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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link="#0563C1" vlink="#954F72"><div class=WordSection1><p class=MsoNormal><span style='font-size:9.0pt;font-family:"Arial",sans-serif'><img width=624 height=152 style='width:6.5in;height:1.5833in' id="Picture_x0020_1" src="cid:image009.png@01D409A6.C1BFCA60" alt="Description: Description: Description: Description: CAL/AAEM: California Chapter of the American Academy of Emergency Medicine"></span><span style='font-size:9.0pt;font-family:"Arial",sans-serif'><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:9.0pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><div style='margin-left:15.0pt;margin-top:7.5pt;margin-right:15.0pt;margin-bottom:7.5pt' id=content><div style='border-top:solid #7F7F7F 1.0pt;border-left:none;border-bottom:solid #7F7F7F 1.0pt;border-right:none;padding:4.0pt 0in 4.0pt 0in'><p class=MsoNormal><b><span style='font-size:11.0pt;font-family:"Arial",sans-serif;color:#7F7F7F'>June 18, 2018<o:p></o:p></span></b></p></div><div style='margin-top:11.25pt;margin-bottom:11.25pt'><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:#DF0009'><o:p> </o:p></span></b></p><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:#DF0009'>ER STAFFING SPLIT ALONG URBAN-RURAL DIVIDE<o:p></o:p></span></b></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0070C0'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0070C0'><a href="https://www.healthleadersmedia.com/clinical-care/er-staffing-split-along-urban-rural-divide-0">HealthLeaders</a></span><span style='color:#0070C0'><o:p></o:p></span></p><p class=MsoNormal style='margin-right:15.7pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'>BY CHRISTOPHER CHENEY | JUNE 18, 2018<o:p></o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'>Nearly two-thirds of emergency medicine physicians work in urban communities, and the staffing mix in rural counties reflects an emergency physician shortage in those areas of the country.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'>"Rural area patients are now considered a disparity population, and rural areas are faced with an ongoing problem of insufficient numbers of emergency medicine-specialty physicians to staff their emergency departments," Hall told HealthLeaders last week.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'>Hall says earlier research has shown that rural areas have fewer incentives and more barriers compared to urban areas for ER physicians seeking employment. That research found several factors influence job location choice:<o:p></o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><ul style='margin-top:0in' type=disc><li class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:60.95pt;margin-bottom:11.25pt;margin-left:0in;mso-list:l3 level1 lfo4'><span style='font-family:"Arial",sans-serif'>Lifestyle<o:p></o:p></span></li><li class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:60.95pt;margin-bottom:11.25pt;margin-left:0in;mso-list:l3 level1 lfo4'><span style='font-family:"Arial",sans-serif'>Access to amenities and recreation<o:p></o:p></span></li><li class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:60.95pt;margin-bottom:11.25pt;margin-left:0in;mso-list:l3 level1 lfo4'><span style='font-family:"Arial",sans-serif'>ER volume and acuity<o:p></o:p></span></li><li class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:60.95pt;margin-bottom:11.25pt;margin-left:0in;mso-list:l3 level1 lfo4'><span style='font-family:"Arial",sans-serif'>Family and spouse considerations<o:p></o:p></span></li><li class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:60.95pt;margin-bottom:11.25pt;margin-left:0in;mso-list:l3 level1 lfo4'><span style='font-family:"Arial",sans-serif'>Access to specialists<o:p></o:p></span></li><li class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:60.95pt;margin-bottom:11.25pt;margin-left:0in;mso-list:l3 level1 lfo4'><span style='font-family:"Arial",sans-serif'>Location of residency programs, which are mostly set in urban locations<o:p></o:p></span></li></ul><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'>In rural areas, research published in 2013 indicates there also are budgetary and strategic factors at play in the employment of ER physicians. Some hospital executives reported that low ER patient volume and acuity did not justify hiring emergency medicine specialists. The executives also reported satisfaction with the care provided by their non-emergency medicine physicians and advanced practice providers.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'>In rural areas, cost considerations discourage the hiring of emergency medicine physicians, Hall says." A provider mix with preferential hiring of non-emergency medicine physicians and advance practice providers at lower salaries can form a larger staff than a few highly paid emergency medicine-specialty physicians, which can in turn provide care to larger rural areas.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'>Hall and his team found that rural areas have a much larger proportion of nonemergency physicians and advanced practice providers than urban areas.