New analysis reveals worsening shortage of emergency physicians in rural areas

Despite the nation's growing reliance on emergency departments, large areas of rural America are experiencing shortages of emergency physicians, according to a new emergency medicine workforce analysis in Annals of Emergency Medicine.

"The number of emergency physicians is increasing but there is a clear unmet need for emergency physicians in rural areas," said Christopher Bennett, MD, MA, assistant professor of emergency medicine at Stanford University School of Medicine and lead study author. "Policymakers and health leaders should prioritize opportunities to make sure that emergency departments across the country are led by appropriately trained and certified emergency physicians."

According to the "National Study of the Emergency Physician Workforce, 2020," the nation's rural emergency physician shortage is expected to worsen in the coming years, the authors note. Of the 48,835 clinically active emergency physicians in the United States, 92 percent (44,908) practice in urban areas with just 8 percent (3,927) practicing in rural communities, down from 10 percent in 2008.

The analysis also shows that the rural emergency physician workforce is aging. Nearly all (96 percent) of the emergency medicine residency or fellowship graduates within the last four years practice in more urban areas. Conversely, emergency physicians in rural communities tend to be closer to retirement age, with more than 70 percent having completed their medical training more than 20 years ago. While the median age for an urban emergency physician is 50 years old, the median age in large rural communities is 58 years old and 62 years old in smaller rural communities.

Still, there are signs of growth in the specialty. As older emergency physicians prepare to leave the workforce, the nation's residency programs continue to expand. There were 4,565 residents in 145 programs in 2008, and today there are 7,940 residents in 247 programs. Nearly a third (28 percent) of practicing emergency physicians today are women, a modest increase from 22 percent in 2008.

One in five Americans lives in a rural area, and the American College of Emergency Physicians (ACEP) recognizes that action is needed to address emergency physician shortages and other challenges facing rural emergency care. This research underscores ACEP's concerns and complements a developing analysis from its Emergency Medicine Workforce Task Force that will help identify best practices, site supervision requirements, and funding mechanisms to support research, cost savings, and promotion of residency training programs with more focus on rural emergency care.

"Demand for emergency care in rural areas will remain high while emergency physician shortages in these communities continues to pose significant challenges for health systems and patients," said Dr. Bennett. "There are reasons to be optimistic about the pipeline of residents and trainees, however; we need to encourage a larger percentage of these individuals to work in rural America."