Background Emergency departments in underserved areas face chronic staffing challenges. One possible solution is to use physicians who are quicker to train and more pervasive in lieu of more extensively trained physicians. Canada allows for emergency medicine specialization via a 3-year pathway (CCFP(EM)) and a 5-year pathway (FRCPC) which means different geographic areas are exposed to EM physicians with different training lengths.

Methods We examine Ontario, Canada which has both widespread geographic diversity and emergency providers with these two lengths of postgraduate training. We scrape the College of Physicians and Surgeons of Ontario public registry in 2015 and 2024. We map the geographic distribution of physician types and estimate spatial autocorrelation measures using global and local Morans I to determine whether these physicians became more geographically concentrated.

Results Between 2015 and 2024, the number of CCFP(EM) and FRCPC physicians increased in overall numbers but their unique locations remained stable. Mapping of these locations suggests clustering into urban or suburban areas in the province. CCFP(EM) physicians have become more concentrated over time (Morans I of 0.234 and 0.308 in 2015 and 2024) relative to FRCPC physicians (Morans I of 0.096 and 0.103).

Conclusion We find that, from 2015 to 2024, emergency physicians have become more concentrated in the province of Ontario due to CCFP(EM) physicians concen-trating around urban areas with academic centres. Policies relying on less exten-sively trained providers to plug staffing gaps may not necessarily be effective in improving equitable access to physicians.

Note: Preprint This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

The authors have declared no competing interest.

This study did not receive any funding.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study uses ONLY data made publicly available by the College of Physicians & Surgeons of Ontario, as set out by Ontario's Regulated Health Professions Act, 1991. Data was originally located at: register.cpso.on.ca. This study only uses aggregate and non-sensitive data for which there is no expectation of privacy (i.e. professional information).

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The authors can provide the aggregated data, as privacy allows, and the underlying code to replicate this project upon reasonable request to the authors.