But for rural EDs, it may not be that physicians don’t want to relocate to rural settings, but rather that hospitals are unable to pay the salary needed to attract an EM-certified physician to their rural community.
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ACEP Now: Jan 01“A lot of hospitals say they can’t afford a physician, but we know that it is cheaper for their payroll costs to employ an NP or PA,” Dr. Koskenoja said. “It’s hard to know exactly what they can afford versus what they say they can afford. I currently work in an ED that has less than 5,000 visits per year, and it’s exclusively staffed by MDs and DOs. So my hospital is affording it.”
Dr. Koskenoja said that there is a role for PAs and NPs to work in EDs as physician extenders; they are an integral part of the clinical team. But there is a wide difference in training, and that is just a fact, she said.
Stephen Jameson, MD, FACEP, a physician in the ED at Sanford Medical Center, Fargo, N.D., and another past chair of ACEP’s Rural Emergency Medicine Section, said it will be hard to reconcile the gap between a standard for mandated physician presence and what rural hospitals are able to deliver. He studied these while serving on ACEP’s Rural Task Force, starting in 2019.
Dr. Jameson
“In our minds, we felt we should get emergency physicians into every ED,” Dr. Jameson explained. A 27 percent increase in emergency residency program slots in the previous decade seemed like a move in the right direction, he said.
But then a workforce study by Bennett and colleagues showed that although the number of emergency medicine residency programs had increased, most were added to states that already had a lot of them.10 In contrast, there was an emergency physician “desert” in other, rural parts of the United States.
If you want to fill the gaps, Dr. Jameson said, “first you have to recognize that the trend toward PAs and NPs staffing the smallest EDs, typically working independently, is a reality. The question is what to do with these small volume, critical access and frontier rural hospitals?” Dr. Jameson said. “How far down in volume of patient visits per year can you go and still justify hiring a physician for the ED? And will we ever be able to staff the lowest volume EDs?”
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2 Responses to “ACEP Takes Firm Stand on Physician Leadership”
January 7, 2025
Nate MinnickThere’s a catch for rural rotations for residents. The ACGME requires for EM:
“Faculty members supervising emergency medicine residents in an adult emergency department must either be ABEM/AOBEM board eligible or have current ABEM and/or AOBEM certification in emergency medicine.”
In the strictest sense, this limits programs from sending residents to sites that could possibly have FM physicians, since it would make scheduling more complicated.
Perhaps the ACEP Rural section can work with CORD to discuss with the ACGME. FM residents could to a rural rotation and work with EM or FM physicians.
January 12, 2025
Michael MenowskyI think this is a great first step for states and ACEP. I know Inwill catching a lot of backlash, but I believe Emergency Departments should be staffed by those trained to work there.
A 2 month of EM rotation during 3 yrs residency, I don’t think provides the knowledge or skills to provide quality, efficient and comprehensive Emergency Care. During residency I was required to do 3 months of Trauma Service, that does not make me a Trauma Surgeon.
With discussions of workforce shortages in EM and that being a factor in recent MATCH numbers, rural EM provides the opportunity for residents post graduation to expand into those areas.
I will leave you with this tale, I received a trauma patient that arrived as a transfer after a motor vehicle collision. The physicians I received the call from, told me he was a “family doctor” and did not know how to do a chest tube. He spotted the large pneumothorax on chest XRay. He stated he just wanted to get them out of the ED and asked if I would accept? Of course I did, the patient arrive in cardiac arrest, as soon as I did a thoracostomy, and 2 more rounds of CPR our team was able to resuscitate the patient. Trauma surgeon arrived and patient went to the OR for other injuries. My question, shouldn’t anyone working in an ED be capable of performing a chest tube, the ACGME requires that and many other to complete an EM residency?