Factors Influencing Future Demand for Emergency Physicians

Emergency physicians are becoming more involved in a variety of professional activities outside of the direct clinical care of ED patients. The Society for Academic Emergency Medicine (SAEM) website for fellowships now lists 500 available positions in nearly 40 different fellowship programs, and the American Board of Emergency Medicine (ABEM) listed 2,927 ABEM emergency physicians with subspecialty certification in 12 different subspecialties. The National Residency Match Program (NRMP) match data for 2021 showed that ACGME-certified fellowships experienced record high numbers of filled positions.

Despite significant interest in pursuing emergency medicine, the latest 2022 NRMP match illustrated a big drop in the percentage of positions filled, with a 7.0 percent point drop compared to last year. The reasons for this change are uncertain, but may reflect uncertainty relating to future employment opportunities.

Given the number of unanticipated changes that have a significant impact on the healthcare workforce, such as the COVID-19 pandemic, emergency physicians will continue to explore ways to diversify their careers. A study from 2011 demonstrated that 36% of EDs surveyed reported an observation unit in their hospital, with over half of those units staffed by emergency physicians. Urgent care centers have increased in the US from 6100 in 2013 to 9616 in 2019. A recent systematic review of telehealth during the COVID-19 pandemic listed several categories of use in the ED, and the number of descriptive papers regarding emergency physicians using telehealth continues to grow. Tele-emergency allows a specialty-trained EP to provide oversight for another clinician in a remote ED. This practice has been shown to improve the quality of care and health outcomes in rural hospitals. These trends in EP training and in clinical practice arrangements may decrease the number of emergency physicians providing basic ED care, but they may also increase the quality of care and the treatment benefits enjoyed by ED patients.

Conclusions

The future of the EM workforce depends on the supply and distribution of emergency physicians and the demand for emergency medical care. Potential actions to balance these forces should be evaluated using the ethical principles of beneficence (doing good), nonmaleficence (primum non nocere, or “do no harm”), and justice (fair and equitable treatment). Patient access, safety, and the quality of emergency care should be the primary goals of balancing the emergency medicine workforce.

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