Emergency medical care in rural America.

The delivery of high-quality emergency care in a rural setting requires a conceptual framework quite different from that required in urban and suburban environments, given that available resources are limited in the rural setting. The intermittent and episodic nature of seriously ill and injured patients who present to rural emergency departments makes it difficult to plan, staff, and equip in order to provide emergency medical care at the same level seen at higher volume urban or suburban institutions. The objective of this article is to describe the distinctive nature and widely unrecognized features of emergency medicine in rural and remote areas, with a focus on clinical, workforce, and economic issues. We present recommendations for a shift in thinking and a call to action on behalf of all emergency medicine professionals that are based on a realistic assessment of the current status of emergency medicine and that are needed to develop and sustain high-quality emergency medical care in rural America.

[1]  A. Drummond.  Physician services in small and rural emergency departments: a critique of the Scott Report. , 1998, The Journal of emergency medicine.

[2]  T. Larson,et al.  Highway Statistics 1990 , 1991 .

[3]  R. Cooper,et al.  Current and projected workforce of nonphysician clinicians. , 1998, JAMA.

[4]  A. Imershein,et al.  Rural community and physician perspectives on resource factors affecting physician retention. , 1992, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[5]  J. Prescott,et al.  Physicians in rural West Virginia emergency departments: residency training and board certification status. , 1998, Academic Emergency Medicine.

[6]  P. Hogan,et al.  A study of the workforce in emergency medicine. , 1998, Annals of emergency medicine.

[7]  S. Felt-Lisk,et al.  Medicaid managed care programs in rural areas: a fifty-state overview. , 1998, Health affairs.

[8]  W. Watson,et al.  Emergency medicine resident choice of practice location. , 1998, Annals of emergency medicine.

[9]  J. Kralewski,et al.  Association between rural hospitals' residencies and recruitment and retention of physicians , 1994, Academic medicine : journal of the Association of American Medical Colleges.

[10]  R M Williams,et al.  Distribution of emergency department costs. , 1996, Annals of emergency medicine.

[11]  Haskins Rj,et al.  Staffing in small rural hospital emergency rooms: dependence on community family physicians. , 1994 .

[12]  S. Oswald,et al.  Prediction of hospital failure: a post-PPS analysis. , 1996, Hospital & health services administration.

[13]  M. Cutchin.  Community and self: concepts for rural physician integration and retention. , 1997, Social science & medicine.

[14]  J. Macy.  The role of emergency medicine in the future of American medical care. , 1995, Annals of emergency medicine.

[15]  E. Blunt,et al.  Role and productivity of nurse practitioners in one urban emergency department. , 1998, Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association.

[16]  D. Wakefield,et al.  Contracting for emergency room coverage by rural hospitals. , 1994, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[17]  T. Konrad,et al.  Studying the retention of rural physicians. , 1994, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[18]  K. Fickenscher,et al.  Effects of an expanded medical curriculum on the number of graduates practicing in a rural state , 1991, Academic medicine : journal of the Association of American Medical Colleges.