Emergency Physician Assessment of Productivity and Supervision Practices

Despite a lack of data guiding safe standards for physician productivity and supervision of non-physician practitioners (NPP), legislation dictating supervision ratios for emergency physicians (EP) has been enacted in Florida and elsewhere across the country. To inform future legislation, we aim to identify current productivity and supervision practices among practicing EPs as well as those physicians' safety assessments of their current practices.

We conducted a cross-sectional observational study regarding EPs' perspectives on safe staffing and supervision models. A survey, consisting of 14 questions examining different variables affecting supervision and productivity, was used to determine physicians' opinions on the safety of productivity and supervision models across a range of annual volumes, employers, and years of experience. We coded safety assessments as binary (yes/no) and measured productivity by patients treated per hour. Ratios of physician to supervisee (either resident physician or or NPP) were given as number of supervisees: EP.

The survey response rate was 4.8% (196/4,004). On average, most EPs treated 2.6 patients per hour, regardless of years of experience, employment model, or supervision model. More than 80% of EPs felt that their current patients-per- hour practice was safe. Direct supervision represented 59% of total visits and the majority in all employment models except for community contract-management groups (CMG). A minimum of 80% of physicians felt that their current supervision practices were safe across employment models, with the notable exception of community CMGs. Most felt that a safe ratio for direct supervision of NPPs was 1:1. Over 30% reported there was no safe staffing ratio for indirect supervision.

With the exception of those employed by community contract-management groups, EPs felt that their current productivity and supervision practices were safe; however, average productivity and supervision ratios are much lower than prior estimates and in current legislation governing emergency department practice. Standards of care for both productivity and supervision that take into account current practices and safety assessments should be established and considered when future policies and legislation are developed.