Lack of 24/7 Attending Physician Coverage in US Emergency Departments, 2022

The growth of nonphysician emergency department (ED) practitioners and the rural shortage of emergency physicians have raised concerns about the declining presence of physicians in EDs. Our objective was to identify the percentage of US EDs without 24/7 attending physician coverage and to investigate the location and characteristics of these EDs.

The National ED Inventory (NEDI)-USA survey is sent annually to the ED director of every nonfederal US ED. The 2022 survey (administered in 2023 to all EDs open during 2022) included the question: "Is at least one attending physician (not resident) on duty in the ED 24 h/d?" The NEDI-USA database includes basic ED characteristics such as annual visit volume, critical access hospital (CAH) status, rural location, and freestanding ED status. We investigated the association of ED characteristics with a lack of 24/7 attending physician coverage.

The 2022 NEDI-USA database identified 5622 EDs, of which 4621 (82%) responded to the 24/7 attending physician question. Overall, 344 of 4621 (7.4%) EDs reported the absence of 24/7 attending physician coverage. In several states, ≥30% of the state EDs lacked 24/7 coverage; the states with the highest percentages were North Dakota (58%), South Dakota (56%), and Montana (46%). Among these 344 EDs, 318 (92%) had annual visit volumes <10,000. Most EDs (307 [89%] of 344) were in a CAH; 248 (72%) were rural, and 6 (2%) were freestanding.

Approximately 1 in 13 US EDs lacks 24/7 attending physician coverage. The absence of 24/7 attending physician coverage was more common in low-volume EDs and CAHs. These observations highlight important gaps in ED care nationally. Changes in CAH regulations may help address this important workforce issue.