Finally, in order to incentivize emergency physicians to practice in rural areas where patient volumes may be lower, we must seek out ways to compensate them for the hours they put in standing at the ready for critically ill patients to arrive. We do not fund rural fire departments solely based on the number of fires they respond to per year, and we should not pay rural emergency physicians based solely on the number of patients they see. A rural ED staffed by a well-trained EP is an essential resource in small communities that may be otherwise lacking in readily available healthcare resources. Both rural EDs and rural EPs should receive compensation reflecting the critical nature of that resource. All EPs are currently experiencing the pain of our current boarding crisis, and the lack of sufficient funding of our safety net and surge capacity is a contributor to that crisis. We cannot continue to make that mistake in rural America, where our neighbors deserve the same access to high-quality emergency physicians delivered in urban areas.

Ryan A. Stanton, MD, FACEP

Current Professional Positions: Emergency physician, Central Emergency Physicians, Lexington, Kentucky; medical director, Lexington Fire/EMS; medical director, AMR/NASCAR Safety Team; public safety medical director, Blue Grass Airport, Lexington; Kentucky and Florida medical director, AirMed International

Internships and Residency: Surgery internship, James H. Quillen College of Medicine, Johnson City, Tennessee; emergency medicine residency, University of Kentucky

Medical Degree: MD, James H. Quillen College of Medicine (2003)

Response

The workforce study shook the foundation of emergency medicine (EM). After decades of assumptions that we would “never fill all the seats,” we have been faced with the threat of an overabundance of emergency physicians which has led to some of the downstream impacts, including the match struggles. What is even more clear is that we continue to have a significant distribution issue within EM with abundance pushing down larger markets while rural and critical access setting still struggle to fill shifts. More recent data has demonstrated that the initial study significantly underestimated physician career longevity and attrition (which is an issue in itself), but it has provided an opportunity to address challenges that were known and unknown. The workforce efforts must continue with opportunities to guardrail residency growth, raise the bar on the skillsets of emergency physicians, and ensure we continue to recruit the best and brightest to this wonderful specialty. One of the major areas of focus must be on the distribution of emergency physicians with opportunities within residency to have substantive rural and critical access experience. This also means advocating for incentives that can assist attracting physicians of all career stages to rural and critical access settings.