Objective: To describe the training and certification of physicians who staff small EDs in rural West Virginia.
Methods: A survey of rural hospital-based EDs was performed. The authors chose to study all hospitals in counties with populations of <30,000 and in which the hospital was the only one in the county. Interviews were conducted with the medical director of the ED or the hospital administrator, depending on who was available at the time of interview. Data collected describing the emergency physicians (EPs) employed at each facility included: medical school and residency training, specialty board certification, and certification in a variety of life support courses. General information about each ED, such as census and hospital resources, was also obtained. Interview data were collected on a survey form and subsequently entered into a database. Descriptive analyses were performed.
Results: 20 hospitals met rural criteria for inclusion in the study and all were included. The median number of full-time physicians per ED was 2 (IQR 2-4). 98 part-time doctors were identified; 28 (29%) of these were residents in training. 13/40 (33%) of full-time and 37/98 (38%) of part-time physicians were foreign medical graduates. Only 3/40 (7.5%) of full-time EPs completed residency training in emergency medicine (EM). Only 4/98 (4%) of part-time EPs were residency-trained in EM. 50% of full-time EPs were board-certified in a primary care specialty. Only 5/42 (12%) of full-time EPs were board-certified in EM. One third of full-time and the majority of part-time EPs were not board-certified in any specialty whatsoever. The majority of EPs had been certified in Advanced Cardiac Life Support, but fewer had been certified in Advanced Trauma Life Support and/or Pediatric Advanced Life Support/Advanced Pediatric Life Support.
Conclusions: The majority of physicians staffing small rural EDs in West Virginia are neither residency-trained nor board-certified in EM. Further studies are warranted to determine the most efficient and effective way to maximize the skills and availability of emergency care providers in rural settings.