Clinical Practice Patterns of the Emergency Physician Workforce Before and After Attrition

Practice patterns of the emergency physician workforce have garnered increasing attention in recent years. Our objective was to assess the clinical service volume preceding and settings practiced following emergency physician workforce attrition.

We performed a repeated cross-sectional analysis using 2013-2021 Medicare data. Emergency physician workforce attrition was defined as not billing for emergency department (ED) services in the year after having billed at least 50 services in the prior year. Outcomes included the following: (1) the quantity of ED-based clinical services in the years prior to attrition and (2) the observed non-ED practice settings billed after attrition.

Between 2013 and 2021, 60,140 unique emergency physicians billed Medicare for more than 50 ED services in one or more years. Of these, 13,888 exhibited workforce attrition, with annual attrition rates ranging from 3.1% to 6.6% during the study period. Compared with those who remained in practice, those who exhibited attrition delivered 12.3% fewer ED services in the year immediately preceding attrition (602.2 versus 687.0 services). Notably, 27.9% of those exhibiting attrition reduced their services by more than 50% in the year before leaving, compared with 3.5% among nonattrition physicians. After leaving emergency medicine practice, 23.7% continued billing Medicare in non-ED settings, most commonly in urgent care and office-based settings.

Emergency physicians reduce clinical service volume in the year preceding attrition from the workforce. After leaving the emergency medicine workforce, the minority transitioned to other clinical settings, with those remaining in the broader health care workforce commonly practicing in urgent care and office-based settings that bill Medicare.