Residency-trained emergency physicians: their demographics, practice evolution, and attrition from emergency medicine.

Concern exists about the ability of Emergency Physicians (EPs) to maintain a career in Emergency Medicine (EM) over a professional lifetime. The objectives of this study were to assess the practice characteristics of residency trained EPs, to document how the EP's responsibilities evolve throughout a career, and to assess career longevity. A retrospective cohort study using a mailed questionnaire was used to document practice characteristics, evolution of responsibility, and career longevity from all physicians who graduated from allopathic EM residencies between 1978-1988 (inclusive). Non-responders were compared to responders to assess the extent of selection bias. The response rate was 58.1% (1635/2812). There were no differences between responders and non-responders on any of five demographic variables. Responders who were more likely to remain in EM included those who had higher reimbursement, were board certified in EM, or did not train in another specialty or do a fellowship outside of EM. Throughout the 15-year careers studied, EPs noted a significant shift in the time spent doing clinical work (decreased) and the time doing administrative work (increase). The attrition from EM practice for this cohort was < 1% per year.