Workforce Attrition Among Emergency Medicine Non-Physician Practitioners

Area of Science:

• Emergency Medicine
• Health Workforce Research
• Healthcare Policy

Background:

• Non-physician practitioners (NPPs), including nurse practitioners and physician assistants, are crucial in emergency departments (EDs), especially in rural settings, to address physician shortages.
• Limited data exists on the durability and demographic trends of NPPs in EDs.
• Understanding NPP attrition is vital for maintaining ED staffing and patient care.

Purpose of the Study:

• To investigate attrition rates and demographic trends among NPPs in emergency medicine.
• To identify factors influencing NPP departure from the ED workforce.

Main Methods:

• A repeated cross-sectional analysis was performed using Medicare data from 2014 to 2021.
• The study included NPPs providing at least 25 independent evaluation and management services annually for Medicare beneficiaries.
• Attrition was defined as the cessation of ED clinical services, stratified by gender, clinician type, and practice urbanicity.

Main Results:

• The ED NPP workforce grew between 2014 and 2021, with women comprising 64.6% and rural practitioners 15.7%.
• The weighted annual attrition rate was 13.8%, increasing from 12.1% in 2014 to 17.6% in 2019.
• Higher attrition was observed among physician assistants, women, and rural NPPs, with earlier attrition ages compared to physicians.

Conclusions:

• NPP attrition from emergency medicine is higher and occurs at younger ages than physician attrition.
• Gender and geographic disparities in attrition mirror those found in physician data.
• Targeted retention strategies are essential to enhance the durability of the emergency medicine workforce and mitigate disparities.