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'>In the study, which was published by Annals of Emergency Medicine, urban counties accounted for 50,157 emergency medicine clinicians, with ER physicians dominating the mix:<o:p></o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><ul style='margin-top:0in' type=disc><li class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:60.95pt;margin-bottom:11.25pt;margin-left:0in;mso-list:l0 level1 lfo1'><span style='font-family:"Arial",sans-serif'>Emergency physicians, 63.9%<o:p></o:p></span></li><li class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:60.95pt;margin-bottom:11.25pt;margin-left:0in;mso-list:l0 level1 lfo1'><span style='font-family:"Arial",sans-serif'>Non-emergency physicians such as family practice doctors, 12.0%<o:p></o:p></span></li><li class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:60.95pt;margin-bottom:11.25pt;margin-left:0in;mso-list:l0 level1 lfo1'><span style='font-family:"Arial",sans-serif'>Advanced practice providers such as nurse practitioners and physician assistants, 24.1%<o:p></o:p></span></li></ul><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'>Rural counties accounted for 8,408 emergency medicine clinicians, with non-emergency physicians and advanced practice providers outnumbering emergency medicine physicians:<o:p></o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><ul style='margin-top:0in' type=disc><li class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:60.95pt;margin-bottom:11.25pt;margin-left:0in;mso-list:l2 level1 lfo2'><span style='font-family:"Arial",sans-serif'>Emergency physicians, 44.8%<o:p></o:p></span></li><li class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:60.95pt;margin-bottom:11.25pt;margin-left:0in;mso-list:l2 level1 lfo2'><span style='font-family:"Arial",sans-serif'>Non-emergency physicians, 28.3%<o:p></o:p></span></li><li class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:60.95pt;margin-bottom:11.25pt;margin-left:0in;mso-list:l2 level1 lfo2'><span style='font-family:"Arial",sans-serif'>Advanced practice providers, 26.8%<o:p></o:p></span></li></ul><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'>In addition to lower staffing costs and easing the ER physician shortage, Hall says non-emergency physicians and advanced practice providers are a good fit at rural ERs with expanded care models. He says non-ER physician providers can be essential caregivers in an integrated emergency medicine and primary care model." As emergency departments increasingly serve as health safety nets in rural areas—becoming both primary sources for hospital admission and hubs for unplanned acute care—a mixed ER staff of emergency physicians, non-emergency physicians, and advanced practice providers may be able to better collaborate on care coordination."<o:p></o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'>Under this model, non-emergency physicians and advanced practice providers give more comprehensive care than traditional ER models, says Hall, an assistant professor at the University of Washington School of Medicine in Seattle."<o:p></o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'>The varied and usually primary care-centered training and skills of non-emergency medicine physicians and advanced practice providers serve as a valuable asset in addressing patients' health over a longer term than typically considered in traditional ER models."<o:p></o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'>Hall says hospital executives should consider four factors when deciding ER staffing targets:<o:p></o:p></span></p><ul style='margin-top:0in' type=disc><li class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:60.95pt;margin-bottom:11.25pt;margin-left:0in;mso-list:l1 level1 lfo3'><span style='font-family:"Arial",sans-serif'>Whether patient volume is large enough to generate a cost-neutral or cost-saving employment of emergency medicine physicians<o:p></o:p></span></li><li class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:60.95pt;margin-bottom:11.25pt;margin-left:0in;mso-list:l1 level1 lfo3'><span style='font-family:"Arial",sans-serif'>Whether budget considerations dictate the hiring of non-emergency physician staff to serve a coverage area adequately<o:p></o:p></span></li><li class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:60.95pt;margin-bottom:11.25pt;margin-left:0in;mso-list:l1 level1 lfo3'><span style='font-family:"Arial",sans-serif'>Whether the care model favors emergency physicians or a more balanced mix of healthcare providers<o:p></o:p></span></li><li class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:60.95pt;margin-bottom:11.25pt;margin-left:0in;mso-list:l1 level1 lfo3'><span style='font-family:"Arial",sans-serif'>Whether there is the capability to provide training and experience for non-ER physicians who lack emergency medicine board certification<o:p></o:p></span></li></ul><p class=MsoNormal style='margin-right:30.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:45.95pt'><span style='font-family:"Arial",sans-serif'>Christopher Cheney is the senior clinical care editor at HealthLeaders.<br><br><o:p></o:p></span></p></div><p class=MsoNormal style='margin-right:15.75pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><strong><span style='font-family:"Arial",sans-serif'>Jeff Wells</span></strong><span style='font-family:"Arial",sans-serif'><br>Deputy Editor, CAL/AAEM News Service<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><strong><span style='font-family:"Arial",sans-serif'>Brian Potts</span></strong><b><span style='font-family:"Arial",sans-serif'> MD, MBA</span></b><span style='font-family:"Arial",sans-serif'><br>Managing Editor, CAL/AAEM News Service<br><br></span><o:p></o:p></p></div><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'>Contact us at: <span style='color:#0070C0'><a href="mailto:calaaem.news.service1@gmail.com">calaaem.news.service1@gmail.com</a></span><br><br>For more articles, visit our <span style='color:blue'><a href="http://www.calaaem.org/news_archives.php"><span style='color:blue'>archives</span></a></span>. <br><br></span><span style='font-size:9.0pt;font-family:"Arial",sans-serif'><a href="mailto:somcaaem@uci.edu"><span style='font-size:7.5pt;font-family:"Verdana",sans-serif;color:black;text-decoration:none'>To</span></a></span><span style='font-size:7.5pt;font-family:"Verdana",sans-serif;color:#0070C0'><a href="https://maillists.uci.edu/mailman/listinfo/calaaem"><span style='color:#0070C0;text-decoration:none'> </span><span style='color:blue'>unsubscribe</span></a></span><span 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