EM Residents Earn Their Keep

When Chattanooga started an emergency medicine residency program, the EM residents improved attending efficiency, increased RVUs, and allowed decreased staffing, which almost covered the entire cost of the EM residency program.

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Acad Emerg Med. 2016 Jan;23(1):78-82. doi: 10.1111/acem.12834. Epub 2015 Dec 29.

The Effect of Emergency Medicine Residents on Clinical Efficiency and Staffing Requirements.

Clinkscales JD1, Fesmire FM1, Hennings JR1, Severance HW1, Seaberg DC1, Patil N2.

Author information:

1Department of Emergency Medicine, Erlanger Institute for Clinical Research, University of Tennessee College of Medicine Chattanooga, Erlanger Health System, Chattanooga, TN.

2Department of Quality Management, Greenville Health System, Greenville, SC.


The effect of emergency medicine (EM) residents on the clinical efficiency of attending physicians is controversial. The authors hypothesized that implementing a new EM residency program would result in an increase in relative value units (RVUs) generated per hour by attending physicians and decrease staffing requirements.


This was a retrospective observational analysis of an emergency department before, during, and after the establishment of a new EM residency program. We analyzed the change in RVUs billed, patients seen, and hours worked by attending physicians, midlevel providers (MLPs), and residents, and addressed potential confounding factors.


The clinical efficiency of attending physicians increased by 70%, or 4.98 RVUs/hour (from 7.12 [SD ± 1.4] RVUs/hour to 12.1 [SD ± 2.2] RVUs/hour, p < 0.001) with the implementation of an EM residency program. Overall, net department RVU generation rose by 32%, even as attending physician coverage decreased by 6.3% (p < 0.05), and MLP coverage dropped by 60% (p < 0.05). We estimated that the implementation of the residency saved 4,860 hours of attending physician coverage and 5,828 hours of MLP coverage per year. This represents an estimated $1,741,265 in annual staffing savings, comparable to the residency program's annual operating cost of $1,821,108.


The implementation of an EM residency program had a positive effect on the clinical efficiency of attending physicians and decreased staffing requirements.

© 2015 by the Society for Academic Emergency Medicine.

PMID: 26714030 [PubMed - in process]

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