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The Link Between Emergency Medicine and Primary Care in Rural America

Ameen Taleb, MD, a Diplomate of the American Board of Physician Specialties® (ABPS) and program director of Monroe Clinic Emergency Medicine Fellowship in Monroe, WI, sat down recently with Lori Rodefeld, medical education coach at Monroe, to share their thoughts on the link between emergency medicine and primary medicine in rural America.

Ameen Taleb, MDOver the years, emergency departments have seen an increase in visits for primary medical and lower acuity medical concerns. As the healthcare landscape further evolves, the emergency department will play an even larger role in primary care for some patients. Currently, for some people in rural communities, the ER can be the only access to health care.

According to a 2008 American Academy of Family Physicians (AAFP) report, family physicians outnumber emergency physicians about 7 to 1 in rural areas. One of the major causes of this disparity is that rural communities lack the population density necessary to support a residency-trained emergency physician. The staffing of rural emergency departments can vary based on volume and available providers, and rural EDs typically struggle to recruit physicians who are either EM residency or fellowship trained. At Monroe Clinic, while staffing varies for weekdays, evenings, and weekends, our pool of physicians is sometimes not deep enough for us to have flexibility with coverage and scheduling.

Lori RodefeldIn light of our nation’s current shortage of EM physicians, it’s crucial for primary care trained physicians to work in rural emergency care. The breadth of training in family medicine makes the family physician a nearly ideal provider of emergency services in rural areas. In fact, family physicians and other primary care doctors provide a wide spectrum of medical care in rural ERs, including the bulk of emergency care. With a solid understanding of clinical follow-ups, they are often the physicians who first see the patient and reevaluate the patient on follow-ups.

No doubt, working in rural areas can be challenging. Rural hospitals may have limited resources in terms of providers, limited access to specialty care, and must deal with long distances for patient transfers.  But rural communities offer a better quality of life, affordable housing, good schools, and lower crime rates. Also, outdoor recreational opportunities like camping, hiking, bicycling, and hunting are readily available in rural areas.

How Physicians Benefit From Working in Rural Areas

Physicians who work in rural America not only benefit from being a part of a smaller community, but, as they become integrated into the area, they also get to know their patients better. The small-town atmosphere offers the chance for a personal connection between physicians and patients. A lower patient population gives physicians more time to familiarize themselves with patients’ medical needs as well as personal needs, thereby fulfilling the traditional role of the primary care physician.

It’s notable that physicians in rural areas often see patient populations that are different from urban areas. For example, the scope of illnesses is broader, which means that health care professionals provide a wider variety of services, some of which in urban areas might be the domain of physician specialists. Working in a rural setting means that a physician must be proactive in performing several aspects of medicine, whether it’s minor surgery or treating minor injuries. For rural physicians, this greater clinical responsibility can lead to professional growth.

Fellowship Training in Emergency Medicine

There can be challenges regarding the credentialing of ER providers for rural communities. Thankfully, many credentialers understand that EM fellowship training through a program approved by the American Academy of Emergency Physicians (AAEP) ensures that a physician is competent and is more likely to be comfortable with higher acuity patients than a physician trained only in a primary care residency program. EM fellowships also provide improved training in a variety of areas, such as trauma, critical care, procedural competency, and ultrasound.

The AAEP Recognizes Distinguished Emergency Medicine Fellowships

Graduates of AAEP-approved fellowships become eligible to apply for board certification through the Board of Certification in Emergency Medicine (BCEM), which is governed by the ABPS.

Earning BCEM certification designates a physician as a qualified emergency medicine specialist, opening the door to greater career opportunities and positioning them as leaders in the healthcare community.

Hospitals and institutions offering these fellowships may seek recognition through the AAEP’s Emergency Medicine Fellowship Recognition Program. This designation is awarded only to programs that demonstrate a high standard of training, equipping physicians with the skills needed to excel in emergency medicine. Recognized fellowships must meet the following criteria:

  • Provide supervision by faculty with comprehensive experience in all areas of emergency medicine.
  • Foster a structured, academic environment that supports advanced medical education.
  • Be based in institutions across the United States.

This recognition underscores a program’s commitment to training the next generation of emergency medicine leaders.

Why Emergency Medicine Fellows Should Pursue BCEM Certification

Obtaining certification from the BCEM is a meaningful milestone that reflects a physician’s advanced knowledge and clinical expertise. BCEM-certified physicians have proven their capabilities through comprehensive exams and performance-based evaluations, making them highly regarded by healthcare leaders and institutions.

