Note: Watch a video of the complete Workforce Roundtable here.

I recently met with four emergency physicians—Jesse Pines, MD, MBA, FACEP, national director of clinical innovation at US Acute Care Solutions (USACS) and professor of emergency medicine at Drexel University; Viktoria Koskenoja, MD, chair-elect of the Rural Section of ACEP, who practices in the Upper Peninsula of Michigan; James “Jay” B. Mullen III, MD, FACEP, chair of the Democratic Group Practice Section of ACEP, a practicing emergency physician, and CEO of BlueWater Health, which staffs emergency departments and urgent cares throughout New England; and Sudave D. Mendiratta, MD, FACEP, chair and chief of emergency medicine at University of Tennessee/Erlanger, who also serves as the President of the Tennessee Chapter of ACEP—to discuss the recent emergency medicine workforce projections published in Annals of Emergency Medicine.¹ Our conversation spanned just under an hour and pondered the implications of the authors’ estimates for the future emergency medicine workforce and what it means for emergency physicians.

After recently sitting with a medical student mentee over coffee, I know concerns about the future of the EM workforce invade the minds of not just the leadership of ACEP but also practicing physicians, residents, and the brilliant young men and women who want to follow in our footsteps.

In this article, I have limited space to summarize a few of the important themes. What will the emergency medicine workforce look like at the end of the decade? According to the report, experts anticipate more then 67,000 total emergency medicine practitioners, of which emergency physicians would make up 70 percent. Physician assistants (PAs) and nurse practitioners (NPs) would assume 23 percent of the workforce, while other non-emergency-trained physicians would comprise the remainder. In 10 years, this workforce would slightly exceed the demand for emergency services, creating a surplus that threatens the future of the specialty. One of the first questions I posed to the members of roundtable was, what should the future of emergency medicine look like?

Advanced Practice Professionals

“If we’re going to define the perfect world, we’re going to want high-value medicine,” started Dr. Mullen, referencing that board-certified emergency physicians represent the pinnacle of training and experience in emergency care, but for low-acuity care, advanced practice professionals (APPs) such as NPs and PAs would remain valuable to the clinical team.

Dr. Koskenoja pushed back a little on this notion, saying that “it’s kind of like the wild wild West out there,” referring to her practice in rural Michigan. Recalling anecdotes of patient harms from inexperienced NPs and PAs, she reported that “patients are being hurt in these scenarios when there’s someone … just basically taking care of someone alone and that’s not a safe environment.”

The team approach is better, both agreed, with the emergency physician in the lead. So did Dr. Mendiratta, who stated that “the appropriate use of APPs should not be determined by economic factors. It should be determined by the needs of our patients.” Thus, the leadership skills of emergency physicians become critical. Whether that leadership occurs in real time at busier emergency departments or is available to consultation in lower-volume sites, Dr. Mendiratta affirmed that “an emergency physician should be the leader of a collaborative care team.”

Unfortunately, in some places, such as rural Maine, that is not always the case. “Financially strapped rural hospitals that are having trouble staffing their emergency department, they may reach out and start having an independent PA or nurse practitioner work there,” said Dr. Mullen. “And that’s just so wrong for the patients but also so wrong for that practitioner because they’re going to be faced with challenges they are not up to, and that can sometimes be career-ending.”