Strategies for CMOs to Manage 24/7 Absence of Physicians in Emergency Departments

In a recent study published by the Journal of the American College of Emergency Physicians Open, it was revealed that 7.4% of emergency departments in the US do not have 24/7 attending physician coverage. This shortage is a pressing issue, particularly in rural communities.

Two major healthcare providers, Sanford Health and Avera Health, based in Sioux Falls, South Dakota, are facing this challenge head-on. Both organisations have turned to Advanced Practice Providers (APPs) to cover emergency rooms when attending physicians are unavailable.

Sanford Health has equipped its APPs to handle 90% of patients seeking care at an emergency room. To support these providers, Sanford Health has implemented telehealth at 31 of its rural hospitals. This technology enables virtual consults with neurology, psychiatry, and board-certified emergency medicine physicians.

Avera Health, too, has embedded telehealth technology into its rural emergency departments. This allows APPs to consult remotely with emergency physicians, ensuring quality care even in the absence of an attending physician on-site.

The strategy of relying on APPs is not without its challenges, however. Recruitment of emergency medicine physicians to work at rural hospitals is a persistent issue for both Sanford Health and Avera Health. The states with the highest percentages of hospitals without 24/7 attending physician coverage are North Dakota, South Dakota, and Montana.

To address this, Avera Health is exploring additional emergency medicine certification for its rural nurse practitioners and physician assistants. Sanford Health, meanwhile, provides simulation training for APPs who are leading emergency rooms.

Kevin Post, DO, CMO of Avera Health, notes that recruiting physicians for small, rural communities can be difficult, especially when the physicians are not from the area. Jeremy Cauwels, MD, CMO of Sanford Health, states that some of their facilities are in towns with low populations (e.g., 800 people) and low patient volumes or acuity, making it difficult to support a physician in the emergency department on a regular basis.

Despite these challenges, the use of APPs and telehealth technology is proving to be a valuable solution in addressing the physician shortage in emergency rooms. With the push of a button, an emergency medicine physician and nurse can be available in an exam room at an Avera Health rural emergency department. This technology ensures that quality care is not compromised, even in the absence of an attending physician on-site.

The physician shortage is expected to continue for at least the next 5 to 10 years, according to Post. However, with the integration of APPs and telehealth, these healthcare providers are making significant strides in ensuring that emergency care is accessible and of high quality, even in rural communities.