ER in the Deep South

Emergency Physicians Demand Outpacing Supply; Rural Areas Hit Hardest

The number of the nation's nearly 40,000 clinically active emergency physicians is not adequate to treat the growing number of people who visit emergency departments every year, according to the recently released National Study of the Emergency Physician Workforce. 
Medical schools are not turning out emergency physicians fast enough, and shortages are predicted to persist for decades.
The grim news does not bode well for the South, which is largely rural, where shortages in emergency physicians already exist. The growing reluctance of emergency physicians to practice in rural areas is a particularly disturbing trend. Of emergency physicians who graduated more than 20 years ago, 15 percent are practicing in a rural area. By contrast, of emergency physicians who graduated within the past five years, only 5 percent are practicing in a rural area. 
"States in the Deep South had the lowest access to both emergency medicine trained/board certified emergency physicians and any emergency physician in the country," said Adit Ginde, MD, of the Department of Emergency Medicine at the University of Colorado-Denver School of Medicine, and lead author of the study.
According to the most recently released National Hospital Ambulatory Medical Care Survey, 227 visits are made every minute to emergency departments nationwide. However, only 3.3 percent of active doctors are emergency physicians.
"It's difficult to satisfy completely the current demand for emergency physicians with emergency medicine board certified physicians, especially in rural areas," said Ginde. "We need to improve access to high quality emergency care for all Americans."
Nationwide, emergency physicians are moving into retirement with the rest of America's baby boomers.
"As older emergency physicians retire, the pronounced shortage in rural areas may even worsen," cautioned Ginde, who collaborated with the Emergency Medicine Network at Massachusetts General Hospital to analyze the 2008 American Medical Association Physician Masterfile, which contains data on all 940,000 U.S. physicians.
Of the nation's 39,061 clinically active emergency physicians, 57 percent were board certified in emergency medicine; this percentage climbed to 69 percent when all emergency medicine trained physicians were included. Nearly all (98 percent) of emergency physicians who graduated within the last five years were emergency medicine trained or emergency medicine board certified, compared to only 44 percent of emergency physicians who graduated more than 20 years ago. 
"Although an increasing number of emergency physicians are now emergency medicine trained or board certified in emergency medicine, 31 percent of practicing emergency physicians were neither," noted Ginde.
Medical schools across the country graduate approximately 1,400 new emergency physicians annually.
"The good news is that the increased public access to emergency medicine trained and emergency medicine board certified physicians demonstrates the growth of our specialty in a very short time, "said Nick Jouriles, MD, president of the American College of Emergency Physicians (ACEP). "But the news on continued shortages of emergency medicine specialists is sobering, particularly in rural areas." 
The 2009 National Report Card on the State of Emergency Care, prepared by the ACEP, gave the United States a C-, with individual state grades ranging from the highest, a B in Massachusetts, to the lowest, a D- in Arkansas. Even though the grade of C- is the same as that reported in the 2006 report card, the two editions are significantly different and not directly comparable, said Jouriles.
"The 2009 report card provides a more extensive evaluation of the nation's emergency care system and confirms its tenuous condition," he explained.
In the South, Alabama, Arkansas, Kentucky, and Louisiana all received Ds. Florida, Georgia, Mississippi, North Carolina, South Carolina, Tennessee and Virginia each received a C. No southern state merited a B grade.
Concerning access to emergency care, three southern states flunked: Florida, Georgia and South Carolina. In quality and patient safety environment, Arkansas and Kentucky failed. Kentucky and North Carolina received an F for medical liability environment. Bottom performers for public health and injury prevention included Alabama, Arkansas, Louisiana, Mississippi, South Carolina, all of which received an F. Arkansas and Tennessee were among the lowest ranked states for disaster preparedness.
"The states with large rural or frontier areas, including low population densities and large distances to medical facilities, face greater challenges regarding healthcare access and health status generally," said Jouriles, an attending physician at Akron General Medical Center in Ohio. "Data confirm that people living in rural areas are more likely than their urban or suburban counterparts to report being in poor health, and are more likely to have higher rates of chronic diseases, poor nutrition, cigarette smoking, and deaths from injuries.
"Rural populations, on average, tend to be older than those in urban areas and suffer from greater levels of poverty and unemployment. They are also more likely to be geographically isolated and lack access to transportation, a regular health provider, and health services. Many rural areas also face major shortages of healthcare providers. For example, though 20 percent of America's population lives in rural areas (Mississippi's population, by comparison, is 55 percent rural), those areas are home to only 9 percent of the nation's practicing physicians."
Bottom line, emergency care is a national priority, said Jouriles.
"We need to train more emergency medicine specialists," he said. "This is a critical concern as lawmakers and the nation take up healthcare reform."

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