State of the National Emergency Department Workforce: Who Provides Care Where?
State of the National Emergency Department Workforce: Who Provides Care Where?
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DOI：
10.1016/j.annemergmed.2018.03.032
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发表时间：
2018-09-01
影响因子：
6.2
通讯作者：
Venkatesh, Arjun
中科院分区：
文献类型：
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作者：
Hall, M. Kennedy;Burns, Kevin;Venkatesh, Arjun
研究目的：根据临床医生类型描述美国目前的急救医疗劳动力，并考察城乡急救医疗劳动力的差异。方法：利用2014年联邦医疗保险公共使用文件，我们对所有在急诊科接受评估和管理(E/M)服务(级别1至5)的临床医生进行横断面研究，以获得医疗保险B部分受益人的服务费用。提供者被定义为急诊医生、非紧急医生或高级实践提供者，与Medicare Public Use Files数据集相对应。主要结果是提供超过10个E/M索赔的临床医生的数量被列为不同的相遇。结果：58,641名急诊临床医师中，35,856名(61.1%)为急诊医师，8,397名(14.3%)为非急诊医师，14,360名(24.5%)为高级医师。在被归类为急诊临床医生的非急诊医生中，家庭医生和内科医生分别占41.7%和19.9%。在高级执业医师中，医师助理(68.4%)和执业护士(31.5%)占主导地位。共有58,565名急救医学临床医生被映射到美国2,291个县或类似县。城市县的急诊医生比例(63.9%)高于农村县(44.8%)；27.1%的县没有急诊医生，41.4%的县没有医保B部分报销的急诊医生。结论：这项工作建立了新的急救劳动力基线估计，涵盖了近6万名急诊临床医生，其中急诊医生不到三分之二。城乡社区在急诊临床医生配置类型上存在显著差异。
Study objective: We describe the current US emergency medicine workforce in terms of clinician type and examine rural and urban emergency medicine workforce differences.Methods: Using the 2014 Medicare Public Use Files, we performed a cross-sectional study of all clinicians receiving reimbursement for evaluation and management (E/M) services (levels 1 to 5) to Medicare fee-for-service Part B beneficiaries in the emergency department. Providers were defined as emergency physicians, nonemergency physicians, or advanced practice providers, corresponding with the Medicare Public Use Files data set. The primary outcome was the number of clinicians providing greater than 10 E/M claims tabulated as a distinct encounter. Urbanicity data were obtained from the National Bureau of Economic Research.Results: Of 58,641 unique emergency medicine clinicians, 35,856 (61.1%) were classified as emergency physicians, 8,397 (14.3%) as nonemergency physicians, and 14,360 (24.5%) as advanced practice providers. Among nonemergency physicians categorized as emergency medicine clinicians, family practice and internal medicine predominated (41.7% and 19.9%, respectively). Among advanced practice providers, physician assistants (68.4%) and nurse practitioners (31.5%) predominated. A total of 58,565 emergency medicine clinicians were mapped to 2,291 US counties or equivalents. Urban counties had a higher proportion of emergency physicians (63.9%) compared with rural counties (44.8%); 27.1% of counties had no emergency medicine clinicians and 41.4% of counties had no emergency physicians reimbursed by Medicare fee-for-service Part B.Conclusion: This work establishes a new baseline estimate of the emergency care workforce, encompassing nearly 60,000 emergency medicine clinicians, of whom fewer than 2 in 3 were emergency physicians. Notable differences exist in the type of clinician staffing of emergency care between urban and rural communities.