DO ESTIMATES OF EMERGENCY PHYSICIAN WORKFORCE UNDERESTIMATE CURRENT NEEDS

Study objective: Two widely used formulas for calculating the number o f practicing emergency physicians (EPs) are based on the total number of US emergency departments and patient visits. In this study we hypot hesized that the number of physicians now working in EDs is significan tly greater than the estimates yielded by these formulas. Therefore we attempted to determine the accuracy of these methods for predicting t he true number of practicing EPs. We also examined the training, board certification, and distribution of EPs. Methods: The EDs of all hospi tals listed by the Missouri Hospital Association (MHA), excluding chil dren's and psychiatric hospitals, were surveyed over a 9-month period in 1994 with regard to the number and board status of all physicians p racticing in their EDs and the numbers of full-time equivalents (FTEs) required for adequate staffing. These numbers were compared with 1994 estimates for Missouri based on two common methods of calculation. Re sults: Of 134 hospitals with EDs, 118 (88%) completed our survey. Thes e EDs employed 458 full-lime EPs and 690 part-time EPs, with 41% and 7 % board-certified in emergency medicine, respectively. Board-certified emergency physicians were concentrated in large cities and at univers ity hospitals and were sparsely represented in rural areas. Adequate s taffing of these EDs required 677 FTEs, compared with estimates of 358 (formula A) and 555 (formula B). Previously published formulas undere stimate the need for EPs in our stare by 47% (formula A) or 18% (formu la B). Conclusion: Current staffing estimates regarding EPs working in Missouri greatly underestimate actual staffing needs. Board-certified EPs are in severe shortage and are unequally distributed in Missouri. Extrapolated nationally, these estimates may negatively affect fundin g and available residency positions for emergency medicine.