Rural Areas Experiencing Emergency Medicine Workforce Shortage

Researchers find that 98% of emergency medicine residents are working in urban areas of the country.

Emergency medicine residents are disproportionately located in urban areas of the country, which is contributing to an emergency physician "desert" in rural America, a new research article says.

Earlier research on clinically active emergency physicians found that the number of emergency physicians increased by more than 9,000 from 2008 to 2020. However, 92% of emergency physicians were located in urban areas, with only 6% located in large rural areas and 2% located in small rural areas.

The new research article, which was published by Annals of Emergency Medicine, identified emergency medicine residents in the 2020 American Medical Association (AMA) Physician Masterfile and compared 2020 to 2008 data. The researchers also compared the number of Accreditation Council for Graduate Medical Education-accredited emergency medicine residency programs from 2013 versus 2020.

There were nearly 7,000 emergency medicine residents in the 2020 AMA data set. The overwhelming majority of the emergency medicine residents (98%) were located in urban areas, with 6,850 of the clinicians in urban areas, 114 in large rural areas, and 23 in small rural areas.

The number of residency programs increased significantly, from 160 in 2013 to 265 in 2020. However, the new residency programs were disproportionately added in states that already had a high number of programs.

• In California, the number of residency programs increased from 14 to 22
   
• In Florida, the number of residency programs increased from 5 to 19
   
• In Michigan, the number of residency programs increased from 11 to 25
   
• In New York, the number of residency programs increased from 21 to 31
   
• In Ohio, the number of residency programs increased from 9 to 18
   
• In Pennsylvania, the number of residency programs increased from 12 to 21

Several, mostly rural, states had no emergency medicine residency programs in 2013 or 2020: Alaska, Hawaii, Idaho, Montana, North Dakota, South Dakota, and Wyoming.

"The number of emergency medicine residency programs has increased; most new programs were added to the states that already had emergency medicine residency programs. There is an emergency physician 'desert' in the rural United States, lacking both residents and residency training programs," the co-authors of the new research article wrote.

Telehealth could help address the shortage of emergency medicine physicians in rural areas, the co-authors wrote. "One potential means of bringing emergency physician care to these rural areas without necessarily bringing the emergency physicians there could be an expansion of telehealth infrastructure and increased uptake of telehealth in the rural areas where emergency physician care is most needed."

Having emergency medicine residents work in rural areas is an attractive option to relying on telehealth, they wrote. "Increased emphasis on and availability of rural rotations for emergency medicine residents could alternatively provide residents exposure to clinical sites not routinely encountered in their training and increase the rate of graduating emergency physician residents relocating to these environments. Ultimately, if we are not increasing the opportunities for residents to practice in rural, more resource-limited environments, it is likely that many will be unprepared for the unique challenges of working in these environments and subsequently more unwilling to take more jobs in rural areas."