Figure 1.

Sankey diagrams of number of clinicians by clinician type entering and leaving the emergency workforce, 2013 to 2019.

Note – Clinicians were included if they performed ≥50 ED levels 1 to 5 E/M services in a study year.

Note – Summed column percentages may not equal exactly 100% due to rounding.

Note – As an example interpretation, in calendar year 2015 there were 34,495 EM physicians, 5,127 non-EM physicians, and 12,018 Advanced Practice Providers that comprised the EM workforce. There were 264 EM physicians, 115 non-EM physicians, and 298 Advanced Practice Providers that re-entered the workforce in 2015, evidenced by the recognition that they were not in the 2014 EM workforce, but were noted in the 2013 EM workforce. There were 2,297 EM physicians, 664 non-EM physicians, and 2,779 Advanced Practice Providers that entered the workforce brand new (for the first time in the study years) in 2015. Subsequently, there were 476 EM physicians, 160 non-EM physicians, and 478 Advanced Practice Providers considered to exhibit temporary attrition, in that they were within the 2015 EM workforce, absent from the 2016 EM workforce, but then again recognized to perform the required number of services in a later study year. There were also 1,426 EM physicians, 641 non-EM physicians, and 1,549 Advanced Practice Providers that exhibited permanent attrition, in that they were within the 2015 EM workforce, but then not recognized in any of the remaining study years.

Abbreviations: A – attrition: includes attrition for the 2018 study year as permanent attrition (PA) or temporary attrition (TA) was not able to be differentiated given that 2019 was the final study year; BN – brand new: clinicians not identified within any preceding year in the dataset (e.g. graduating residents); E – entry: includes entry for the 2014 study year as brand new (BN) or re-entering (RE) was not able to be differentiated given that 2013 was the first study year; PA – permanent attrition: clinicians not identified within any subsequent year in the dataset (e.g. retiring clinicians); RE – re-entering: clinicians not identified within the immediate preceding year, but did provide services in a year earlier in the dataset (e.g. Non-EM physician foregoing ED moonlighting for 2 years due to other priorities, then re-entered the workforce); TA – temporary attrition: clinicians not identified within the immediate subsequent year, but did provide services in a year later in the dataset (e.g. Advanced Practice Provider leaving primary ED practice for another specialty, then performs per diem ED work 3 years later once established in the new specialty.