Elsevier

The Journal of Emergency Medicine

Volume 17, Issue 1, January–February 1999, Pages 7-15
The Journal of Emergency Medicine

Original Contributions
Residency-trained emergency physicians: their demographics, practice evolution, and attrition from emergency medicine

https://doi.org/10.1016/S0736-4679(98)00119-XGet rights and content

Abstract

Concern exists about the ability of Emergency Physicians (EPs) to maintain a career in Emergency Medicine (EM) over a professional lifetime. The objectives of this study were to assess the practice characteristics of residency trained EPs, to document how the EP’s responsibilities evolve throughout a career, and to assess career longevity. A retrospective cohort study using a mailed questionnaire was used to document practice characteristics, evolution of responsibility, and career longevity from all physicians who graduated from allopathic EM residencies between 1978–1988 (inclusive). Non-responders were compared to responders to assess the extent of selection bias. The response rate was 58.1% (1635/2812). There were no differences between responders and non-responders on any of five demographic variables. Responders who were more likely to remain in EM included those who had higher reimbursement, were board certified in EM, or did not train in another specialty or do a fellowship outside of EM. Throughout the 15-year careers studied, EPs noted a significant shift in the time spent doing clinical work (decreased) and the time doing administrative work (increase). The attrition from EM practice for this cohort was < 1% per year.

Introduction

The issues of burn-out and career longevity of emergency physicians (EPs) remain important, frequently discussed issues, even though the specialty is approaching its fourth decade of existence 1, 2, 3, 4. Suggested ranges of attrition range from 1–2% per annum to 50% every 5–10 years 2, 4, 5. Attempts have been made to determine the total number of trained EPs that is required to staff emergency departments (EDs) in the U.S. (6). However, estimates have limited accuracy because the practice characteristics and attrition of EPs have not been fully characterized.

With increased attention on the health care system in the United States, physician manpower issues are the subjects of debate. The Macy Foundation Report on Emergency Medicine projected a shortfall of trained emergency physicians, and recommended an increase in training positions (7). These recommendations were made with various assumptions, including that EPs will continue to practice clinical Emergency Medicine (EM), and that the annual attrition of EPs is in the 2–3% range.

Because of the importance of making policy decisions using the best data available, and the paucity of data on this topic, we sought to answer the following questions:

  • 1.

    What are the personal and professional characteristics of residency trained EPs 5–15 years after completing their residency in emergency medicine?

  • 2.

    What changes occur in EM practice patterns over time?

  • 3.

    What is the annual attrition (career longevity) of residency trained EPs?

  • 4.

    Why do EPs leave EM practice?

  • 5.

    What characteristics of EM practice are associated with a more rapid attrition?

Section snippets

Materials and methods

All physicians graduating from accredited U.S. allopathic EM training programs between 1978 and 1988 (inclusive) were eligible to be included in the cohort. The graduates from 1978–1982 had been polled previously (4). That cohort was polled again and the group expanded to include the 1983–1988 graduate group. Letters requesting the names and addresses of all residency graduates in this expanded time frame were sent to all EM residencies that existed in 1988. If no reply was received after two

Non-responders

Of the 2812 deliverable questionnaires, 1638 (58.3%) were returned. Table 1 compares the responders and non-responders on the five demographic variables. No significant differences were found between these two groups on any of these factors. Importantly, there were no differences regarding board certification in EM, or in other specialties. Regarding membership in Emergency Medicine organizations, 85% (51/60) of the non-responders sampled belonged to either the American College of Emergency

Discussion

Previous studies have evaluated the burn-out of EPs from practice 1, 15. These studies have found that EPs plan to remain in EM for a relatively short period of time, with attrition from EM ranging from 2–10% each year. Our study finds that the actual attrition from EP is much less than this; approximately 1% per year.

One difference that might account for this discrepancy is that we measured the actual attrition of physicians trained in EM, while other articles asked practicing EM physicians

Conclusion

The attrition of EM residency trained physicians, at 1%/year, is lower than previously estimated. In fact, it is lower than estimations currently used by national EM organizations in discussions concerning EM manpower needs.

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Supported by a grant from the AMA Education and Research Fund. Presented at the SAEM Annual Meeting in Washington DC, May, 1994.

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