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The first major national study of the emergency medicine workforce shows that 32,026 physicians are clinically employed in this new specialty that emerged over the past 30 years in the United States, according to the May issue of Annals of Emergency Medicine. Another study in the issue reports that male spectators in the 20- to 35-year old age group consume the most alcohol at sporting events; 10.8 percent of those in the study were found to be legally intoxicated, and almost 5 percent of spectators with blood alcohol levels of .08 percent or higher claimed to be driving home.
A STUDY OF THE WORKFORCE IN EMERGENCY MEDICINE
A national survey of hospitals with emergency department estimates that 32,020 physicians fill 24,548 full time equivalent (FTE) positions in the nation's 4,945 hospitals with emergency departments. A total of 942 hospitals with emergency departments responded to the survey, representing all 50 states, as well as the District of Columbia and Puerto Rico (a 45.6-percent response rate).
"To begin assessing emergency medicine workforce needs, we need a description of what currently exists," said Dr. John C. Moorhead, one of the study's authors and president-elect of the American College of Emergency Physicians. "The study does not project future needs but is the first step in determining significant trends and where we need to go from here. The next step will be to conduct another study in the next 2 years and compare the results."
The study also indicates there are 4.96 FTEs (full-time equivalents) per emergency department, with a ratio of 1.5 physicians for each FTE. The figure of 32,020 adjusts for physicians who work at more than one emergency department. The average number of emergency physicians per hospital was 7.48.
The study focuses on emergency physicians practicing clinically, not in nonclinical settings, such as teaching, research, administration, and government service. It found that emergency medicine goes beyond hospital settings into such areas as urgent care centers, observation units, cruise ships, emergency medical services, and occupational settings. Future need also would include emergency physicians providing such nonclinical services.
A majority (58 percent) of emergency physicians are residency trained and/or board certified in emergency medicine (54 percent were board certified), according to the study. Academic medical centers have the largest percentage of residency-trained or board-certified emergency physicians (65 percent). The highest percentage of nonresidency-trained and/or board certified physicians are in rural locations and federal facilities. In addition, the study found that 31 percent of emergency physicians have additional medical specialty training or are certified in other specialties; family practice (32 percent) and internal medicine (28 percent) are the dominant specialties. In addition to working an average of 40 clinical hours per week, the study found that full-time emergency physicians also spend an average of 23.6 additional hours on other tasks, consisting of 3.6 hours on nonscheduled clinical duties; 13.9 hours providing on-call backup to the emergency department; and 6.1 hours on administrative work, teaching, or research.
The results include certain characteristics of those who practice clinical emergency medicine. For example, the average age of emergency physicians is 42. Emergency physicians are predominantly white (81 percent) and male (83 percent). The highest percentage of female emergency physicians practice in academic medical centers. Public facilities (federal and nonfederal) employ the highest percentage of ethnic minority physicians, and younger emergency physicians on average practice in urban hospitals.
BASEBALL AND BEER: AN ANALYSIS OF ALCOHOL CONSUMPTION PATTERNS AMONG MALE SPECTATORS AT MAJOR LEAGUE SPORTING EVENTS
A study of 747 male spectators of drinking age found that those in the 20- to 35-year old age group consumed the most alcohol at sporting events and were the most likely to be legally intoxicated. The study was conducted at two stadiums over the course of three games at each venue using breath analyzer tests at entrance gate and during the fifth inning. A total of 50.8 percent of participants tested positive for alcohol, and 8.4 had blood alcohol levels at or above the legal limit of .08 for operating a motor vehicle, and 4.6 percent of those who were legally intoxicated during the fifth inning claimed to be driving home. Forty-one percent of participants in the 20-to 35-year old age group tested positive for alcohol, and 10.8 percent of them were legally intoxicated.
"Spectator care is a new area of focus in emergency medicine," said Dr. Jeanette Wolfe, M.D., Assistant Clinical Professor at Tufts University, Baystate Medical Center, in Massachusetts. "Although many factors contribute to spectator safety, alcohol often is cited as the most important risk for event-related injuries. The bottom line of the study is that even though there were strict alcohol management policies in place at these events, a small but disturbing number of intoxicated spectators planned to drive home. Event planners need to target this group because it consists of those who are most at risk to cause injury to themselves and others. Designated driver programs and other plans which focus on the use of alternative transportation need to be implemented and aggressively marketed to keep them from getting behind the wheel. More study also is needed to determine what interventions actually work."
OTHER ARTICLES
CHANGE OF SHIFT: SUPERSTITIONS IN MEDICINE: BAD LUCK OR BAD LOGIC? This story describes the unpredictable nature of emergency medicine, a first-hand experience of an emergency physician working in the emergency department on Friday the 13th, during a full moon. CDC UPDATE: ISOLATION OF AVIAN INFLUENCE A (H5N1) VIRUSES FROM HUMAN BEINGS-HONG KONG 1997-98. This update reports on the 16 confirmed and three suspected cases of human infection with avian influenza viruses in Hong Kong.
Copies of articles and the entire table of contents from this issue can be obtained from the Washington office of the American College of Emergency Physicians.
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Annals of Emergency Medicine is the peer-reviewed journal of the American College of Emergency Physicians, a national medical society representing more than 19,000 physicians who specialize in emergency medicine. ACEP is committed to improving the quality of emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia, and a Government Services Chapter representing emergency physicians employed by military branches and other government agencies.
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