Staffing in small rural hospital emergency rooms: dependence on community family physicians.

Objective: This study describes the characteristics of emergency room staffing at rural hospitals in Kansas.

Methods: Administrators at 84 rural hospitals in communities of less than 5,000 were surveyed by telephone using a scripted interview.

Results: Seventy-seven hospitals provided physician-staffed emergency room services. Their average daily emergency room census was 4.4. The average hospital medical staff consisted of 2.9 physicians. Eighty-six percent of all hospital staff physicians were family physicians. Ninety-six percent of all hospital emergency room staffing was provided by the local medical staff. Fee-for-service was the only method of reimbursement to physicians in 44 hospitals. Alternatives to emergency room staffing by local physicians included contracted part-time emergency room physicians, locum tenens physicians, mid-level practitioners, or emergency room closure.

Conclusions: Rural family physicians have considerable responsibility for providing emergency care. Physicians must have adequate training in emergency medical care to practice in communities such as these.