A study of the workforce in emergency medicine: 2007

Abstract

Introduction

This study was undertaken to describe the current status of the emergency medicine workforce in the United States.

Methods

Surveys were distributed in 2008 to 2619 emergency department (ED) medical directors and nurse managers in hospitals in the 2006 American Hospital Association database.

Results

Among ED medical directors, 713 responded, for a 27.2% response rate. Currently, 65% of practicing emergency physicians are board certified by the American Board of Emergency Medicine or the American Osteopathic Board of Emergency Medicine. Among those leaving the practice, the most common reasons cited for departure include geographic relocation (46%) and better pay (29%). Approximately 12% of the ED physician workforce is expected to retire in the next 5 years.

Among nurse managers, 548 responded, for a 21% response rate. Many nurses (46%) have an associate degree as their highest level of education, 28% have a BSN, and 3% have a graduate degree (MSN or higher). Geographic relocation (44%) is the leading reason for changing employment.

Emergency department annual volumes have increased by 49% since 1997, with a mean ED volume of 32 281 in 2007. The average reported ED length of stay is 158 minutes from registration to discharge and 208 minutes from registration to admission. Emergency department spent an average of 49 hours per month in ambulance diversion in 2007. Boarding is common practice, with an average of 318 hours of patient boarding per month.

Conclusions

In the past 10 years, the number of practicing emergency physicians has grown to more than 42 000. The number of board-certified emergency physicians has increased. The number of annual ED visits has risen significantly.

Introduction

Emergency medicine (EM) was officially recognized by the American Board of Medical Specialties in 1979. The first residency training program in EM was established in 1970. Also in 1970, the Emergency Department Nurses Association (now Emergency Nurses Association [ENA]) was founded.

In 2006, the number of patients in the United States seeking care in the ED reached 119 million annual visits, whereas the number of emergency departments (EDs) decreased [1], [2], [3], [4], [5], [6]. From 1995 to 2005, the number of annual ED visits increased by 20%, whereas the number of EDs decreased by 10%, resulting in a mean ED increase in volume from 23 000 to 30 000 [4], [6]. The challenges confronting emergency physicians and nurses in the United States have recently been highlighted by the Institute of Medicine's publication Hospital-Based Emergency Care: At the Breaking Point[7].

Workforce studies are essential to the development and growth of any profession. Several studies have identified a projected shortage of physicians to meet the workforce needs in the United States [8], [9]. Workforce projections have important implications for training, as well as consideration of other approaches to workforce planning. For example, because of the projected physician shortage, the Association of American Medical Colleges has recommended increased enrollment in US medical schools to contribute to the physician workforce [10]. Specifically, in emergency care, an accurate understanding of the nationwide workforce, including numbers, qualifications, and plans of the country's emergency physicians and registered nurses (RNs), is vital to the ideal planning of professional endeavors, including training programs, professional planning, board certification, continuing education, administrative agenda, organizational support, legislative advocacy, and others.

Two previous studies conducted by the American College of Emergency Physicians (ACEP) have investigated the status of the workforce in EM in 1997 and again in 1999 [11], [12]. Similar national benchmarking studies were conducted by ENA, most recently in 2005 [13]. The most recent workforce study of 1999 estimated that approximately 32 000 physicians practice EM full-time and that training and board certification among these physicians varied widely. Between 1997 and 1999, the total number of ED visits increased during a time when the number of hospital EDs decreased. The workforce of emergency physicians has been dominated by white men and, as such, is not representative of the US population. Both previous workforce studies demonstrated a significant nationwide shortage of board-certified emergency physicians, despite dramatic increases in the number of Accreditation Council for Graduate Medical Education (ACGME)-approved EM residency programs [14]. Recently, ACEP has reaffirmed its statement that “there is currently a significant shortage of physicians appropriately trained and certified in emergency medicine [15], [16].” A similar statement addressing the nursing shortage in EDs and its impact on patient care was issued by ENA[17]. There is wide variation across the nation regarding the type and size of EDs, as well as staffing, credentials, and qualifications [18].

This study is undertaken to describe the current status of the EM and nursing workforces in the United States, including both physician and nursing data, demographics, training and credentials, and other characteristics of emergency physicians, as well as patient characteristics, ED functions, nursing issues, and other factors influencing the practice of EM. Comparison to earlier ACEP workforce studies from 1997 to 1999 and other literature will provide important information in trends in EM care over the past decade. The addition of nursing data enriches the depth of workforce descriptions and supplies comparative data for future studies.