Strategies for striking an optimal balance between the supply of emergency physicians and societal needs for emergency medical care remain uncertain. Some have argued that emergency medicine training requirements should become more rigorous and longer. This is potentially a good solution for enhancing the skills of residency-trained emergency physicians and promoting high-quality patient care. Any changes in training requirements should be directly related to proficiency and quality patient care.

Demand for Emergency Physicians COVID-19’s Effect on Emergency Physician Demand

Initial COVID-19 surges decreased ED volumes and emergency physician staffing in 2020, but these rebounded in 2021. Physicians report greatly increased stress and burnout since the onset of the current pandemic. In a survey by the Physicians Foundation, 58% of physicians often had feelings of burnout versus 40% in 2018, and 37% wanted to retire in the next year., A study of physician interruptions of practice during the pandemic found that these were mostly transient, but that practice interruptions without return for physicians aged 55 and older were significantly greater than for younger physicians. These data suggest that the emergency physician attrition rate of 3% used to calculate emergency physician demand is likely an underestimate due to COVID-19. If that is the case, reductions in the number of emergency medicine residency program graduates could create a future shortage of emergency physicians, with adverse consequences for the accessibility and quality of emergency medical care.

EMTALA and the prudent layperson standard requiring an emergency service to evaluate and treat any condition that patients believe requires immediate unscheduled medical care ensures that there will be continuing demand for emergency physicians. Demand for emergency physicians’ services is reinforced by their commitment to a fundamental moral duty to act for the benefit and welfare of their patients and “respond promptly and expertly, without prejudice or partiality, to the need for emergency medical care,” while being stewards of finite healthcare resources.

Distribution of Emergency Physicians

Rural EDs serve larger proportions of disadvantaged populations. They also face the challenge of a shortage of physicians, especially emergency physicians. Access to care in rural areas is anticipated to worsen, for these reasons:

• While approximately 20% of the US population lives in rural areas, only about 10% of all physicians practice in those areas.
• Physicians practicing in rural EDs are less likely to be EM trained or board certified.
• Over approximately the last decade, this shortage has increased, with the density of emergency physicians per capita in small and large rural areas decreasing.
• Many rural emergency physicians are nearing retirement age.
• Rural hospitals are experiencing a closure crisis due to financial challenges. This crisis pre-dated the COVID-19 pandemic and has subsequently been exacerbated by it.
• Rural hospitals have higher mortality rates for acute conditions.

The challenges facing emergency medical practice in US rural areas pose a significant threat to the moral goal of universal and timely access to quality emergency medical care. While financial incentives are effective in attracting physicians to rural locations, the effects may be transient – once student loans are repaid, physicians tend to return to urban areas. The most consistent factor influencing practice in a rural area is growing up in a rural area.