Leon Haley, vice chair of clinical affairs in the Department of Emergency Medicine at Emory University and deputy senior vice president of medical affairs for the Grady Health System, said we will not be able to produce enough trained emergency medicine board-certified physicians to match the demand in the coming years. He said emergency department (ED) visits have increased 32 percent since 1990, from 90 million to 120 million, and the U.S. population continues to increase rapidly, especially in areas such as the South and Southwest. At the same time, the number of hospitals that provide emergency care has declined. There are now approximately 485 fewer EDs and approximately 198,000 fewer hospital beds than there were in 1990.

In 2002 approximately 25,000 physicians identified themselves as ED physicians, although not all practiced in the ED. Many additional physicians are employed in the ED who do not have that specialty training. Although there has been a 79 percent increase in the number of emergency medicine practitioners over the past 10 years and the resident workforce has increased 116 percent, overall supply will not be able to match the increasing demand in the coming years, especially in the areas that have experienced the most population growth.

Approximately 95,000 nurses are practicing in emergency carecenters across the country, including about 4,000 advanced-practice nurses. Approximately 2,300 physician assistants (PAs) are providing care in EDs. It is critically important to note, Haley said, that there is no current certification for either of those groups for specialty training in emergency medicine. A few PA programs are designed to help train PAs in emergency medicine, but there is no defined certification, nor is there defined certification for nurse practitioners.


J. Wayne Meredith, director of the Division of Surgical Sciences and a Richard T. Myers professor and chair of the Department of General Surgery at Wake Forest University, said the workforce in surgery is not only failing to grow, but is shrinking relative to the population. General surgery training programs in the United States turn out just under a thousand general surgery training chief residents every year. They have done that every year for the past 30 years. In addition, this year 80 percent of those graduates will go on to do some sort of fellowship training on top of their general surgery training (as compared to about 20–30 percent 25 years ago). So the number of people who are available to practice general surgery is dramatically diminishing, he said. “Hyperspecialization is creating too few people who can practice general surgery and more people who can only do highly

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