While the number of patients being seen in hospital emergency departments is increasing, the emergency physician workforce has remained flat over the past two years, according to the second national study of America's emergency medicine to be published in the July 2002 Annals of Emergency Medicine. The study compares the data collected in 1999 to those data collected for the first workforce study in 1997.

"Many experts thought that the hundreds of hospital emergency department closures over the past decade would shrink demand for emergency physicians, but this study proves otherwise," said John C. Moorhead, MD, MS, one of the study's authors and a past president of ACEP. "It turns out that more patients are being seen in fewer hospital emergency departments, which have had to hire more emergency physicians to meet increased demand."

According to the study's authors, the nation could be facing an emergency physician shortage in years to come. Between 1997 and 1999, the number of practicing, board-certified emergency physicians grew by only 4 percent, while emergency department visits increased during that same period by 7 percent.

"Currently, the marketplace has just enough emergency physicians to fill the full-time positions available," said Dr. Moorhead. "But if increases in patient visits continue to outpace the number of new emergency medicine graduates entering the market, the viability of our health care safety net is greatly threatened."

In 2000, emergency departments reported volume climbed to a 108 million patient visits, an increase of 14 percent from 1997. A study published in the April 2002 Annals of Emergency Medicine found patients visiting California emergency departments are sicker than ever before, and noted critical emergency care visits increased 59 percent between 1990 and 1999.

"The alarm bells in the nation's emergency departments have been sounding for some time," said Dr. Moorhead. "As the country's population ages and the number of uninsured Americans increases, it is inevitable that patients with more complex and severe medical problems will seek emergency medical care. These patients require a higher level of care, which will take physicians more time to diagnose and treat, ultimately increasing the need for more highly trained emergency physicians."

The survey found in 1999, approximately 32,000 physicians practicing emergency medicine on a full-time basis. Nearly two-thirds (62 percent) of those physicians are board certified in emergency medicine, and most practice in urban emergency departments.

"Since jobs are still available to new emergency medicine graduates in urban areas, we have not seen a significant migration of board-certified emergency physicians to rural areas," said Dr. Moorhead. "This speaks to the need to expand the number of rural residency slots in emergency medicine. ACEP is coordinating a multi-organizational group to develop a strategy for training physicians to staff rural emergency departments and to encourage migration of board-certified emergency physicians to rural areas."

Annals of Emergency Medicine is the peer-reviewed journal of the American College of Emergency Physicians, a national medical organization with nearly 23,000 members. ACEP is committed to improving the quality of emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia, and a Government Services Chapter representing emergency physicians employed by military branches and other government agencies.