Readers Forum: More Emergency Physicians Vital to State

By JOHN C. SACRA

Last month the American College of Emergency Physicians released a report that ranked Oklahoma 48th out of 50 states and the District of Columbia in a national report card on the State of Emergency Medicine. Do Oklahomans deserve better emergency medicine services? What could be done to improve the situation and is it worth the trouble?

The ACEP’s national report card gave Oklahoma a D-plus on factors in four categories: access to emergency care, quality and patient safety, public health and injury prevention and the medical liability environment. The report, which addresses state support for the emergency care system, confirms what Oklahoma experts already knew and recommends that Oklahoma increase the number of board certified emergency physicians and improve disaster-response training.

Modern roles for emergency physicians encompass not only care provided in hospital emergency departments but also support for pre- hospital care, injury prevention, disaster medicine and trauma system development.

Board certified emergency physicians, who have a wide-breadth of medical knowledge and require three years of post-graduate training prior to sitting for board examinations, are essential to care for ill patients of all ages and individuals injured in motor vehicle crashes and other traumatic events.

Since trauma so often impacts younger citizens, it claims more years of lost life than any other disease for those under age 44. Board certified emergency physicians, working within an organized trauma system, have proven effective in reducing mortality and morbidity for trauma victims.

Emergency physicians also have a vital role in emergency preparedness, statewide disaster response and homeland security. Oklahoma has been the site of powerful tornadoes and a mass casualty terrorist bombing, both of which produced many injured patients. Emergency physicians, as the first receivers at hospitals, will also be needed in any pandemic such as Avian flu.

One of the major factors in Oklahoma’s poor ranking is that more emergency physicians are needed. Nationally, and in our own state, visits to emergency departments have been on the increase for years. Oklahoma ranks in the bottom 25 percent of the country for number of emergency department visits per board-certified emergency physician and the ratio of board-certified emergency physicians per 100,000 people.

Meanwhile, the number of board-certified emergency physicians in the state is on the decline with a third of these physicians approaching retirement age and replacements scarce. When last surveyed, 22 of the state’s emergency departments were seeking 42 emergency medicine physicians.

Oklahoma has two residency programs for osteopathic physicians in emergency medicine but lacks an allopathic, or M.D., residency program. While the two osteopathic programs are producing about 10 emergency physicians each year, that number doesn’t come close to meeting the demand. Medical school graduates of the University of Oklahoma must leave the state to pursue residencies in emergency medicine. Many of the state’s brightest students never return, since physicians frequently remain in the states where they train.

The University of Oklahoma College of Medicine-Tulsa has created a new entity to support emergency medicine in the state. The Institute for Disaster and Emergency Medicine is working to develop a world-class education and research organization that supports emergency medicine and disaster response services throughout the region. The institute also has its sights set on establishing an M.D., emergency medicine residency program in Oklahoma.

At this point, money must be found at the federal or state level to fund a residency that will produce emergency physicians. No one anticipates needing an emergency physician but more than 1.5 million visits are made to Oklahoma’s 67 emergency departments every year. Shouldn’t our state rank higher than 48th in support of emergency medicine? Let’s convince our legislators to fund an allopathic residency to help solve this problem.

John C. Sacra is the medical director for the Medical Control Board, which provides medical oversight to all Fire First Responders and transport medics in the EMSA regulated service area (Tulsa and Oklahoma City areas). He is past president of the American Trauma Association and is involved in Trauma System Development in Oklahoma.