Freestanding Emergency Centers Improve Access and Satisfaction for Patients, and Lessen Burnout for the Physicians Who Treat Them

posted in: Issue #3 | 2

Michael J. Sarabia, MD, FACEP

Affiliations:

Councillor, Section for Freestanding Emergency Centers, American College of Emergency Physicians

Attending, CHI Baylor/St. Luke’s Healthcare System, with its hospital-owned FECs, Houston, Texas, USA

Medical Director, PhysiciansER, Houston, Texas, USA

Board Member and Secretary, Texas Association for Freestanding Emergency Centers

 

Background/Objective: In 2014 the American College of Emergency Physicians gave the United States a grade of “D-” for access on its report card for emergency healthcare.  Fifty-two percent of current Emergency Medicine physicians are experiencing burnout.  The industry of freestanding emergency centers (FECs) (including independent and hospital-owned) is an emerging model for healthcare delivery.  This survey of emergency physicians seeks to understand the impact FECs have on patient healthcare and emergency physician burnout.

Methods: A survey was conducted of Emergency Medicine physicians via leaders of groups from a variety of FEC practice environments.  It solicited responses to statements on a 5-point Likert scale.  An average greater than 3.5 corresponded with a result of the sample group “agreeing” with the statement, and greater than 4.5 corresponded with the group “strongly agreeing.”

Results: Three hundred and eleven physicians participated.  The sample group “agreed” or “strongly agreed” with the following statements (percentage, +/- margin of error).  “For patients who use them, FECs provide an important access point to healthcare.” (88%, +/- 4)  “Patients are generally more satisfied with the care that they receive from FECs by comparison to hospital EDs.” (87%, +/- 4)  “My work at FECs has improved my job satisfaction.” (80%, +/- 5)  “My work at FECs will likely improve my career longevity.” (84%, +/- 4)  Participants who work at independently-owned FECs seem to “strongly agree” with all the above statements.

Conclusion: Freestanding emergency centers improve access and satisfaction for patients, and lessen burnout for the physicians who treat them.

 

Introduction

Background and Importance

The American College of Emergency Physicians (ACEP) gave the U.S. a grade of “D-” for access on its report card for emergency healthcare.[1]  Fifty-two percent of current Emergency Medicine physicians are experiencing burnout, second highest among all specialties.[2] Freestanding emergency centers (FECs) (including independent and hospital-owned) present an emerging model for healthcare delivery.  An estimated four hundred exist across the nation, including approximately two hundred facilities in Texas alone.

Legislators and physician leaders are in need of data as they embark on proposals to regulate the FEC industry.  There is surprisingly little research with which to understand the wishes of constituents, nor the impact FECs make on the delivery of healthcare.  Most current literature about the model lacks statistical power or capacity to make generalized conclusions.  FECs may have a global impact wherever patients of hospital emergency departments experience long wait times, and emergency physicians experience high burnout.

Goals of This Investigation

This survey of emergency physicians seeks to understand the perspective of the providers who work in the FEC model, and to understand the impact FECs have on patient healthcare and emergency physician burnout.

 

Methods

An internet-based survey was conducted among Emergency Medicine physicians.  The sample group was generated by encouraging all members of the Texas Association of Freestanding Emergency Centers and all members of ACEP’s Section for FECs to forward the link to the survey to all of their partners and contacts within their groups.  Anonymous responses to statements on a 5-point Likert scale were collected.  Margin of error and weighted averages were calculated.  An average greater than 3.5 corresponded with a result of the sample group “agreeing” with the statement, and greater than 4.5 corresponded with the group “strongly agreeing.”

 

Results

Three hundred and eleven physicians participated.  Of these, 53% do some of their work in hospital emergency departments (EDs), 16% do some of their work in hospital-owned FECs, and 76% do some of their work in independently-owned FECs.  Most doctors presently work in more than one of the settings.  Eighty-one percent are board certified in Emergency Medicine.  Regarding geographic location, 85% work in Texas, and 41% work in Houston, which has been dubbed the “epicenter” of FECs.  The median number of years working in the FEC setting was three.

The sample group “agreed” or “strongly agreed” with the following statements (percentage, +/- margin of error).  “For patients who use them, FECs provide an important access point to healthcare.” (88%, +/- 4)  “Patients are generally more satisfied with the care that they receive from FECs by comparison to hospital EDs.” (87%, +/- 4)  “My work at FECs has improved my job satisfaction.” (80%, +/- 5)  “My work at FECs will likely improve my career longevity.” (84%, +/- 4)  See pie charts #1 through 4.

An analysis of subgroups showed additional findings of interest.  Physicians who work at independently-owned and licensed FECs (IFECs) seem to “strongly agree” with all the above statements (see Table #1).  Physicians in the Dallas (weighted average 4.81, 95% CI 4.71-4.91) and Houston (4.63, 4.51-4.74) metropolitan areas strongly agree with the patient satisfaction statement.  Furthermore, the Dallas subgroup strongly agrees with the access statement (4.66, 4.50-4.81).  This would suggest FECs have a significant impact in and near dense urban areas.  Of note, the results did not change significantly for the following subgroups, who also “agreed” with all of the statements: board certified in Emergency Medicine, and presently working in hospital EDs.

 

Limitations

This survey did not broadly seek the perspective of emergency physicians who do not work in FECs as it was believed that there were too many misconceptions among those without first-hand experience.  Of note, however, 53% of participants currently do some of their work in hospital EDs.  At times, the survey accepted a response of “wouldn’t know” or “not applicable” as being the same as “no impact” or “unsure.”  This flaw of design likely lowered the weighted averages, but did not change the overall conclusions.

 

Discussion

Before this work, to our knowledge, there has been no research/perspective on the patient experience at FECs with significant statistical power and broad applicability, with the exception of promotionally displayed healthcare performance scores.  The website of the largest system of independently-licensed FECs in the country states that it was recognized for “highest quality emergency medical care and received the 2013 Press Ganey Guardian of Excellence for exceeding the 95th percentile in patient satisfaction nationwide.”[3]  The same system states that they were even better in 2014 as they were in the top 1% for patient experience.

The healthcare “safety net,” as emergency departments are considered, is in need of repair.  Poor access takes a heavy toll on the wellbeing of patients in remote rural communities and in overcrowded urban environments alike.  The complications can be devastating for the patient and expensive for the healthcare system.

 

Conclusion

Freestanding emergency centers are an important access point to healthcare.  Patients who use FECs are generally more satisfied with the care that they receive by comparison to hospital EDs.  FECs also lessen burnout for the physicians who treat the patients.

 

 

[1] http://www.emreportcard.org/, accessed on June 10, 2015

[2] http://www.medscape.com/viewarticle/838437_7, accessed on June 10, 2015

[3] http://www.adhc.com/companies, accessed on June 10, 2015

 

FEC.Careers.Table

2 Responses

  1. Very interesting research. Avoiding burnout is an important concern for Emergency docs.

  2. Spencer Smith

    Interesting article. It again goes to show that there is a role for FECs as they relate to both patients and providers. It will be interesting to see how payer and market forces refine this role. I think, overall, longevity of EPs will be positively impacted and thus the specialty as a whole.

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