Clinical Practice Patterns of the Emergency Physician Workforce Before and After Attrition - 04/03/25
, Arjun K. Venkatesh, MD, MBA a, b, Craig Rothenberg, MPH a, Jesse M. Pines, MD, MBA c, d, Fernanda Bellolio, MD, MS e, Molly M. Jeffery, PhD, MPP e, f, D. Mark Courtney, MD, MSc g, Cameron J. Gettel, MD, MHS a, bAbstract |
Study objective |
Practice patterns of the emergency physician workforce have garnered increasing attention in recent years. Our objective was to assess the clinical service volume preceding and settings practiced following emergency physician workforce attrition.
Methods |
We performed a repeated cross-sectional analysis using 2013-2021 Medicare data. Emergency physician workforce attrition was defined as not billing for emergency department (ED) services in the year after having billed at least 50 services in the prior year. Outcomes included the following: (1) the quantity of ED-based clinical services in the years prior to attrition and (2) the observed non-ED practice settings billed after attrition.
Results |
Between 2013 and 2021, 60,140 unique emergency physicians billed Medicare for more than 50 ED services in one or more years. Of these, 13,888 exhibited workforce attrition, with annual attrition rates ranging from 3.1% to 6.6% during the study period. Compared with those who remained in practice, those who exhibited attrition delivered 12.3% fewer ED services in the year immediately preceding attrition (602.2 versus 687.0 services). Notably, 27.9% of those exhibiting attrition reduced their services by more than 50% in the year before leaving, compared with 3.5% among nonattrition physicians. After leaving emergency medicine practice, 23.7% continued billing Medicare in non-ED settings, most commonly in urgent care and office-based settings.
Conclusion |
Emergency physicians reduce clinical service volume in the year preceding attrition from the workforce. After leaving the emergency medicine workforce, the minority transitioned to other clinical settings, with those remaining in the broader health care workforce commonly practicing in urgent care and office-based settings that bill Medicare.
Le texte complet de cet article est disponible en PDF.Keywords : Emergency medicine workforce, Attrition
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| Please see page XX for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Richelle J. Cooper, MD, MSHS. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: DSA, AKV, and CJG conceived the study design and performed analyses. DSA, AKV, CR, JMP, FB, MMJ, DMC, and CJG iteratively drafted the article, interpreted the results, contributed substantially to its revision, approved the final article, and agreed to be accountable for all aspects of the work. DSA takes responsibility for the paper as a whole. |
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| Data sharing statement: The entire deidentified dataset, data dictionary and analytic code for this investigation are available upon request from the date of article publication by contacting Doreen Agboh, MD at email doreen.agboh@yale.edu. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). DSA is a postdoctoral fellow in the National Clinician Scholars Program, which receives support from the Clinical and Translational Science Awards Program (TL1 TR001864) at the National Center for Advancing Translational Science, a component of the National Institutes of Health. In the past 36 months, MMJ has received unrelated funding from Nation Institute on Drug Abuse, the United States Food and Drug Administrations, the Agency for Healthcare Research and Quality, and National Center for Advancing Translational Science. CJG receives support from the American Board of Emergency Medicine/National Academy of Medicine Fellowship and the National Institute on Aging of the National Institutes of Health (R03AG073988). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation or approval of the manuscript. AKV and CJG receive support for contracted work from the Centers for Medicare and Medicaid Services to develop hospital and health care outcome and efficiency quality measures. JMP has received funding from CSL Behring and Abbott Point-of-Care for unrelated work. |
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| Presentation information: This work has been presented at the 2024 Society for Academic Emergency Medicine Annual Meeting in Phoenix, AZ on May 16, 2024. |
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