Rural EDs Face Staffing Challenges

As the gap between supply and demand continues to grow for emergency department (ED) physicians, rural hospitals must focus on continuing education to ensure quality of ED care.

The finding comes from the Rural Health Research Center (RHRC), which surveyed a national sample of rural hospitals on ED staffing challenges and quality of care. RHRC deputy director Michelle Casey authored the study report, along with SPH professors Ira Moscovice and Doug Wholey.

"It’s not realistic to expect an increase in the number of board-certified emergency medicine physicians in rural areas anytime in the near future," says Casey.

She points to a national shortage of ED doctors, a lack of emergency medicine residency programs in rural states, and the low patient volume of rural EDs. The study found that rural hospitals are using a variety of arrangements to staff their EDs, including combinations of physicians on their own medical staff, physician assistants and nurse practitioners, and contracts with emergency physician management groups and individual physicians.

The staffing also varies significantly by hospital characteristics including ownership type, region, and size. The researchers suggest that rural EDs ramp up continuing education for these staff members. Training should focus on the technical skills needed to provide ED care and the ability to work well in teams with nurses and other hospital staff.

Survey results indicate that rural hospitals may need to add training in the areas of care for children and trauma patients.

"Staffing EDs is just one of the challenges faced by rural hospitals," says Moscovice. "As rural emergency departments continue to rely on a variety of staff members, it’s critical that those members receive the training they need to deliver effective care."