Physician Specialties and Their Effects on Emergency Patients at Veterans Hospitals

Emergency medicine as practiced by the Veterans’ Affairs Department of the United States is undergoing significant changes. For many years, patients in the emergency departments of these hospitals were treated by specialists in internal medicine or family medicine, and not by those trained specifically in emergency medicine. However, in recent years, the trend has been towards locating and hiring more physicians trained in emergency care to work in veterans’ hospitals. The latest recommendations from the American College of Emergency Physicians advise that all physicians who go on to practice emergency medicine be board-certified in the specialty. It has also been recommended that the number of emergency physicians in veterans’ hospitals be increased over time to more closely match the numbers of trained staff that are generally seen in civilian hospitals across the country.

The reasons behind the push for more board-certified emergency physicians are diverse, but, not surprisingly, one of the major ones is that patients seen by specialists tend to have less need for return trips to the ER, as well as fewer hospitalizations overall. One way to measure has been by using the so-called rate of unscheduled returns to the ER. One particular study that was carried out in the emergency department of an urban veterans’ hospital looked at average rates of hospital admission, relative readmission rates, and relative revisit rates, and compared the statistics from the patients seen by doctors trained in internal medicine versus those trained in emergency medicine. A statistical test called a chi-squared analysis was used to determine the likelihood that the variations in data were due to random chance. P-values are the metrics used for this type of analysis, and a p value of less than 0.001 means the likelihood that the variations are due to chance is less than 1%.

The study covered a time period of 90 days; during this time a total of 2,891 patients were seen in…

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