We talk a lot about diversity in medicine, but we don’t talk about diversity of where people come from. —Viktoria Koskenoja, MD
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ACEP Now: Vol 40 – No 10 – October 2021
Rural Medicine
“We really have to directly address the rural issue. I think that’s not a 2030 issue,” interjected Dr. Pines. “That’s a today issue.” One idea to begin dealing with this crisis is to offer rotations in rural emergency medicine for today’s current crop of emergency medicine residents.
“One of the main hurdles, honestly, is that to be considered an appropriate elective in a residency training program, there needs to be a board-certified emergency medicine physician there in the ER,” Dr. Koskenoja reminded the group. The Resident Review Committee for Emergency Medicine requires that for emergency medicine blocks, residents’ cases are staffed by a board-certified/board-eligible emergency physician. Thus, we are left with a chicken-and-egg paradox. How do we get more physicians to experience the rural environment if we can’t get experienced emergency physicians to work in rural departments?
The panel brainstormed a possible solution: going even further back into the medical school pipeline to more strongly recruit and support college students from rural areas who might, after graduating medical school and residency, be more inclined to subsequently practice in rural areas. “We talk a lot about diversity in medicine, but we don’t talk about diversity of where people come from,” said Dr. Koskenoja, referring to a lack of medical school and residency candidates from rural backgrounds.
For practicing physicians, competitive salaries and loan forgiveness could serve as other incentives to draw physicians from geographically oversupplied regions to undersupplied regions. The concept of geographic maldistribution for emergency physicians, as well as other key specialists such as obstetrician-gynecologists and surgical subspecialties, was more believable to the roundtable participants than a situation where emergency physicians were oversupplied in every region of the nation.
Rural medicine offers a welcome and different challenge to urban medical centers or traditional community hospitals in the suburbs. According to Dr. Mullen, “once we actually stabilize the staffing [in rural departments], we find that some people really enjoy the challenge of rural medicine.” Dr. Mendiratta, reminiscing about days of old, felt that practicing in a critical access hospital in an extremely small town was “truly a magical experience.”
Understanding reality, Dr. Koskenoja quipped, “Nobody expects to get a liver transplant when they live in a town of 22,000 people, but you should be able to get good primary care and good emergency care anywhere in the country.”
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One Response to “Emergency Physicians Explore the Future of the Emergency Medicine Workforce”
October 27, 2021
Concerned ED DocWhile I appreciate the time and effort some of these doctors have put into conversing with the editor, I feel like they are quite out of touch from our major concerns.
NPs and PAs are in not “advanced practice.” They’re mid-level practice at best. Yes it would be great to use them in a team setting but in reality in most EDs around this country the volume and staffing doesnt permit the ED physician from in-time reviewing what they see and do. This leads to the façade of a team dynamic and physician led ED while in reality it just puts our licenses at risk.
The newer EM grads, especially those in the past 1-5 years of residency (not to mention those currently in residency) didn’t get into emergency medicine to do telemedicine. We became EM physicians because we appreciated the complexity, randomness, and high pace (at times) of emergency medicine. We wanted to do procedures while also being able to take care whatever came through the doors.
Yes, I agree we need to recruit and make wanting to work in a rural environment a priority but thats not going to solve the 9,000 additional grad problem in 9 years.
Do something to stop the proliferation of profit driven (ex: HCA) EM residency programs. Stop promoting the usage of NPs and PAs in place of physicians. Create standards that require staffing requirements and in-time supervision of patients with mid-levels. Promote transparency in billing practices in our names. Stop the “full practice authority” that has proliferated the NPs and created a false sense of equivalency with physicians.