Proposed Changes Would Hurt Emergency Departments

10-21-97
Hershey, Pa. -- Possible changes by the federal government to try to reduce the number of medical residents nationwide should not include emergency physicians, according to James Holliman, M.D., associate professor of surgery in Penn State's College of Medicine.

"We do not have enough board-certified emergency physicians now and to cut the number of residents would only make the problem worse," says Holliman, also associated with Penn State Geisinger Health System, Hershey Medical Center.

The new plan by the federal government is designed to reduce the overall number of doctors. The plan would pay teaching hospitals to reduce the number of residents. Hospitals that voluntarily downsize will get additional money over five years to eliminate residency positions. Federal officials believe the changes will help reduce health-care costs.

Holliman says his work is the first workforce analysis projection for emergency physicians since 1990. His results are in the article, "Workforce Projections for Emergency Medicine: How Many Emergency Physicians Does the United States Need?" in the July issue of the journal Academic Emergency Medicine.

Holliman contends that probably an additional 1,200 to 1,500 emergency physicians will be needed each year for at least the next decade. He says that estimate is based on the number of advertised openings each year. He estimates the total number of emergency physicians to be between 27,000 and 30,000 nationwide. Currently residencies graduate about 1,000 emergency physicians each year. However, Holliman contends that with a 3 percent retirement rate, that 1,000 will only keep up with demand and cutting the number would potentially be harmful to patients.

"Emergency medicine includes a lot of orthopedics, pediatrics and trauma. Internal medicine and family practice doctors do not have this specialized training. However, we should not prematurely get rid of those doctors who currently staff emergency departments. What we should do is replace them with residency-trained and board-certified emergency physicians when they retire," says Holliman.

He adds that while there may be some variables regarding the number of emergency physicians needed in the future, two keys will almost definitely mean an increase is needed.

"We know we have an aging population. The elderly legitimately need an emergency department about twice as often as young, healthy persons. We also know our population increases by about two million each year. Even if some rural emergency departments are forced to close in years to come because of costs, these two factors I have cited will definitely mean an increased use of emergency departments."

He concludes, "Any reduction in the number of emergency medicine residency graduates could result in a progressive decrease in the supply of emergency medicine board-certified emergency physicians for the United States, thereby failing to meet the future emergency medical needs of the country."

**ER DOCTORS**

Contacts:
Leilyn Perri (717) 531-8604 (o) leilyn.perri@hmc.psu.edu
M. Steven Bortner (717) 531-8607 (o) (717) 838-5910 (h)