Citing a critical physician workforce shortage and severe challenges in meeting a growing population that needs emergency services, Arizona ranked 45th in the nation, scoring near the bottom with an overall grade of D+, according to the American College of Emergency Physicians’ (ACEP’s) National Report Card on the State of Emergency Medicine. The Report Card comes at the time when the national picture looks bleak: job and insurance losses, a rapidly growing senior population and a recent survey forecasting critical shortages of primary care doctors all point to escalating emergency patient populations.
Arizona received an impressive A- for Disaster Preparedness and a national ranking of 9th in this category. In contrast, Arizona’s other grades were failing or below average, except for the Quality & Patient Safety Environment category, where the state earned a C.
In the most heavily weighted category, Access to Emergency Care, Arizona received a grade of F and a near-the-bottom ranking of 48th in the nation. A major contributing factor included a shortage of registered nurses – just 560.8 per 100,000 people. Additionally, there are only 7.1 emergency departments and 1.1 trauma centers per 1 million people. In addition, 22.3% of adults and 17% of children in Arizona lack health insurance, significantly more than the national average of 17.2% of adults and 11.7% of children who are uninsured.
“In Arizona, we're facing serious crowding and boarding issues in emergency departments and hospitals, as well as a general workforce shortage and lack of on-call specialists,” said Craig Norquist, MD, president of the Arizona Chapter of ACEP. “This is a crisis, and we need to work closely with hospitals and other facilities to identify ways to increase capacity and serve a larger population before the situation gets worse.”
With relatively high medical liability insurance premiums for primary care physicians and specialists ($22,798 and $87,175, respectively), no additional liability protections for EMTALA-mandated emergency care, no caps on medical liability non-economic damages and no pretrial screening panels to discourage frivolous lawsuits, Arizona received its second F grade in the Medical Liability Environment category, with a ranking of 48th in the nation.
“This may seem obvious, but if Arizona wants to continue to attract and maintain a broader workforce, we need to take immediate action to improve the Medical Liability Environment,” said Dr. Norquist. “Otherwise doctors will not want to practice here and our current personnel shortcomings will continue to worsen.”
Arizona closely avoided its third failing grade, receiving a D- in Public Health and Injury Prevention. The state’s greatest shortcoming in this category is its especially low immunization rates. Fewer than three-quarters of Arizona’s children between the age of 19 and 35 months are immunized (74.8%), compared with 80.5 % nationally. Additionally, less than two-thirds of adults aged 65 years and older received influenza and pneumococcal vaccinations (65.4% and 66.5%, respectively). Arizona also has one and a half times the national average in unintentional fall-related fatalities, yet the state spends nothing on fall injury education or prevention and is near the bottom (47th) in total injury prevention funds. On Arizona’s roads, 45% of all traffic fatalities are alcohol-related and there is no helmet law for motorcyclists. The numbers in this category also reveal a higher than average homicide and suicide rate.
“Prevention has to be a bigger part of our overall program and more children and adults need to have adequate health insurance,” said Dr. Norquist. “The high rates of uninsured patients, lack of health education and a depleted workforce hamper access to adequate preventive and emergency care, which I sincerely believe will further strain the medical system.”
Arizona fared better in the Quality & Patient Safety Environment category earning a C. Over 90% of Arizona counties have Emergency 911 service and 40% of hospitals have electronic medical records. While most items in the category were on par with national averages, the number of emergency medicine residents was very low – only 10.6 for every 1 million people. Arizona also does not have a uniform system for providing pre-arrival instructions in their emergency departments or require adverse event or hospital-based infections reporting.
As mentioned previously, Arizona ranked near the top (9th) of the nation in Disaster Preparedness, with a grade of A-. Despite receiving only $9.51 per person for disaster preparedness (the national average is $13.82 per person), Arizona has established a statewide patient tracking system as well as a statewide syndromic surveillance system. Arizona also was highly ranked in regard to the per capita percentage of nurses and physicians registered in the state-based Emergency System for Advance Registration of Volunteer Health Professionals program.
“The weakened economy combined with a failing health care system mean that growing numbers of people will need emergency care,” said Dr. Nick Jouriles, president of ACEP. “In fact, the role of emergency care has never been more critical to this nation, which is why emergency patients must become a top priority for health care reform. We are urging President-elect Obama and the new Congress to strengthen emergency departments, because they are a health care safety net for us all.”
The nation’s failure to support emergency patients resulted in a C- for the country overall. Massachusetts earned the highest overall grade of a B and Arkansas ranked last (51st) in the nation with a D-. The national grade was calculated using the same methodology used for the overall state grades and is a weighted average of the nation’s category grades.
The grades are from ACEP’s National Report Card on the State of Emergency Medicine, a comprehensive analysis of the support that states provide for emergency patients. The new Report Card contains more than twice the measures of ACEP’s first Report Card in 2006, as well as a new category for disaster preparedness, which makes it more comprehensive, although not directly comparable to the previous Report Card.
The five Report Card categories (and weightings) are: Access to Emergency Care (30%), Quality and Patient Safety Environment (20%), Medical Liability Environment (20%), Public Health and Injury Prevention (15%) and Disaster Preparedness (15%).
The National Report Card on the State of Emergency Medicine was made possible, in part, by funding from the Emergency Medicine Foundation, which gratefully acknowledges the support of The WellPoint Foundation and the Robert Wood Johnson Foundation.
The Arizona College of Emergency Physicians is a state chapter of ACEP, a national medical specialty society representing emergency medicine with more than 27,000 members. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.