Employing a BCEM-certified physician sends a clear message about a facility’s commitment to quality care, enhancing its reputation and building trust within the community. For fellowship graduates, BCEM certification demonstrates a commitment to excellence that extends beyond their training—positioning them as exceptional candidates for emergency department roles across the country.

If you would like to learn more about the relationship between primary and emergency care in rural communities, or if you want information about EM fellowship programs developed under the rigorous standards of the American Academy of Emergency Physicians, an affiliate of the AAPS, contact the ABPS today.

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With declining access for maternity care amid rising maternal mortality, ABPS and their Board Certification in Family Medicine Obstetrics has been essential for me and many of my colleagues in getting privileges and thereby creating local access for mothers and their children.

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John B. Waits, MD
Family Medicine Obstetrics
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Spencer Price MD, MPH, MBA
Administrative Medicine
In this era, when continuous updated medical knowledge means so much to you, when quality of emergency care matters most to you ,when you need to excel in your medical career to continue providing exceptional service to your critically ill patients, please consider board certification with the Boad of Certification in Emergency Medicine (BCEM). Where your knowledge & expertise translates to credentialing & certification with wider approval & recognition every day at many fronts. We Welcome you to join our team for a brighter future of our emergency healthcare where dedication to profession relies not solely on clinical practice but also on sound academic certification.

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Ashraf A. Gerges, MD, FAAEP
Emergency Medicine
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Ashish Anand, MD, FAASOS
Ashish Anand, MD, FAASOS
Orthopedic Surgery
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Jeffrey B. Stricker, DO, MBA, FAASD
Jeffrey B. Stricker, DO, MBA, FAASD
Dermatology
Serving as a member on the American board of Integrative Medicine (ABOIM) for many years and now serving as a Member at Large of the American Board of Physician Specialties (ABPS) has been an enriching and rewarding experience. The board’s commitment to excellence, integrity, and positive impact is truly inspiring. I am grateful to collaborate with such a dedicated and visionary group, and I am proud of the meaningful progress we continue to achieve together.

Arti Prasad, MD, FACP
Arti Prasad, MD, FACP
Integrative Medicine
There are many ways board certification advances a physician career. ABPS Board examination verifies your accuracy, precision, and reflects your mastery of your residency training verifying your expertise. ABPS Board certification demonstrates your level of expertise beyond your practice experience, primary education degrees, and training which are necessary for insurance reimbursement and practice privilege requirements. Attaining your ABPS Board Certification will clarify your purpose, secure your practice growth, and expand into leadership positions. Board certification can serve as an indication of a physician’s commitment to medicine, beyond the minimal standards and competency of training, their measurement to quality of care, and attaining an award for excellence.

Chris Kunis MD
Internal Medicine
When the American Board of Physician Specialties offered to host the American Board of Integrative Medicine, ABPS became a landmark organization working to move medicine into the twenty first century. Certifying physicians who have completed rigorous academic training in Integrative Medicine ensures that the field of Integrative Medicine will continue to develop academically, clinically, and professionally. The leadership of ABPS continues to impress me - they are diligent in constantly innovating to provide certifications for physicians who want to advance their careers and their areas of expertise. I am honored to be a part of this organization.

Ann Marie Chiasson, MD
Integrative Medicine
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Art Cooper, MD
Disaster Medicine
Far too often, medicine is led by less than 5% of non-practicing physicians taking away and replacing the voice of the 95% of physicians practicing and placing patient safety and care first on the front lines every day. The American Board of Physician Specialties has raised the standards in physician board certification not only in the quality of their boards of certification, but in hearing and allowing for the voice of those active physicians caring directly for patients. Having been a part of the ABPS over the last 28 years has allowed me to grow as a woman leader in a field often wrought with challenges. It helped me and others raise the bar of the standards of care in my specialty, Emergency Medicine, through their Board Certification in Emergency Medicine (BCEM). ABPS also helped raise the standards of care for 21st century medicine through their certifications in other specialties, particularly in Integrative Medicine & Disaster Medicine. Having physician voices heard matters to medicine and is essential in the betterment of patient safety and care.

Sarah E. Gilbert, MD, FAAEP
Sarah E. Gilbert, MD, FAAEP
Emergency Medicine
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