PPP Leader’s Research Exposes Shocking Lack of Physician Coverage in U.S. Emergency Departments

Physician supporters of Patients for Patient Protection (PPP) have been sounding the alarm that, due to corporate interests and lenient collaboration laws, there are emergency departments (EDs) across the US where there are no physicians available.

Imagine you or your family have a medical emergency. You arrive at the ER and, instead of seeing an attending physician who has a minimum of 12,000 hours of standardized, supervised training before independent practice, there is only an NP/PA available who has non-standardized clinical exposure ranging from 500 hours for NPs to 2000 hours for PAs. Can you be sure that your care is safe? That your diagnosis is correct? That the treatment will help you?

A recent national survey revealed that 1 in 13 EDs lack 24/7 physician availability. PPP leader Deborah D. Fletcher, MD was instrumental in the inclusion of the key question “Is at least one attending physician (not resident) on duty in the ED 24 hours per day? The full findings are published in the April 2025, peer-reviewed, Journal of the American College of Emergency Physicians (JACEP OPEN).

This survey was sent to all 5,622 ED’s in the U.S. and achieved an 82% response rate. 344 ED’s (7.4%) reported the absence of 24/7 attending physician availability. In some states, over 30% of ED’s in that state lacked 24/7 physician coverage.

92% of the 344 ED’s without 24/7 attending physician coverage are considered low volume with visit encounters of 10,000 per year. It could be extrapolated that over 3.44 million patient visits per year are at risk of not having an ER physician available.

Even more concerning, nearly 70% of those 344 EDs without 24/7 physician coverage reported that there was zero two-way voice communication available with any physician within or outside the hospital at all.

At the time of the article’s publication, only two states had recently introduced legislation requiring 24/7 in-person physician coverage in EDs – Indiana and Virginia.