title: The Effect of Emergency Medicine Residents on Clinical Efficiency and Staffing Requirements.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  The implementation of an EM residency program had a positive effect on the clinical efficiency of attending physicians and decreased staffing requirements.
authors.affiliation: Department of Emergency Medicine, Erlanger Institute for Clinical Research, University of Tennessee College of Medicine Chattanooga, Erlanger Health System, Chattanooga, TN.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Clinkscales
authors.affiliation: Department of Emergency Medicine, Erlanger Institute for Clinical Research, University of Tennessee College of Medicine Chattanooga, Erlanger Health System, Chattanooga, TN.
authors.forename: Francis M
authors.initials: FM
authors.lastname: Fesmire
authors.affiliation: Department of Emergency Medicine, Erlanger Institute for Clinical Research, University of Tennessee College of Medicine Chattanooga, Erlanger Health System, Chattanooga, TN.
authors.forename: Jacob R
authors.initials: JR
authors.lastname: Hennings
authors.affiliation: Department of Emergency Medicine, Erlanger Institute for Clinical Research, University of Tennessee College of Medicine Chattanooga, Erlanger Health System, Chattanooga, TN.
authors.forename: Harry W
authors.initials: HW
authors.lastname: Severance
authors.affiliation: Department of Emergency Medicine, Erlanger Institute for Clinical Research, University of Tennessee College of Medicine Chattanooga, Erlanger Health System, Chattanooga, TN.
authors.forename: David C
authors.initials: DC
authors.lastname: Seaberg
authors.affiliation: Department of Quality Management, Greenville Health System, Greenville, SC.
authors.forename: Nirav
authors.initials: N
authors.lastname: Patil
mesh_terms: D000328:Adult; D017598:Efficiency, Organizational; D004635:Emergency Medicine / Q000193:education; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D008505:Medical Staff, Hospital / Q000458:organization & administration* / Q000600:supply & distribution; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D010820:Physicians; D012189:Retrospective Studies; D000078329:Workforce