ER STAFFING SPLIT ALONG URBAN-RURAL DIVIDE

From HealthLeaders Media:

Key Takeaways

  • 63.9% of emergency medicine physicians work in urban areas
  • Cost factors depress hiring of emergency physicians in rural areas
  • Shortage of emergency physicians in rural areas is severe

Video of Emergency Physician Mocking Patient Goes Viral

From CBS:

“I’m sorry, sir. You were the least sick of all the people who were here who are dying,” Keegstra was heard saying on the video. “You want us to wheel you to your house in a gurney?”

When Samuel said he could not inhale, the doctor responded by laughing. “He can’t inhale? Wow. He must be dead! Are you dead, sir?”

The video also shows the doctor yanking Samuel’s arm when he could not sit up. She was also recorded cussing several times.

We’re getting closer to AI doctors

From Axios:

It’s not unrealistic to think that 80% of what doctors do will be replaced by algorithms and artificial intelligence. The idea, evangelized by venture capitalist Vinod Khosla two years ago, is that machines can more accurately diagnosis us — and that will reduce deadly medical errors and free doctors up to do other things.

The bottom line: We’re getting closer to this reality. Algorithms, for example, can already diagnose diseases from imaging scans better than human radiologists. Computers possibly could take over the entire radiology specialty.

Rural emergency departments strained by physician shortages

Press Release:

The geographical distribution of emergency physicians in the United States, and which health professions are providing emergency department care, are among the workforce issues examined in a new study published this week in the Annals of Emergency Medicine. The report is,  “State of the National Emergency Department Workforce: Who Provides Care Where?

“Emergency departments are an especially vital safety net for patients in rural settings,” said M. Kennedy Hall, a UW Medicine emergency physician and assistant professor, Department of Emergency Medicine at the University of Washington School of Medicine in Seattle. He was the lead study author.

“This study shows that there is an opportunity to address emergency medicine workforce challenges and narrow any potential gaps in training for those providing emergency care, Hall said. “Staffing differences between rural and urban communities should factor into optimal care delivery decisions and sound policymaking.”

Of 58,641 emergency medicine clinicians identified by the analysis, 61 percent (35,856) were classified as emergency physicians. Qualified health professionals who work under physician supervision, known as advanced practice providers made up 24.5 percent (14,360). Non-emergency physicians made up 14.3 percent (8,397). Among the advanced practice providers, physician assistants (68.4 percent) and nurse practitioners (31.5 percent) were most common. Among non-emergency physicians, family practice (41.7 percent) and internal medicine (19.9 percent) physicians were most represented.

In rural areas, clinicians are often trained in other specialties and advanced practice providers conduct disproportionately more emergency care, especially where there may not be an emergency physician available, the authors note.

More emergency physicians were mapped to urban counties (63.9 percent) than their rural counterparts (44.8 percent). More than one-quarter of counties (27.1 percent) had no emergency clinicians of any kind and 44.9 percent of counties had no emergency physicians reimbursed by Medicare Part B.

The highest proportion of emergency physicians can be found bi-coastally and in the Mountain Time Zone. The lowest proportions can be found in the southern United States and in the Central Time Zone.

“Our analysis revealed that more than one third of emergency department clinicians are someone other than an emergency physician,” said Hall. “This points to the need for a broader approach to emergency care training. Health systems have unique needs. Hospitals, particularly in rural areas,  will continue to be challenged to harness the provider mix in their regions.”

Hall added that the emergency services workforce is broad-based with a variety of ambulatory care skillsets in addition to emergency medicine experience.

“It is important,” he said, “to provide additional emergency medicine specific training when needed, as well as examine standards for advanced practice provideds and non-emergency physicians, especially in locations where access to trained emergency physicians is limited.”

The analysis was based on the 2014 Medicare Public Use Files, or MPUF dataset of 932,243 physicians. This group includes 58,641 (6 percent) unique emergency medicine clinicians. The study found at least 20,000 more emergency physicians than the previously published workforce analysis from a decade ago.

Rural emergency departments struggling with physician shortages, analysis finds

From Becker’s:

Workforce challenges persist in rural emergency departments amid physician shortages, according to a study in Annals of Emergency Medicine.

“Our analysis revealed that more than one third of emergency department clinicians are someone other than an emergency physician,” said the study’s lead author, M. Kennedy Hall, MD, assistant professor in the department of emergency medicine at the University of Washington School of Medicine in Seattle. “This points to the need for a broader approach to emergency care training. Health systems have unique needs, and hospitals, particularly in rural areas, will continue to be challenged to harness the provider mix in their regions.”

Implantable defibrillators may cause dilemmas for older patients

From Reuters:

Defibrillators implanted in the body to kickstart the heart can be lifesaving for some people, but as patients age they may face difficult conversations about when to replace or deactivate the devices.

Conversations about end-of-life care, in particular, can drive a wedge between patients and doctors and create difficult decisions for families, an international team of cardiologists writes in the American Journal of Medicine.

“The standard consent process does not fully inform patients receiving (the device) about all the downstream implications,” said co-author Dr. Arnold Eiser, an adjunct fellow at the Center for Public Health Initiatives at the University of Pennsylvania in Philadelphia and a professor of medicine at Drexel University.

Rural Healthcare Simulation Training Center – User Survey

From the Rural Health Information Hub:

The Rural Healthcare Simulation Training Center (RHSTC) will be located in the Praxis Center for Innovative Learning in Butte, Montana. This next generation facility will be the nation’s first, independently owned, non-affiliated, 501(c)(3) non-profit medical simulation training center focused primarily on the training needs of rural healthcare practitioners. More information is available in the RHSTC website.

RHSTC is seeking feedback on these trainings via a survey.