Written by Ketan Patel
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Younger age and longer tenure at a site increased patients-per-hour (PPH) without increasing 72-hour returns.
Faster, not looser: What really drives ED patients-per-hour
While many prior studies have addressed physician productivity parameters based on departmental factors and other extrinsic nuances, none have particularly parsed out broader site- and provider-specific factors.
This is a retrospective observational analysis of 234,146 shifts by 2,099 physicians across 184 EDs using a fixed-effects models, analyzing how age, site tenure, nights, shift load, and boarding affect PPH and potential harm from higher PPH. The mean PPH was 1.94 across all sites and physicians. Tenure at a site was the biggest driver, increasing PPH (+0.11 at 12 months; +0.19 at ≥60 months). Overnight shifts had the largest negative impact on PPH: -0.18. Age 55–59 vs. <35 years was associated with a decrease in PPH -0.11 (95%CI -0.17 to -0.06). Male physicians saw slightly more than female: PPH +0.07 (95%CI 0.04 to 0.09). In addition, each additional shift worked in the preceding 3-30 days added 0.003 PPH. Boarding only slightly reduced PPH. Perhaps a bit surprisingly, higher PPH actually reduced 72-hour returns: physician-fixed effects -0.21% (95%CI -0.21% to -0.28%).
These data were from a single national group, with substantial exclusions (i.e. teaching sites, solo coverage, atypical shifts), which limits generalizability. Also, 72-hour returns to EDs outside this group limits make this metric less reliable.
How does this change my practice?
Being a medical director at our group, I play a role in our staffing decisions. Given the relatively small impacts, this supports not utilizing age, tenure, and other such factors when making staffing decisions. Instead, it supports our model of staffing to patient volume demands and emphasizes to me that a nuanced, site-specific approach is crucial in staffing and productivity.
Source
Predictors of Emergency Physician Productivity in a National Emergency Medicine Group. Ann Emerg Med. 2025 Oct;86(4):347-358. doi: 10.1016/j.annemergmed.2025.02.002. Epub 2025 Mar 28. PMID: 40152844.
