Trends in Emergency Care Provided by Non-Physician Providers and Physicians: 2009–2021
Summer Ghaith, Cameron Gettel, Megan McElhinny, Aidan F. Mullan, Molly M. Jeffery, Rachel A. Lindor
Academic Emergency Medicine, August 8, 2025
🩺 Clinical Relevance
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NPPs are managing a growing proportion of ED visits—including moderate-to-high acuity cases.
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This shift is broad but especially pronounced in rural settings where staffing challenges persist.
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Implications for training, supervision, and quality assurance should be considered, particularly as NPPs take on more complex cases.
🔍 Study Overview
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Data source: National Hospital Ambulatory Medical Care Survey (2009–2021)
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Objective: Assess how the EM workforce composition has changed, focusing on physician vs. non-physician provider (NPP) care (PAs and NPs).
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Visit types categorized as:
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Physician only
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Physician + resident
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Physician + NPP
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NPP only
📊 Key Findings
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ED visit totals (2009–2021):
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Total estimated: 1.684 billion
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Physician only: 1.171 billion (↓ from 77% to 62%)
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Physician + resident: 136.3 million
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Physician + NPP: 209.1 million (↑ from 9% to 17%)
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NPP only: 167.4 million (↑ from 6% to 11%)
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Acuity shift:
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Even “emergent” (Level 2) patients increasingly seen by NPPs.
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Physician-only visits ↓ by 20%
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Physician + NPP ↑ by 13%
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NPP-only ↑ by 3%
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Geographic patterns:
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Urban areas:
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Physician-only visits ↓ by 14%
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NPP-only visits ↑ by 5%
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Rural/non-metro areas:
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Physician-only visits ↓ by 17%
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NPP-only visits ↑ by 9%
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Patient characteristics:
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Patients seen by physicians only were older, had higher acuity, longer ED stays, and higher admission rates.
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NPP-only visits tended to be for lower acuity and shorter encounters but are increasingly managing higher-acuity patients.
Ghaith, S., Gettel, C., McElhinny, M., Mullan, A.F., Jeffery, M.M. and Lindor, R.A., 2025. Trends in Emergency Care Provided by Non‐Physician Providers and Physicians: 2009–2021. Academic Emergency Medicine.