Board-Certified Emergency Physicians Comprise a Minority of the Emergency Department Workforce in Iowa

Introduction: The American College of Emergency Physicians (ACEP) endorses emergencymedicine (EM) residency training as the only legitimate pathway to practicing EM, yet the economicreality of Iowa’s rural population will continue to require the hiring of non-EM trained physicians.The objective of our study is to better understand the current staffing practices of Iowa emergencydepartments (EDs). Specifically, we seek to determine the Iowa community size required to supporthiring an emergency physician (EP), identify the number of EDs staffed by advanced practiceproviders (APPs) in solo coverage in EDs, determine the changes in staffing over a 4-year period,and understand the market forces that contribute to staffing decisions.Methods: Researchers surveyed all 119 hospitals throughout the state of Iowa regarding their EDhiring practices, both in 2008 and 2012. From these data, we determined the mean populationthat supports hiring EPs and performed a qualitative examination of the reasons given for hiringpreferences.Results: We found that a mean population of approximately 85,000 is needed to support EPonlystaffing practices. In 2012, only 14 (11.8%) of Iowa’s EDs were staffed exclusively with EPs.Seventy-two (60.5%) staff with a combination of EPs and FPs, 33 (27.7%) staff with FPs alone, and72 (60.5%) have physician assistants or nurse practitioners working in solo coverage for at leastpart of the week. Comparing the data from 2008 and 2012, there is no statistical change in the hiringof EPs versus FPs over the 4 years (Chi-square 0.68, p=0.7118), although there is a significantincrease in the number of APPs in solo practice (Chi-square 11.36, p= 0.0008). Administrators athospitals cited several factors for preferring to hire EPs: quality of care provided by EPs, availabilityof EPs, high patient acuity, and high patient volume.Conclusion: Many EDs in Iowa remain staffed by family medicine-trained physicians and are beingincreasingly staffed by APPs. Without the contribution of family physicians, large areas of the statewould be unable to provide adequate emergency care. Board-certified emergency physicians remainconcentrated in urban areas of the state, where patient volumes and acuity support their hiring.