Forecast for Emergency Physician Surplus by 2030 Likely Overstated, Study Finds

The assumed annual clinician attrition rate in the prediction of an emergency physician surplus appears to be too low.

A predicted emergency medicine physician surplus by 2030 may not be as large as anticipated, according to a recent research article.

A study published in December 2021 that analyzed Medicare claims data and the American Medical Association Masterfile forecast there would be a surplus of 7,845 emergency physicians by 2030. The study assumed a 3% annual clinician attrition rate.

The recent research article, which was published by Annals of Emergency Medicine, features data collected about more than 82,000 clinicians from 2013 to 2019. In that timeframe, emergency physicians experience a collective annual attrition rate of 5.3% to 5.7%, including 3.8% to 4.9% permanent attrition.

The co-authors of the recent research article say that if the attrition rate for emergency physicians was 1% higher than the assumed 3% rate, the forecast surplus would be only 2,486 clinicians. "The annual rate of emergency physician attrition was collectively more than 5%, well above the 3% assumed in a recently publicized projection, suggesting a potential overestimation of the anticipated future clinician surplus," the co-authors wrote.

The recent research article has four other key findings about the emergency medicine workforce, which consists of emergency physicians, non-emergency medicine physicians, and advanced practice providers.

• The proportion of advanced practice providers in the emergency medicine workforce increased from 20.9% in 2013 to 26.1% in 2019, while the proportion of emergency physicians decreased from 68.1% in 2013 to 65.5% in 2019.
   
• Emergency clinician entry to the workforce peaked in 2016 and clinician exit from the workforce was still rising in 2018.
   
• Emergency physicians account for less than half of the rural emergency medicine workforce, with a 51.3% proportion of all clinicians in 2013 and 46.4% proportion in 2019. The proportion of advanced practice providers working in rural areas increased significantly during the study period, rising from 23.0% of rural clinicians in 2013 to 32.7% in 2019.
   
• There was significant state-level variation in emergency clinician densities per 100,000 population. In 2013, the three states with the highest emergency physician densities were Washington, DC (23.0), Michigan (16.5) and Rhode Island (16.4), and the three state with the lowest densities were South Dakota (6.0), Nebraska (6.9), and Montana (7.0). In 2019, the three states with the highest densities were Washington, DC (24.2), Rhode Island (20.6), and Michigan (19.6), and the three states with the lowest densities were Alabama (7.0), Idaho (7.4), and South Dakota (8.3).

The study has troubling findings for the practice of emergency medicine in rural areas, the co-authors wrote. "Rural clinicians providing emergency care in 2019 are now more likely to be nonemergency physicians or advanced practice providers rather than emergency physicians. Our work uniquely identifies a concerning trend regarding the recruitment of rural emergency physicians. From 2013 to 2019, the number of emergency physicians entering the rural workforce never offset the number leaving from the prior year, suggesting that shortages and inequities in access will persist unless substantial efforts are made to address emergency physician recruitment and retention issues."

Related: Rural Areas Experiencing Emergency Medicine Workforce Shortage