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10% of ED Patients See No Physician

By Stacey Kusterbeck, special to

About 10% of ED patients see no physician, a recent study found.1 Researchers analyzed 11 years of data (from 2009-2019) from the National Hospital Ambulatory Medical Care Survey, for 156,696 patient visits seen by at least one physician and 18,575 patient visits seen by no physician. Previous research found that most ED patients prefer to be seen by a physician.2 “But we knew from the data that a proportion of ED patients did not see any physician at all during their visits,” says Ellen Kurtzman, PhD, MPH, RN, FAAN, the study’s lead author and professor and executive director of Health Administration at Rutgers University.

Kurtzman and colleagues conducted a study to answer the questions: When patients do see a physician, how are those patient visits different from those that do not see a physician? Are there differences in the practice patterns when an ED patient is seen by at least one physician compared to when a similar ED patient sees no physician at all?

After controlling for patient characteristics including age, acuity, expected payment source, and chief complaint/reason for visit, the researchers identified were multiple differences in the two groups. Compared to patients who saw no physician, patients seen by at least one physician during the ED visit:

  • had 0.8 more diagnostic services ordered and provided;
  • had 0.1 more procedures provided;
  • had visits that were an average of 29.4 minutes longer;
  • were more likely to be hospitalized.

It’s unclear how the differences in ED practice patterns impacts patient care. “It could result in a higher quality of care being delivered to some patients if the additional services reflect evidence-based care. Or, alternatively, it could result in less-efficient care if the additional services reflect unnecessary care,” offers Kurtzman.


  1. Kurtzman ET, Barnow BS, Korer B. Differences in the patterns of care between emergency department visits with and without a physician. J Emerg Med 2023;65:e337-e354.
  2. Larkin GL, Hooker RS. Patient willingness to be seen by physician assistants, nurse practitioners, and residents in the emergency department: Does the presumption of assent have an empirical basis? Am J Bioeth 2010;10:1-10.

For more on this and related subjects, be sure to read the latest issue of ED Management.