Practice management models in emergency medicine

Key learning points Discuss the influence of a nation’s healthcare financing and payment policies on the available choices of emergency medicine practice models. List the types of emergency medicine practice models that are used worldwide, and the relative advantages and/or disadvantages of each. Describe models of collaborative practice between emergency physicians that can improve patient care. Introduction In most developed countries, the practice of assigning physicians to staff the emergency department (ED) became common in the twentieth century. Originally staffed by young physicians-in-training and/or nurses, only in the past 40–50 years has the ED begun to be staffed by attending medical staff – most recently by trained emergency medicine specialists – with continued development of this trend globally. Since the birth of emergency medicine as a specialty, there have been dynamic changes in staffing and practice models in the ED that reflect the increasing professionalism and sophistication of emergency medicine practice. This has led to the continued expansion and refinement of practices, and the exploration of diverse scopes of ownership and control similar to that found in other specialties. While expansion of roles is occurring, emergency physicians are for the most part characterized by their clinical practice in the hospital ED. Globally, in any individual hospital the type of emergency medicine practice model used is ultimately a function of the variables of the specific practice setting. These variables include hospital type, available reimbursement mechanisms, and local laws concerning the practice of medicine and nursing. All of these factors contribute to significant diversity in emergency medicine practice management models.