Board-Certified Emergency Physicians Comprise a Minority of the Emergency Department Workforce in Iowa
Board-Certified Emergency Physicians Comprise a Minority of the Emergency Department Workforce in Iowa
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DOI：
10.5811/westjem.2012.8.12783
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发表时间：
2013-03-01
影响因子：
3.1
通讯作者：
DeRoo, Eric
中科院分区：
文献类型：
--
作者：
Groth, Heather;House, Hans;DeRoo, Eric
简介：美国急诊医师学院（ACEP）认可急诊医学（EM）住院医师培训为实施EM的唯一合法途径，但爱荷华州农村人口的经济现实将继续需要雇用非EM培训的医生。我们研究的目的是更好地了解爱荷华州急诊部门（ED）目前的人员配置做法。具体而言，我们试图确定爱荷华州社区规模所需的支持雇用急诊医生（EP），确定由高级实践提供者（APP）在ED中单独覆盖的ED数量，确定4年期间人员配置的变化，并了解有助于人员配置决策的市场力量。方法：研究人员在2008年和2012年调查了爱荷华州所有119家医院的艾德招聘情况。从这些数据中，我们确定了平均人口，支持雇用EP，并进行了定性检查的原因，为雇用preferences.Results：我们发现，平均人口约85,000是需要支持EP只人员配置的做法。2012年，爱荷华州只有14个（11.8%）的急诊室配备了专门的急诊室医生。72（60.5%）的工作人员与EP和FP的组合，33（27.7%）的工作人员与FP单独，72（60.5%）有医生助理或执业护士工作，在一周的至少一部分单独覆盖。比较2008年和2012年的数据，尽管单独执业的APP数量显着增加（卡方检验），但4年来EP与FP的雇用量没有统计变化（卡方检验0.68，p=0.7118）。36，p=0.0008）。在医院的管理人员列举了几个因素，宁愿雇用EP：EP提供的护理质量，EP的可用性，高病人的急性期，和高patient volume.Conclusion：许多ED在爱荷华州仍然由家庭医学培训的医生和越来越多的员工由APP。如果没有家庭医生的贡献，该州的大部分地区将无法提供足够的紧急护理。委员会认证的急诊医生仍然集中在该州的城市地区，那里的病人数量和敏锐度支持他们的招聘。
Introduction: The American College of Emergency Physicians (ACEP) endorses emergency medicine (EM) residency training as the only legitimate pathway to practicing EM, yet the economic reality of Iowa's rural population will continue to require the hiring of non-EM trained physicians. The objective of our study is to better understand the current staffing practices of Iowa emergency departments (EDs). Specifically, we seek to determine the Iowa community size required to support hiring an emergency physician (EP), identify the number of EDs staffed by advanced practice providers (APPs) in solo coverage in EDs, determine the changes in staffing over a 4-year period, and understand the market forces that contribute to staffing decisions.Methods: Researchers surveyed all 119 hospitals throughout the state of Iowa regarding their ED hiring practices, both in 2008 and 2012. From these data, we determined the mean population that supports hiring EPs and performed a qualitative examination of the reasons given for hiring preferences.Results: We found that a mean population of approximately 85,000 is needed to support EPonly staffing practices. In 2012, only 14 (11.8%) of Iowa's EDs were staffed exclusively with EPs. Seventy-two (60.5%) staff with a combination of EPs and FPs, 33 (27.7%) staff with FPs alone, and 72 (60.5%) have physician assistants or nurse practitioners working in solo coverage for at least part of the week. Comparing the data from 2008 and 2012, there is no statistical change in the hiring of EPs versus FPs over the 4 years (Chi-square 0.68, p=0.7118), although there is a significant increase in the number of APPs in solo practice (Chi-square 11.36, p=0.0008). Administrators at hospitals cited several factors for preferring to hire EPs: quality of care provided by EPs, availability of EPs, high patient acuity, and high patient volume.Conclusion: Many EDs in Iowa remain staffed by family medicine-trained physicians and are being increasingly staffed by APPs. Without the contribution of family physicians, large areas of the state would be unable to provide adequate emergency care. Board-certified emergency physicians remain concentrated in urban areas of the state, where patient volumes and acuity support their hiring.