PHILADELPHIA – Family physicians play a major role in delivering emergency-medicine care, especially in rural communities, and family physicians want more people to know that.
Family physicians took a big step toward raising their emergency-care profile 2 years ago, when they started the Special Interest Group in Emergency Medicine (SIG-EM) of the American Academy of Family Physicians (AAFP). When the group held its third annual meeting, during the AAFP’s annual sessions, a top goal was boosting recognition by the health care community that family-practice physicians are the backbone for delivering a large swath of American emergency medicine, especially in places with fewer than 20,000 people.
"I think ACEP sees that a collaborative, cooperative relationship with family medicine needs to happen."
Several SIG-EM members reported numbers documenting this last May at the Association of American Medical Colleges’ Workforce Research Conference in Washington. In U.S. communities with fewer than 20,000 people, emergency department physicians without emergency medicine residency training (primarily family physicians) supplied 40%-50% of the physician workforce, reported Dr. Kim Bullock, Dr. W. Anthony Gerard, and their associates.
During 2008-2010, family physicians specifically provided 42%-51% of emergency care in six states: Arkansas, Montana, Nebraska, North Dakota, South Dakota, and Wyoming. They also provided 32%-41% of emergency medicine care in another seven states: Alabama, Alaska, Idaho, Iowa, Kansas, Louisiana, and Mississippi.
Data presented to the Workforce Research Conference also showed that during 2006-2010, the extent of family physician involvement in delivering emergency care held steady, with 24%-30% of all family physicians providing emergency care as part of their practice. Among family physicians in rural settings, roughly 40% provided emergency care.
"We want to improve recognition of family physicians in emergency medicine among the wider health-care community," Dr. Gerard said in an interview following the SIG-EM meeting.
Family physicians who provide emergency care have shifted from seeking a formal certification process for their subspecialty to just broadened recognition that family-practice physicians play an important role in providing Americans with emergency care, said Dr. Gerard, a family physician and AAFP member who practices as an emergency medicine physician at Good Samaritan Hospital in Lebanon, Pa.
"The reality is that family physicians are the rural emergency-medicine providers," he said. But, "we need to open doors [for emergency medicine] in the city, too."
"The data we compiled showed that all emergency medicine training programs are in urban academic centers," with easy access to technology and specialists, said Dr. Perry A. Pugno, AAFP’s vice president for education at the Academy’s office in Leawood, Kan.
But, "family medicine is the emergency medicine workforce outside urban settings," he added, and emergency medicine organizations have been slow to acknowledge that.
Dr. Perry A. Pugno
"We can’t produce enough" emergency medicine physicians, but the emergency-medicine organizations and societies "won’t take the step to say that we should work with family medicine because they are the ones who are out there and doing it," Dr. Pugno said.
The American College of Emergency Physicians has noticed the AAFP’s SIG-EM, and that emergency medicine organization has held out the prospect of working with family physicians. ACEP’s senior director for membership and development, Michele Byers, came to last month’s gathering of about 30 AAFP attendees.
During the SIG-EM’s meeting, Ms. Byers acknowledged the role family physicians play in emergency care: "We realize that’s a reality," she said. "We are looking at opportunities to provide CME and information to family physicians working in emergency departments," Ms. Byers said.
"I think ACEP sees that a collaborative, cooperative relationship with family medicine needs to happen," said Dr. Gerard.