Emergency Physicians Reduce Clinical Volume Before Attrition

TOPLINE:

Emergency physicians reduced their clinical service volume in the year before attrition. After leaving emergency medicine, only a minority continued practicing in other clinical settings, primarily in urgent care and office-based settings.

METHODOLOGY:

• Researchers conducted a repeated cross-sectional analysis using Medicare Data on Provider Practice and Specialty from 2013 to 2021, assessing practice patterns among 60,140 unique emergency physicians who billed for more than 50 emergency department (ED) services annually.
• Attrition was defined as not billing for ED services after previously billing at least 50 services in a year.
• The primary outcome was the ED-based service volume before attrition, and the secondary outcome was the observed practice settings after workforce exit.

TAKEAWAY:

• Annual attrition rates among emergency physicians ranged from 3.1% to 6.6% during the study period, with 13,888 physicians leaving the workforce. Among those who left emergency medicine, 23.7% continued billing Medicare, primarily in urgent care clinics (36.1%) and office-based settings (31.8%).
• Physicians who left emergency medicine provided 12.3% fewer ED services in the year before attrition than those who remained in practice (602.2 vs 687.0 services).
• A significant proportion (27.9%) of physicians who left emergency medicine reduced their service volume by more than 50% in the year before attrition, whereas only 3.5% of those who remained in practice exhibited a similar reduction.
• The most common post-attrition practice settings were urgent care clinics (36.1%), office-based settings (31.8%), and hospital outpatient departments (15.1%).

IN PRACTICE:

The authors wrote, “A substantial population of emergency physicians reduces their clinical workload before leaving the emergency medicine workforce, with the vast majority not subsequently providing services in other non-ED clinical settings.” They added, “These findings suggest that emergency medicine workforce attrition may be difficult to predict given the abrupt departure of emergency physicians from the workforce, potentially and critically exacerbating barriers to accessing emergency physician care.”

SOURCE:

The study was led by Doreen S. Agboh, MD, Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut. It was published online on March 4, 2025, in Annals of Emergency Medicine.

LIMITATIONS:

The study relied on Medicare data, which might not reflect practice changes among pediatric emergency physicians or those working in Veterans’ Affairs hospitals. Additionally, the dataset may not have fully accounted for physicians who retired or transitioned to non-clinical roles.

DISCLOSURES:

Agboh received support from the National Center for Advancing Translational Science. Additionally, other authors received financial support from various organizations. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.