Predictors of Emergency Physician Productivity in a National EM Group
Authors: Oskvarek JJ, Zocchi MS, Black BS, Burke LG, Kachman M, Leubitz A, Moghtaderi A, Nikolla DA, Rahman N, Pines JM
Journal: Annals of Emergency Medicine, 2025
Conclusions:
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Productivity (patients/hour) is driven by modifiable site/shift factors and experience at the site, not just individual physician traits.
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Higher patients/hour was not linked to worse short-term outcomes—no increase in 72-hour returns with admission; slightly lower overall 72-hour returns.
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Tenure at a site meaningfully boosts throughput for years, arguing for stability/retention and thoughtful onboarding.
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Boarding drags productivity; operational focus on reducing LOS >6 hours should yield throughput gains independent of staffing numbers.
Results:
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Scope: 184 EDs across 24 states; 2,099 physicians, 234,146 shifts (Jan 2021–Dec 2022).
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Throughput: Mean 1.94 pts/hr (SD 0.57).
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Physician factors:
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Younger age → higher pts/hr.
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Tenure at site → higher pts/hr, persisting beyond 60+ months; effect sizes: +0.06 pts/hr at 6 months (95% CI 0.02–0.09); +0.11 at 12 months (95% CI 0.07–0.15).
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Recent workload: weak positive association—+0.003 pts/hr per additional shift worked in prior 3–30 days (95% CI 0.002–0.004).
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Shift/facility factors lowering pts/hr:
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Overnights, non-Monday shifts, more physicians on shift, longer shift lengths.
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More patients boarding (>6h ED LOS) = lower pts/hr.
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Quality outcomes:
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Higher pts/hr (within-site and within-physician comparisons) → slightly decreased 72-hour returns.
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No meaningful difference in 72-hour returns with admission.
Methods:
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Multivariable linear regression of pts/hr with physician, shift, and facility covariates; outcomes included 72-hour returns and returns with admission.
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Data source: national EM staffing group across Jan 2021–Dec 2022.
Oskvarek, J.J., Zocchi, M.S., Black, B.S., Burke, L.G., Kachman, M., Leubitz, A., Moghtaderi, A., Nikolla, D.A., Rahman, N. and Pines, J.M., 2025. Predictors of emergency physician productivity in a national emergency medicine group. Annals of emergency medicine.