WASHINGTON, D.C.—Emergency departments are strained by physician shortages, predominantly in rural areas, according to “State of the National Emergency Department Workforce: Who Provides Care Where?,” a new study in Annals of Emergency Medicine.

“Emergency departments are an especially vital safety net for patients in rural settings,” said M. Kennedy Hall, MD, MHS, Assistant Professor in the Department of Emergency Medicine at the University of Washington School of Medicine and lead study author. “This study shows that there is an opportunity to address emergency medicine workforce challenges and narrow any potential gaps in training for those providing emergency care. Staffing differences between rural and urban communities should factor into optimal care delivery decisions and sound policymaking.”

Of 58,641 emergency medicine clinicians identified by the analysis, 61 percent (35,856) were classified as emergency physicians. Qualified health professionals who work under physician supervision, known as advanced practice providers (APP) made up 24.5 percent (14,360) and non-emergency physicians made up 14.3 percent (8,397).

Among APPs, physician assistants (68.4 percent) and nurse practitioners (31.5 percent) were most common. Among non-emergency physicians, family practice (41.7 percent) and internal medicine (19.9 percent) physicians were most represented.

In rural areas, clinicians are often trained in other specialties and APPs provide disproportionately more emergency care, especially where there may not be an emergency physician available, the authors note.

More emergency physicians were mapped to urban counties (63.9 percent) than their rural counterparts (44.8 percent). More than one-quarter of counties (27.1 percent) had no emergency clinicians of any kind and 44.9 percent of counties had no emergency physicians reimbursed by Medicare Part B.

The highest proportion of emergency physicians can be found bi-coastally and in the Mountain Time Zone. The lowest proportions can be found in the southern United States and in the Central Time Zone.

“Our analysis revealed that more than one third of emergency department clinicians are someone other than an emergency physician,” said Dr. Hall. “This points to the need for a broader approach to emergency care training. Health systems have unique needs and hospitals, particularly in rural areas, and will continue to be challenged to harness the provider mix in their regions.”

“Our EM workforce is broad-based with a variety of ambulatory care skillsets in addition to emergency medicine experience. It is important to provide additional emergency medicine specific training when needed, as well as examine standards for APPs and non-emergency physicians, especially in locations where access to trained emergency physicians is limited,” said Dr. Hall.

The analysis was based on the 2014 Medicare Public Use Files (MPUF) dataset of 932,243 physicians, which includes 58,641 (6 percent) unique emergency medicine clinicians. The study found at least 20,000 more emergency physicians than the previously published workforce analysis from a decade ago.