Progression of Emergency Medicine Resident Productivity

Abstract Objectives: To evaluate the progression in productivity of emergency medicine (EM) residents by post-graduate year, as measured by hourly work in relative value units (RVUs).Methods: This retrospective study was conducted at an Accreditation Council for Graduate MedicalEducation (ACGME)-accredited EM residency with a postgraduate year (PGY) 1-2-3 configuration. A queryof an electronic billing database composed of more than 230,000 visits from academic years July 2003 toDecember 2006, representing at least four classes at each PGY level, was conducted. The main outcomewas change in productivity in RVUs generated per hour, compared by resident PGY level. This measureencompasses not only volume of patients seen but also patient acuity in terms of evaluation and manage-ment services and procedures provided and supported by documentation adequate for coding. Descriptivestatistics 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. Pro-ductivity, as measured by mean RVUs generated per hour, was 2.51 (95% confidence interval [CI] = 2.20 to2.82) 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 eachPGY 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 andPGY-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 commensu-rate with the graduated level of responsibility desired in an EM program.ACADEMIC EMERGENCY MEDICINE 2007; 14:790–794 a 2007 by the Society for Academic EmergencyMedicineKeywords: productivity, relative value scale, emergency medicine, residency and internship