County-level demand for emergency medicine physician services in Texas

Recent studies indicate a significant growth in the number of physicians who specialize in emergency medicine. However, due to the critical nature of emergency medicine (EM) care, considerable attention is still focused on determining the areas where there is inadequate supply of EM physicians to meet patient needs. In particular, many states, including Texas, have identified emergency care as one of the medical specialties for which a county-level shortage analysis is critical. This paper serves towards addressing this need by providing robust estimates of county-level demand for EM physician services in Texas.

In this paper, we estimate the demand for EM physician services based on expressed and met needs. Extant data cataloged in public use data files (PUDF) of the Texas Department of State Health Services provides a record of each patient visit to EM centers affiliated with hospitals in each of Texas’ 254 counties. We estimated the number of patient visits and the time involved in their care based on the revenue codes associated with EM care. The total number of hours entailed in EM care were subsequently converted to EM physician full-time equivalent (FTE) units by using published data on the number of hours the average EM physician works during each calendar year.

For the purpose of developing projections of EM physician demand, we developed utilization rates by demographic group for each county where there was adequate data. The utilization rates were then used in conjunction with population projections to determine county-level EM physician demand through 2030. The data indicate, as expected, that patients aged 65-years and older account for a disproportionate share of EM services. Similarly, underinsured population groups also use EM services at a higher rate than insured patients. Projections indicate that demand for EM services will continue to increase at a rate that is roughly equivalent to the overall growth in the population of each county.