title: Rural Emergency Medicine: patient volume and training opportunities.
abstract: BACKGROUND
  A paucity of board-certified Emergency Physicians practice in rural Emergency Departments (EDs). One proposed solution has been to train residents in rural EDs to increase the likelihood that they would continue to practice in rural EDs. Some within academic Emergency Medicine question whether rural hospital EDs can provide adequate patient volume for training an Emergency Medicine (EM) resident.
  
  
  OBJECTIVE
  To compare per-physician patient-volumes in rural vs. urban hospital EDs in Oklahoma (OK) and the proportion of board-certified EM physicians in these two ED settings.
  
  
  METHODS
  A 21-question survey was distributed to all OK hospital ED directors. Analysis was limited to non-military hospitals with EDs having an annual census > 15,000 patient visits. Comparisons were made between rural and urban EDs.
  
  
  RESULTS
  There were 37 hospitals included in the analysis. Urban EDs had a higher proportion of board-certified EM physicians than rural EDs (80% vs. 28%). There were 4359 vs. 4470 patients seen per physician FTE (full-time equivalent) in the rural vs. urban ED settings, respectively (p = 0.84).
  
  
  CONCLUSIONS
  Patient volumes per physician FTE do not differ in rural vs. urban OK hospital EDs, suggesting that an adequate volume of patients exists in rural EDs to support EM resident education. Proportionately fewer board-certified Emergency Physicians staff rural EDs. Opportunities to increase rural ED-based EM resident training should be explored.
authors.affiliation: Department of Emergency Medicine, Mercy Health Center, Oklahoma City, Oklahoma, USA.
authors.forename: Jeff
authors.initials: J
authors.lastname: Reames
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Handel
authors.forename: A
authors.initials: A
authors.lastname: Al-Assaf
authors.forename: Jerris R
authors.initials: JR
authors.lastname: Hedges
mesh_terms: D000068:Accreditation; D002568:Certification; D004635:Emergency Medicine / Q000193:education*; D019538:Health Care Surveys; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006786:Hospitals, Urban; D006801:Humans; D007396:Internship and Residency; D016015:Logistic Models; D009825:Oklahoma; D010343:Patient Admission; D018709:Statistics, Nonparametric; D000078329:Workforce