The question is as clear as it is unsettling: Are there enough emergency physicians in the United States to fill all the emergency medicine jobs available? Will there be enough qualified physicians in the future? The answer will affect everything from emergency room patient care to the geographic distribution of emergency room jobs around the country.

On a related issue – the demand side – there is no debate: utilization of emergency room services keeps growing steadily. According to the General Accounting Office, emergency room visits have been growing 3% per year for the last several years and show no sign of abating. Driving this demand is the growing number of Americans who are uninsured and who consequently have had no preventive check-ups which might have red-flagged diseases before they became acute and compelled an emergency room visit.

Demographic trends in the US will exacerbate the situation: the US population is growing 2-3% per year which will organically lead to more emergency room visits. The population is also aging which will lead to more patients coming to the emergency room presenting symptoms of respiratory, cardiac and neurological disorders.

Other population trends, such as increasing substance abuse, violence and obesity, just to name a few, will also increase emergency department utilization.

Managed care programs – HMOs, PPOs, etc. – were once heralded as the answer to crowded emergency rooms, but this has not been borne out by the facts.

On the supply side, approximately 1,400 new board-certified physicians arrive at hospitals and clinics every year to fill emergency medicine jobs. This output is increasing by about 3-4% per year but is not enough to meet demand. One study predicts that the supply of emergency physicians will increase gradually to meet demand in 20 to 30 years. However, many experts disagree with this sanguine outlook and predict moderate to severe shortages in the years ahead.

One reason is that not all emergency medicine jobs are found in the emergency room. For example, some emergency medicine physicians will choose jobs in hospital healthcare administration, governmental healthcare administration or medical research. Others will opt to work in non-clinical specialties such as toxicology or sports medicine. Still others will work in clinical emergency medicine jobs at hospitals but less than full-time. All of these career tracks will not help fill full-time emergency medicine job shifts at US hospitals.

Perhaps some of the excess emergency room demand will be met by ER physicians who are not certified by the American Board of Emergency Medicine (ABEM). While the exact number of non-board-certified physicians working in emergency departments today is unknown, one study a few years ago estimated that the percentage could be as high as 50%. However, as the supply of ABEM-certified emergency physicians grows, and as hospitals increasingly require ABEM certification as a condition of employment, the supply of these "non-specialists" will decline .

However, many of these physicians have had long careers in emergency medicine and they will continue to work in the emergency rooms of the future if only for the fact that they will be needed to serve the demand, particularly in rural, low-volume and other less-than-desirable work environments.

Another factor affecting the emergency medicine job workforce is the growing role of non-physician ER providers, such as nurse practitioners (NPs) and physician assistants (PAs). It is widely believed that one NP or PA can increase the efficiency of one primary care physician by approximately 50%. However, it is unclear if this is also true in emergency medicine. What is undisputable is that these mid-level providers can handle a significant portion of emergency department encounters at salaries which are substantially lower than emergency medicine physicians.

And their numbers continue to grow – by as much as 50% over the last few years – as they are turned out at a rate almost three times the output of US medical schools. The hope is that these mid-level practitioners will fill many of the emergency medicine jobs at hospitals and clinics in the future, taking some of the pressure off emergency room physicians.