Workforce Projections for Emergency Medicine: How Many Emergency Physicians Does the United States Need?

Objective: To mathematically model the supply of and demand for emergency physicians (EPs) under different workforce conditions.
Methods: A computer spreadsheet model was used to project annual EP workforce supply and demand through the year 2035. The mathematical equations used were: supply = number of EPs at the beginning of the year plus annual residency graduates minus annual attrition; demand = 5 full-time equivalent positions/ED X the number of hospital EDs. The demand was empirically varied to account for ED census variation, administrative and teaching responsibilities, and the availability of physician extenders. A variety of possible scenarios were tested. These projections make the assumption that emergency medicine (EM) residency graduates will preferentially fill clinical positions currently filled by EPs without EM board certification.
Results: Under most of the scenarios tested, there will be a large deficit of EM board-certified EPs well into the next century. Even in scenarios involving a decreasing "demand" for EPs (e.g., in the setting of hospital closures or the training of physician extenders), a significant deficit will remain for at least several decades. Conclusions: The number of EM residency positions should not be decreased during any restructuring of the U.S. health care system. EM is likely to remain a specialty in which the supply of board-certified EPs will not meet the demand, even at present levels of EM residency output, for the next several decades.     

Equity of African American Men in Headache in the United States: A Perspective From African American Headache Medicine Specialists (Part 2)

In part 1 of this opinion piece, we described inherent and potential challenges of the equity of African American (AA) men in headache medicine including headache disparities, mistrust, understudied/lack of representation in research, cultural differences, implicit/explicit bias, and the diversity tax. We shared personal experiences related to headache medicine likely faced due to the color of our skin. In part 2, we offer possible solutions to achieve equity for AA men in headache including: (1) addressing head and facial pain disparities and mistrust in AA men; (2) professionalism and inclusion; (3) organizational/departmental leadership buy-in for racial diversity; (4) implicit/explicit and other bias training; (5) diversity panels with open discussion; (6) addressing diversity tax; (7) senior mentorship; (8) increased opportunities for noteworthy and important roles; (9) forming and building alliances and partnerships; (10) diversity leadership training programs; (11) headache awareness, education, and literacy with a focus to underrepresented in medicine trainees and institutions; and (12) focused and supported the recruitment of AA men into headache medicine.     

The Very Important Person (VIP) and the Headache Medicine Physician

Headache medicine specialists often treat VIPs but little is known about whether these encounters are different than with other patients. Questions considered include who is a VIP, should you treat a VIP like any other patient, and what are the challenges and advantages? A non-random sampling of comments is presented from headache medicine specialists. Eleven principles are presented to consider in these encounters.     

Complementary and Alternative Medicine Use for Headache and Migraine: A Critical Review of the Literature

Contexts.— An evidence base for complementary and alternative medicine (CAM) consumption within general populations is emerging. However, research data on CAM use for headache disorders remain poorly documented. This paper, constituting the first critical review of literature on this topic, provides a synopsis and evaluation of the research findings on CAM use among patients with headache and migraine. Methods.— A comprehensive search of literature from 2000 to 2011 in CINAHL, MEDLINE, AMED, and Health Sources was conducted. The search was confined to peer‐reviewed articles published in English reporting empirical research findings of CAM use among people with primary headache or migraine. Results.— The review highlights a substantial level of CAM use among people with headache and migraine. There is also evidence of many headache and migraine sufferers using CAM concurrent to their conventional medicine use. Overall, the existing studies have been methodologically weak and there is a need for further rigorous research employing mixed method designs and utilizing large national samples. Discussion.— The critical review highlights the substantial prevalence of CAM use among people with headache and migraine as a significant health care delivery issue, and health care professionals should be prepared to inquire and discuss possible CAM use with their patients during consultations. Health care providers should also pay attention to the possible adverse effects of CAM or interactions between CAM and conventional medical treatments among headache and migraine patients.     

Assessment of Emergency Physician Workforce Needs in the United States, 2005

Objectives: The objective was to estimate emergency physician (EP) workforce needs, taking into account the diversity of U.S. emergency departments (EDs) and various projections of EP supply and demand. Methods: The 2005 National ED Inventory‐USA ( http://www.emnet‐usa.org/ ) provided annual visit volumes for 4,828 U.S. EDs. The authors calculated annual supply based on existing emergency medicine (EM) board‐certified EPs, adding newly board‐certified EPs, and subtracting board‐certified EPs who died or retired. Demand was estimated at each ED by dividing the number of visits by the average EP volume (based on 2.8 patients/hour, 40 hours/week, and 34% nonclinical time). The models assumed that at least 1 EP should be present 24/7 in each ED, which would require at least 5.35 full‐time equivalents (FTEs) per ED. Based on annual EP attrition estimates, results for best‐case, worst‐case, and intermediate scenarios were calculated. Results: In 2005, there were approximately 22,000 EM board‐certified EPs, but 40,030 EPs would be needed to staff all 4,828 EDs (55% of demand met). A total of 2,492 (52%) EDs had a visit volume that required the minimum number (5.35) FTEs, of which 47% were rural. In the unrealistic (no attrition), best‐case scenario, it would take until 2019 to staff all EDs with board‐certified EPs. In the worst‐case scenario (12% attrition), supply would never meet demand. Our intermediate scenario (2.5% attrition) suggested that board‐certified EPs would satisfy workforce needs in 2038. Conclusions: Supply of EM residency‐trained, board‐certified EPs is not likely to meet demand in the near future. Alternative EP staffing arrangements merit further consideration.