings of this review highlight an opportunity to better share the development and evaluation of best practice models in rural generalist medicine.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

International approaches to rural generalist medicine: a scoping review

Schubert

Evans

Battye³

et al. 2018

Hum Resour Health

View full text Add to dashboard Cite

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“…Prior studies also suggest that non-EM board-certified physicians themselves lack confidence is providing certain types of emergency care. 17 Further study is needed to quantify how variations in type and amount of PA supervision affect the quality and safety of patient care.…”

Section: Discussionmentioning

confidence: 99%

Scope of Practice and Autonomy of Physician Assistants in Rural Versus Urban Emergency Departments

Sawyer

Ginde

2014

Acad Emerg Med

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Objectives: This was a study of the scope of practice and autonomy of emergency medicine (EM) physician assistants (PAs) practicing in rural versus urban emergency departments (EDs).Methods: Using the American Academy of Physician Assistants (AAPA) Masterfile, a random sample of 200 U.S. EM PAs were surveyed, with oversampling of an additional 200 rural PAs. Location was classified by zip code-based rural-urban commuting area codes, and responses were compared about conditions managed, procedures performed, and physician supervision between rural versus urban groups.Results: A total of 237 responses were received from PAs in 44 U.S. states, of which (201) were valid responses (105 rural, 96 urban) from PAs currently practicing in EDs (59.3% exclusion-adjusted response rate). Compared to urban PAs, rural PAs more frequently managed cardiac arrest (67% vs. 44%), stroke (86% vs. 72%), multisystem trauma (83% vs. 70%), active labor (44% vs. 23%), and critically ill children (82% vs. 65%) in the past year. They were more likely to have performed intubation (65% vs. 44%), needle thoracostomy (21% vs. 8%), and tube thoracostomy (46% vs. 26%). Rural PAs more often reported never having a physician present in the ED (38% vs. 0%) and less often reported always having a physician present (50% vs. 98%). Rural PAs were also less likely to report that a physician evaluates more than 75% of their patients (8% vs. 18%) and more likely that a physician never evaluates all of their patients (19% vs. 7%).Conclusions: Rural PAs reported a broader scope of practice, more autonomy, and less access to physician supervision than urban PAs.ACADEMIC EMERGENCY MEDICINE 2014;21:520-525

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“…EDs already use nurse practitioners and physician assistants for patient care, 5,19 as well as non-EM boardcertified physicians. 15,20 Physician shortages prompted the Association of American Medical Colleges in 2006 to set a goal of a 30% increase in enrollment in U.S. medical schools by 2015. 21 Identifying strategies to ensure adequate ED staffing is an important policy discussion.…”

Section: Discussionmentioning

confidence: 99%

Supply and Demand of Board‐certified Emergency Physicians by U.S. State, 2005

Sullivan

Ginde

Espinola

et al. 2009

Academic Emergency Medicine

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Objectives: The objective was to estimate the emergency medicine (EM) board-certified emergency physician (EP) workforce supply and demand by U.S. state. Methods:The 2005 National Emergency Department Inventories-USA provided annual visit volumes for U.S. emergency departments (EDs). We estimated full-time equivalent (FTE) EP demand at each ED by dividing the actual number of visits by the estimated average EP visit volume (3,548 visits ⁄ year) and then summing FTEs by state. Our model assumed that at least one EP should be present 24 ⁄ 7 in each ED. The number of EM board-certified EPs per state was provided by the American Board of Medical Specialties (American Board of Emergency Medicine, American Board of Pediatrics) and the American Osteopathic Board of Emergency Medicine. We used U.S. Census Bureau civilian population estimates to calculate EP population density by state. Results:The supply of EM board-certified EPs was 58% of required FTEs to staff all EDs nationally and ranged from 10% in South Dakota to 104% in Hawai'i (i.e., there were more EPs than the estimated need). Texas and Florida had the largest absolute shortages of EM board-certified EPs (2,069 and 1,146, respectively). The number of EM board-certified EPs per 100,000 U.S. civilian population ranged from 3.6 in South Dakota to 13.8 in Washington, DC. States with a higher population density of EM boardcertified EPs had higher percent high school graduates and a lower percent rural population and whites. Conclusions:The supply and demand of EM board-certified EPs varies by state. Only one state had an adequate supply of EM board-certified EPs to fully staff its EDs.

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Emergency Department Coverage by Primary Care Physicians in a Rural Practice‐Based Research Network: Incentives, Confidence, and Training

Cited by 8 publications

References 13 publications

International approaches to rural generalist medicine: a scoping review

International approaches to rural generalist medicine: a scoping review

Scope of Practice and Autonomy of Physician Assistants in Rural Versus Urban Emergency Departments

Supply and Demand of Board‐certified Emergency Physicians by U.S. State, 2005

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