Workforce Attrition Among Emergency Medicine Non-Physician Practitioners

Abstract

Study objective

Non-physician practitioners, including nurse practitioners and physician assistants, increasingly practice in emergency departments, especially in rural areas, where they help mitigate physician shortages. However, little is known about non-physician practitioner durability and demographic trends in emergency departments. Our objective was to examine attrition rates and ages among non-physician practitioners in emergency medicine.

Methods

We conducted a repeated cross-sectional analysis using the Medicare Data on Provider Practice and Specialty and Medicare Provider Utilization and Payment Data. The study included non-physician practitioners providing at least 25 independent evaluation and management services annually for Medicare beneficiaries between 2014 and 2021. Attrition rates, defined as the absence of emergency medicine clinical services in subsequent years, were stratified by gender, clinician type, and practice urbanicity.

Results

The emergency medicine non-physician practitioner workforce grew from 14,559 to 17,679 between 2014 and 2021. Women non-physician practitioners comprised 64.6% of the workforce, and rural non-physician practitioners accounted for 15.7%. Across study years, the weighted annual attrition rate was 13.8%, rising from 12.1% in 2014 to 17.6% in 2019. Attrition rates were higher among physician assistants as well as women and rural non-physician practitioners, with median ages at attrition of 40.2 years for women and 45.9 years for men, and 38.6 years for urban non-physician practitioners versus 43.6 years for rural non-physician practitioners.

Conclusion

The rate of non-physician practitioner attrition from the emergency medicine workforce is considerably higher and occurs at younger ages than prior work evaluating emergency physician attrition, with similar identified gender and geographic disparities. Targeted retention strategies are needed to support a more durable emergency medicine workforce and reduce disparities.