Progression of Emergency Medicine Resident Productivity
Article first published online: 28 JUN 2008
© 2007 Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 14, Issue 9, pages 790–794, September 2007
How to Cite
Brennan, D. F., Silvestri, S., Sun, J. Y. and Papa, L. (2007), Progression of Emergency Medicine Resident Productivity. Academic Emergency Medicine, 14: 790–794. doi: 10.1111/j.1553-2712.2007.tb02353.x
- Issue published online: 28 JUN 2008
- Article first published online: 28 JUN 2008
- Received March 21, 2007; revision received May 17, 2007; revision received May 22, 2007; accepted May 22, 2007
- relative value scale;
- emergency medicine;
- residency and internship
Objectives: To evaluate the progression in productivity of emergency medicine (EM) residents by postgraduate year, as measured by hourly work in relative value units (RVUs).
Methods: This retrospective study was conducted at an Accreditation Council for Graduate Medical Education (ACGME)-accredited EM residency with a postgraduate year (PGY) 1-2-3 configuration. A query of an electronic billing database composed of more than 230,000 visits from academic years July 2003 to December 2006, representing at least four classes at each PGY level, was conducted. The main outcome was change in productivity in RVUs generated per hour, compared by resident PGY level. This measure encompasses not only volume of patients seen but also patient acuity in terms of evaluation and management services and procedures provided and supported by documentation adequate for coding. Descriptive statistics and Tukey's test were used for data analysis.
Results: Over the three-year study period, 70 EM residents were assessed at various levels of training. Productivity, as measured by mean RVUs generated per hour, was 2.51 (95% confidence interval [CI] = 2.20 to 2.82) for PGY-1 residents, 3.51 (95% CI = 3.12 to 3.90) for PGY-2 residents, and 3.61 (95% CI = 3.41 to 3.80) for PGY-3 residents (p < 0.001). Patient acuity (RVUs generated per patient) increased 5%–8% with each PGY progression: 3.05 (95% CI = 2.96 to 3.13) for PGY-1, 3.20 (95% CI = 3.09 to 3.31) for PGY-2, and 3.46 (95% CI = 3.42 to 3.50) for PGY-3 (p < 0.001). There was a statistically significant increase in productivity (p < 0.001) and acuity (p = 0.03) from PGY-1 to PGY-2, with acuity also increasing between PGY-2 and PGY-3 (p < 0.001).
Conclusions: Hourly work productivity and acuity increased with experience within this ACGME-accredited EM residency. The progression in workload and acuity by PGY is measurable and commensurate with the graduated level of responsibility desired in an EM program.