We wanted to answer that age-old question, “how many physicians does it take to staff an emergency department?” So we went straight to the experts - our schedulers. No one knows how many physicians are needed to keep an ED up and running better than those building the schedule!

Katie Sloat gave us the inside look at emergency department staffing. 

Katie is MetricAid’s Implementation Manager and our most experienced scheduler. She has built more schedules than we had time to count, totalling hundreds of thousands of shifts, and has generated staffing reports for multiple EDs - helping them to build better coverage, lower wait times, and happier physicians.

So, what’s Katie’s secret? How does she build such finely-tuned reports for our clients?

Well, aside from her brilliance, Katie uses the tools available within the MetricAid application. 

Our Goals screen allows you to build a scheduling balance sheet - you’re able to see the number of shifts you need to fill, the number of shifts your staff want to work (also known as “shift bids”, “demand” or “commitment”), and the difference between the two.  To reach the Goals screen, select your site from the menu in the header, click on Periods, select the period you’d like to report on, click on Period Setup, then Goals. 

On the Goals screen, you’ll see all your shift counts across the top of the screen and your staff listed along the left side of the screen. Under each header, you can select min/ ideal/ max to pull in the counts provided by your physicians during preference entry. You can also adjust each person’s individual count by either typing it in or using the + or - next to the box.

Once your counts are updated, look across the bottom of the screen where the total shift count and total commitment from staff are listed. This will tell you the number of shifts needing to be staffed.

Here’s how Katie puts together the staffing report from the numbers pulled from Goals; she takes the difference between commitment and shifts needing coverage, then divides it by a standard FTE shift count for the site (usually between 8 - and 12 shifts).

For example: 

You have 36 shifts you need to fill, and a regular FTE is 12 shifts, you can see you’ll need at least 3 full-time physicians to complete your schedule build. Katie suggests, however, that you always be one full-time physician over-staffed, so in this instance, 4 would be the ideal number of doctors to hire. This allows for vacations, leaves, and other unexpected scheduling conflicts to be covered.

Les Blackwell, our CEO, offers another way to think about your roster size in mathematical terms.

For most services with a 24-hour call, nights, evenings, and weekend coverage, you should have at least 3 physicians on the roster for each call or shift, per day.  

For example:

You have an internal medicine schedule that has one 24-hour call per day, as well as 2 inpatient attendings (8-hour shifts on the floor) per day.  That’s 3 assignments/day, so you would need at least 9 physicians to cover this reliably.  

Emergency departments and UCC’s present a variety of different needs, but these can be predicted.  We can reverse-engineer the needed roster based on volume, using the following steps;

1. Divide Annual Visits by Average Assessments per Hour to get Hours of Coverage Needed

2. Divide Hours of Coverage Needed by Shift Length and then by 12 to get Shifts/Month

3. Divide Shifts/Month by number of Shifts Worked per Physician to get final Roster Size

Below, we’ve used that math to cover a matrix of possibilities. We look at ED’s with 40,000, 70,000, and 100,000 visits/year, and the most common compensation strategies and associated assessments/hour with each.  We have also used the following assumptions;

• The average shift length is 7 hours (this will be a future blog post!)

• The average number of shifts/month/physician is 10 (this is within +/- 1 physician in 9/10 of the dozens of ED schedules we manage)

On the final table, we can see there is tremendous variation in how large the roster needs to be, depending on your compensation strategy, but at the centre of the grid (70,000 visits, hybrid compensation model) we have replicated the 3 physicians/shift that was suggested at the start of this article (33 physicians to work 333 shifts/month).

These are just guidelines of course, but in our experience, managing many schedules, all with a mix of full-time-equivalents, the math seems to come out pretty much the same every time.

If you’re struggling to fill your schedule every month, stop, do the math, and give us a call!  We’re happy to discuss it with you!

For more information, or for help building a staffing report, feel free to contact us at support@metricaid.com