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Should Family Physicians Be Ongoing Part of the ED Care Team?

October 6th, 2016

WASHINGTON, DC – If you assume having family physicians practicing in emergency departments is a stop-gap primarily used by rural EDs unable to attract clinicians trained in emergency medicine, think again.

A new study finds that family physicians practice in EDs in all settings and argues the practice should continue.

In the 1-page report published recently in American Family Physician, researchers from the Robert Graham Center for Policy Studies in Family Medicine and Primary Care found that family physicians submitted nearly 12% of the 15 million urban ED claims in 2012 and that filings by family physicians in urban settings filed the most, 67%, of the emergency care claims.

Overall, 25% of the emergency claims were from primary care physicians, including family medicine and general internal medicine professionals, according to the study.

"We know that family physicians in outlying rural settings are contributing to ERs, but nobody ever looked at their contribution in urban and suburban settings," co-author Gerald Banks, MD, MS, said in an American Academy of Family Physicians press release.

For the study, researchers used the AMA Physician Masterfile to determine how many family physicians were working in rural and urban EDs, comparing Medicare claims data from 2012 to determine their contributions by setting.

Overall, they found that 4,000 physicians working in EDs actually completed their last residency in family medicine. They also noted that, despite the misconception that family physicians only handled basic cases, their Medicare claims were for treating conditions such as strokes, heart attacks and fractures.

"The board-certified ER docs say family physicians are just treating colds and coughs, but if you look at the complexity of cases, there is no sign that's true," Banks said, adding that family physicians are vital to emergency care but that some urban hospitals are seeking to replace them with board-certified emergency physicians as a marketing tool to attract patients.

Yet because of a nationwide shortage of emergency physicians and increasing rates of ED visits, he suggested “a perfect storm” could be looming: "If family physicians were removed from all ER facilities because they don't have certification, that could represent one-third of the physician workforce in large cities.”

One solution, according to study authors, is to keep family physicians in the ED but develop an emergency medicine certification program for them, as is available in Canada.

“A shift in the credentialing standards may benefit ED physician recruitment and assure that emergency physicians are qualified, regardless of board certification,” the authors conclude.

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