Abstract (continued) Keywords: attending physician, emergency department, rural, critical access hos- pital, physician coverage
BRIEF REPORT Health Policy Lack of 24/7 Attending Physician Coverage in US Emergency Departments, 2022 Carlos A. Camargo Jr MD, DrPH 1 , Krislyn M. Boggs MPH 1 , Ashley F. Sullivan MS, MPH 1 , Janice A. Espinola MPH 1 , Maeve Swanton 1 , Deborah D. Fletcher MD 2
1 INTRODUCTION 1.1 Background and Importance
physician (eg, a portion assume this based on the color of the clinician ’ s scrubs or whether they are wearing a stethoscope). However, the dramatic growth of nonphysician practitioners over the past 20 years 3 and the rural shortage of emergency physicians 4 have raised concerns about the declining presence of physicians in US EDs. 1.2 Goals of This Investigation The objective of the current study was to identify the per- centage of US EDs without 24/7 attending physician coverage and to investigate the location and characteristics of these EDs.
An essential characteristic of US emergency departments (EDs) is their availability 24 h/d, 7 d/wk (24/7) for anyone who seeks medical care. 1 An American College of Emergency Physicians poll from 2021 suggests that nearly 80% of the US public report that they most trust a physician to lead their medical care while in the ED compared with a nurse, physician assis- tant, or nurse practitioner. 2 This same American College of Emergency Physicians poll suggests that adults do make as- sumptions about whether their treating ED clinician is a
1 Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA 2 Department of Emergency Medicine, Willis-Knighton Medical Center, Shreveport, Louisiana, USA
Correspondence Carlos A. Camargo, MD, Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua St, Suite 920, Boston, MA 02114, USA. Email: ccamargo@mgb.org Received: August 23, 2024 Revised: December 1, 2024 Accepted: December 3, 2024 https://doi.org/10.1016/j.acepjo.2025.100050
Abstract Objectives: The growth of nonphysician emergency department (ED) practi- tioners and the rural shortage of emergency physicians have raised concerns about the declining presence of physicians in EDs. Our objective was to identify the percentage of US EDs without 24/7 attending physician coverage and to investigate the location and characteristics of these EDs. Methods: The National ED Inventory (NEDI)-USA survey is sent annually to the ED director of every nonfederal US ED. The 2022 survey (administered in 2023 to all EDs open during 2022) included the question: “ Is at least one attending physician (not resident) on duty in the ED 24 h/d? ” The NEDI-USA database includes basic ED characteristics such as annual visit volume, critical access hospital (CAH) status, rural location, and freestanding ED status. We investigated the association of ED characteristics with a lack of 24/7 attending physician coverage. Results: The 2022 NEDI-USA database identi fi ed 5622 EDs, of which 4621 (82%) responded to the 24/7 attending physician question. Overall, 344 of 4621 (7.4%) EDs reported the absence of 24/7 attending physician coverage. In several states, ≥ 30% of the state EDs lacked 24/7 coverage; the states with the highest percentages were North Dakota (58%), South Dakota (56%), and Montana (46%). Among these 344 EDs, 318 (92%) had annual visit volumes < 10,000. Most EDs (307 [89%] of 344) were in a CAH; 248 (72%) were rural, and 6 (2%) were freestanding. Conclusion: Approximately 1 in 13 US EDs lacks 24/7 attending physician coverage. The absence of 24/7 attending physician coverage was more common in low-volume EDs and CAHs. These observations highlight important gaps in ED care nationally. Changes in CAH regulations may help address this impor- tant workforce issue. abstract continues
FIGURE. Percentage of US emergency departments without 24/7 attending physician coverage by state, 2022.
Supervising Editor: Henry Wang, MD, MS © 2025 The Authors. Published by Elsevier Inc. on behalf of American College of Emergency Physicians. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).
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