ER Staffing Split Along Urban-Rural Divide

Emergency department staffing patterns have a gaping urban-rural divide, new researchshows.

In 2014 Medicare data, the distribution of emergency medicine physicians is strongly skewed toward urban areas. The researchers found that urban counties had a much higher proportion of emergency physicians -- 63.9%, compared with 44.8% in rural counties. The shortage of emergency physicians in rural areas is severe, said M. Kennedy Hall, MD, MHS, lead author of the research and an emergency department physician at Harborview Medical Center in Seattle.

"Rural area patients are now considered a disparity population, and rural areas are faced with an ongoing problem of insufficient numbers of emergency medicine-specialty physicians to staff their emergency departments."

Hall said earlier research has shown that rural areas have fewer incentives and more barriers compared with urban areas for ER physicians seeking employment. That research found that several factors influence job location choice:

  • Lifestyle
  • Access to amenities and recreation
  • ER volume and acuity
  • Family and spouse considerations
  • Access to specialists
  • Location of residency programs, which are mostly set in urban locations

In rural areas, research published in 2013 indicates that there also are budgetary and strategic factors at play in the employment of ER physicians. Some hospital executives reported that low ER patient volume and acuity did not justify hiring emergency medicine specialists. The executives also reported satisfaction with the care provided by their non-emergency medicine physicians and advanced practice providers.