Supply and Demand of Emergency Medicine Board‐certified Emergency Physicians by U.S. State, 2017

Abstract

Objectives Our objective was to estimate the emergency medicine board‐certified emergency physician (EMBC EP) workforce supply and demand by U.S. state. Methods To estimate state demand, we applied the methodology from our 2005 analysis to calculate full‐time equivalent (FTE) EMBC EP demand for each emergency department (ED). The 2017 National Emergency Department Inventory–USA provided visit volumes for all EDs, while the American Board of Medical Specialties supplied the 2017 number of EMBC EPs per state. Assuming that at least one EMBC EP should be present 24/7 in each ED (requiring 5.35 FTEs minimum), we calculated the total FTEs required by dividing each ED’s visit volume by the estimated average visits seen by an EMBC EP (3,548 visits per year) and then summed FTEs by state. The U.S. Census Bureau provided state demographic characteristics. We used multivariable linear regression to examine the association between state demographics and the density of EMBC EPs per state and compared 2017 results to our prior 2005 analysis. Results There were 40,716 total EMBC EPs in 2017, fulfilling 77% of the estimated national demand. This was a substantial increase from 23,035 total EMBC EPs fulfilling 58% of demand in 2005. The 2017 supply ranged from 24% of demand in North Dakota to 142% in Hawaii. A lower density of EMBC EPs was associated with states in the Midwest and South (p < 0.001) and with a more rural population (p = 0.02). The absolute shortage of EMBC EPs worsened or remained the same in one‐fourth of states. Conclusion While the total number of EMBC EPs nearly doubled between 2005 and 2017, a shortage of full‐time coverage persists. The supply and demand vary greatly by state. Worsening absolute shortages in several states show that the distribution of EMBC EPs is not meeting demand across the United States, particularly in rural areas.

HIV Testing at Visits to US Emergency Departments, 2018

“…This includes ED physician concerns of increased patient length-of-stay in the context of ED crowding and boarding, lack of ability to secure an appropriate follow-up (and linkage to care) after diagnosis, and limited ED resources and staffing. 8,9,25,26 This is especially true in light of the COVID-19 pandemic, which has only exacerbated levels of routine HIV testing. 27 More routine testing for HIV in US EDs would better serve patients, particularly EDs that care for patients and populations disproportionately affected by HIV.…”

Attrition from emergency medicine clinical practice in the United States, 2020

“…In addition to characterizing a growing workforce, we demonstrated decreases in EP densities in both large and small rural areas and nonuniform supply and demand of EPs with wide variation across states 7,8 . There are geographic differences in EP densities exacerbated by the rapid expansion of predominately urban residency programs and a rural population of older EPs poised to retire and leave the clinically active workforce 3,6–8 . Given this, the impact of COVID‐19, and ongoing discussions about the future of the EP workforce, there is a need for an updated assessment of EP attrition accounting for differences by both EP characteristic or location and clarifying whether attrition has changed 1,4,6 .…”

“…We recently completed an updated (2020) characterization of EPs; this included work exploring state‐level EP supply and demand 7,8 . In addition to characterizing a growing workforce, we demonstrated decreases in EP densities in both large and small rural areas and nonuniform supply and demand of EPs with wide variation across states 7,8 .…”

“…We recently completed an updated (2020) characterization of EPs; this included work exploring state‐level EP supply and demand 7,8 . In addition to characterizing a growing workforce, we demonstrated decreases in EP densities in both large and small rural areas and nonuniform supply and demand of EPs with wide variation across states 7,8 . There are geographic differences in EP densities exacerbated by the rapid expansion of predominately urban residency programs and a rural population of older EPs poised to retire and leave the clinically active workforce 3,6–8 .…”

Revisioning the ENP Among Emergency Workforce Changes

“…Other factors affecting ED visit rates and demand for EPs include reduced ED volumes since the pandemic, increased costs and disincentives by insurers for patient ED visits, use of telemedicine, and the growth of urgent care and retail clinics (Pines et al, 2021;Reiter & Allen, 2020). Clay et al (2021) analyzed the National Emergency Department Inventory (NEDI)-USA database and state medical association physician registry data, comparing their findings with a prior workforce study by Sullivan, Ginde, Espinosa, and Camargo (2009), noting a similar maldistribution in the ED workforce. In the most current study (Clay et al, 2021), significant ED workforce gaps continue to persist in rural states including Texas, Alabama, North Dakota, and throughout the Southeast and Midwest.…”