HFO Radius: Issue 5, March 2011: Emergency Department Physician Supply

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HFO Radius logoThe Research

What type of physicians work in Ontario Emergency Departments (EDs)? What is the ED physician supply and distribution and how has it changed over the past five years? Are there gaps in coverage? These are some of the questions that planners and decision-makers tasked with ensuring sustainable ED services in Ontario have been asking.

To answer these questions, our analysis focused on the specialties of emergency medicine (FRCP-EM), family medicine (FM) and family medicine-emergency medicine (CCFM-EM) from 2004 to 2009. A variety of data sources were utilized including the Ontario
Health Insurance Program (OHIP) claims data, Ontario Physician Human Resources Data Centre (OPHRDC), National Ambulatory
Care Reporting System (NACRS) and the Emergency Department Coverage Demonstration Project (EDCDP).

Emergency department serviceMethods

The analysis identified all physicians in Ontario who provided at least one ED service by examining OHIP ED fee codes for services provided in an ED. This data was then matched to the active physician registry data from the OPHRDC, using the OHIP billing number, to determine physician specialties and primary practice location. This data was subsequently matched to the NACRS data to determine the hospital level information for each ED service. The criteria found to the right was applied to determine the ED physician workforce.

Key Findings Between 2004 and 2009

  • In 2009, 2,429 FM, CCFP-EM and FRCP-EM physicians worked at least one shift in an ED, with the following distribution: 63% FM, 29% CCFP-EM and 8% FRCP-EM.
  • 6% fewer FM physicians worked in EDs, despite an 8% increase in the provincial supply of FM physicians. The number of FRCP-EM and CCFP-EM physicians that worked in EDs increased by 42% and 54% respectively.
  • Categorizing physicians according to the number of shifts worked in an ED in a year resulted in the following distribution in 2009: 41% working full-time (100+ shifts), 28% working part-time (50-99 shifts) and 31% working casually (1-49 shifts). FM physicians were more likely to work part-time or casually in an ED.
  • FM physicians are a significant workforce in Ontario EDs, especially in rural Ontario.

Geographic Distribution:

FM physicians were more likely to work in rural EDs than their FRCP-EM and CCFP-EM counterparts. Rural was defined as a census subdivision with a Rurality Index of Ontario (RIO) score of 40 or more.

Emergency Department distribution

Limitations

  • The physician's primary practice location was used to determine whether the physician worked in a rural area. Physicians may work across multiple geographic boundaries (e.g. locums), which this data does not address. However, a comparison of the physician's primary practice location with the primary hospital location (where majority of ED services were provided) did not reveal significant differences.

Questions to Consider

  • What factors are leading to the decline in the number of family medicine physicians working in EDs? Are there specific factors that may influence a family medicine physician to provide some ED coverage?
  • Do FRCP-EM and CCFP-EM physicians share similar practice profiles in EDs?

Coming Soon

A more comprehensive report that further examines the demographics, supply, distribution and work patterns of ED physicians working between the years 2004 and 2009 will be released Spring 2011.

Source: HFO Radius