• Family Physicians Help Meet the Emergency Care Needs of Rural America

    One Pagers | Apr 01, 2006
    Lars Peterson; Andrew Bazemore, MD, MPH; Martey Dodoo, PhD; Robert Phillips, MD, MSPH

    Ensuring access to emergency care in rural areas remains a challenge. High costs and low patient volumes make 100 percent staffing of rural emergency departments (EDs) by emergency medicine residency–trained physicians (EPs) unlikely. As rurality increases, so does the dependence on family physicians (FPs) to provide quality emergent care.

    Emergency medical services should be organized to meet the needs of the patient population in the most effective manner. Today, with increased specialization in medicine, many different clinicians provide ED care. Studies1,2 demonstrate that FPs provide a significant percentage of ED care; the American Academy of Family Physicians reports that 54 percent of its members provide some form of ED care, and 2.5 percent work full-time in ED care.3

    Rural hospitals, because of their smaller and less predictable patient volumes, are less likely to staff an ED with EPs.2 However, the American College of Emergency Physicians’ (ACEP’s) policy is that EPs should be the preferred providers of care in every ED.4

    Nationwide analysis from the Area Resource File shows the consistent presence of FPs, and the decline in EPs, per capita with increasing rurality (see accompanying table).5,6 The percentage of counties with an ED but no EPs increases with rurality. Available data do not account for care provided by physicians across counties.

    Table. 2001 U.S. County-Level Data on ED Workforce by RUCC

        Number per 10,000 persons of:  
    RUCC* Number of counties FPs EPs ED visits Percentage of counties with an ED but no EPs
    1 413 2.02 0.63 3,254 9
    2 325 2.63 0.65 3,215 12
    3 351 2.73 0.63 3,930 12
    4 218 2.44 0.50 4,754 12
    5 105 3.06 0.55 5,033 17
    6 609 2.68 0.29 3,974 43
    7 450 3.25 0.33 4,382 50
    8 235 1.78 0.23 2,208 28
    9 435 2.36 0.15 2,028 40

    ED = emergency department; RUCC = rural-urban continuum code; FP = family physician; EP = emergency medicine residency-trained physician.

    *-1 indicates most urban and 9 indicates most rural.6

    Source: Information from references 5 and 6.

    To succeed, ACEP’s position requiring emergency medicine board certification for credentialing in EDs would require an increase in the number of EPs, a means of inducing their practice in rural areas, and the subsidizing of rural EDs to pay for them. More viable options include designing a system of care that meets emergency care needs with a range of clinicians including FPs, and supporting combined professional efforts to ensure access to high-quality emergent care for rural populations.


    1. Moorhead JC, Gallery ME, Hirshkorn C, Barnaby DP, Barsan WG, Conrad LC, et al. A study of the workforce in emergency medicine: 1999. Ann Emerg Med 2002;40:3-15.
    2. Williamson HA, Rosenblatt RA, Hart LG. Physician staffing of small rural hospital emergency departments: rapid change and escalating cost. J Rural Health 1992;8:171-7.
    3. Practice profile survey. Leawood, Kan.: American Academy of Family Physicians, 2004.
    4. Physician credentialing and delineation of clinical privileges in emergency medicine. Policy 400171. Irving, Tex.: American College of Emergency Physicians, 2004.
    5. Bureau of Health Professions. Area Resource File 2003.
    6. Measuring rurality: rural-urban continuum codes. Washington, D.C.: U.S. Department of Agriculture, Economic Research Service, 2004. Accessed online February 13, 2006, at: http://www.ers.usda.gov/briefing/rurality/RuralUrbCon/

    Peterson LE, Bazemore AW, Dodoo MS, Phillips, RL, Jr. Family physicians help meet the emergency care needs of rural America. Am Fam Physician. 2006 Apr 1;73(7):1163.

    The information and opinions contained in research from the Graham Center do not necessarily reflect the views or the policy of the AAFP. 

    Published in American Family Physician, Apr 1, 2006. Am Fam Physician. 2006;73(7):1163. This series is coordinated by Sumi Sexton, MD, AFP Associate Medical Editor.