ED Medical Director Staffing Survey

Two of the core objectives of New York ACEP are “to establish guidelines for quality emergency care” and “to evaluate the social and economic aspects of emergency medical care”. In order to do so, it is important to understand the current practice patterns across New York State. Specifically, the strategic vision of the current leadership team is to further understand how the utilization of Emergency Departments (EDs) in New York State has been impacted by the pandemic and its downstream consequences and to understand the utilization of Advanced Practiced Clinicians in the ED.

For these reasons the New York ACEP Practice Management Committee designed a survey targeted to all Emergency Department medical directors throughout the state. The survey asked for census and staffing details for 2020, 2021 and 2022. The survey also asked questions related to staffing patterns, shift length, maximal coverage, admission percentage and average number of boarders.

We received 55 responses, each appearing to represent unique Emergency Departments. This represents 29% of the 190 Emergency Departments in New York State. The responses varied throughout the state, though the highest number of responses originated from New York City. The only demographic information collected was the region of the state. That data is shown in Figure 1.

85% of medical directors reported boarding 5+ patients on average. 22% reported 30+ boarders and 9% reporting more than 45 boarding patients on average.

Across the 53 sites reporting yearly data: the number of patient visits grew each year from 2020 to 2022. There were 2.02 million visits reported in 2020, which was up to 2.23 million in 2021 and 2.37 million in 2022.

The medical directors also provided answers on the utilization of APPs (Advanced Practice Providers i.e.: Nurse Practitioners and Physician Assistants) in the Emergency Department. 21% of Emergency Departments reported 0% rate of independent encounters of patients with NP/PA. 17% reported 1-10%, 17% reported 10-20%, 27% reported 20-30% and 17% reported >30%.

The most common length of shift reported was 12 hours, followed by 10 then 8 hours. With many sites having multiple shift lengths. The data is shown in a graph below.

We collected two data points, maximal staffed time and minimal staffed times and requested those numbers of attending physicians, APPs and residents. There were four sites that reported no use of APPs. There were no sites that reported use of only APPs and no physicians. The maximal number of physicians working simultaneously ranged up to eight. 13/55 (24%) were 24/7 single attending coverage sites. 11/55 (20%) reported a maximum of two attending physicians, another 13/55 (24%) reported a maximum of three. Only two responses reported a maximal (or minimal) staffed time with the number of APPs exceeding the number of physicians. For the 51 sites reporting APP utilization, the ratio of physician to APP at the maximal staffed time was on average 1.3.

39/55 emergency departments (71%) reported that the lowest staffed time is a single attending physician, with 28/55 (51%) reporting zero APP use at the minimal staffed time.

24 respondents reported the use of residents, of which eight reported a maximum of one resident working at a time; all of which reported minimal staffing of zero residents. For the other 16 sites reporting data the ratios of attending physicians to residents varied widely.

We asked several questions regarding nurse staffing, the most notable being that 84% of medical directors do not feel the nurse staffing ratios are adequate and only 7.4% reported full time dedicated nursing teams to manage ED holds.

New York ACEP will continue to advocate for all Emergency Physicians and patients and these statistics help illustrate the diversity in practice environments throughout the state of New York. We appreciate all who participated in the survey.

Bonus tip! This can’t be stressed enough: Always remember to have fun with this process!