What You See Is What You Learn: National Variation in Emergency Medicine Clinical Environments

Background and Objectives: ACGME guidelines require EM residency programs’ primary sites to have at least 30,000 annual ED visits to ensure adequate clinical training, a standard first introduced in 1995. Since then, annual national ED visits have risen 60%, and the number of EM residency programs has nearly tripled. Variation in clinical volume across residency sites remains unclear but is an important topic in accreditation and training discussions. We sought to characterize variation in primary site annual visit volumes among EM residency programs.

Methods: We used 2024 Doximity Residency Navigator data to obtain residency program information including name, accreditation year, rotation sites, and months per site, and determined primary sites based highest number of rotation months. We linked this information to the American Hospital Association (AHA) Annual Survey to capture ED volumes, Council of Teaching Hospitals (COTH) designation, and hospital ownership type. The primary outcome was median ED volume of EM residency program primary sites.

Results: Among the 286 EM residency programs we identified from Doximity, the median primary site annual ED volume was 78,699 (IQR: 51,033-106,921), with 14 (5%) having volumes below the 30,000 ED visit threshold. COTH hospitals had significantly higher median volumes than non-COTH (89,471 [IQR: 63,764–115,493] vs. 72,418 [IQR: 42,794–91,264], p < 0.005). Non-profit hospitals had significantly higher volumes than for-profit (80,961 [IQR: 54,810–110,311] vs. 53,415 [IQR: 37,992–69,341], p < 0.005). Median ED volume significantly declined at primary teaching sites based on residency program founding year from 1981 through 2023 (p < 0.005).

Conclusion: ED volumes varied widely across residency sites, with 1 in 20 programs potentially falling below ACGME requirements. ED clinical volumes were significantly higher among primary ED teaching sites with COTH and non-profit status, and residency founding year trends suggest that newer residencies are formed in lower visit volume EDs. Given that volume has a known positive effect on clinical and training outcomes, future research should investigate outcomes differences based on residency program clinical exposure. Additionally, the 30,000 visit threshold, established in 1995 when overall annual ED volumes were considerably lower than today, may warrant reevaluation.

Presenter:

  • Carlisle Topping, BA
Authors

  • Carlisle Topping, BA

    Yale-New Haven Medical Center

    Carlisle is a research year medical student at the Yale School of Medicine pursing an MHS degree. She graduated with a degree in Biology from Columbia University. Prior to medical school, she worked in the Cancer Outcomes Research and Education Program at Massachusetts General Hospital. Her introduction to emergency medicine was at Bellevue Hospital where she worked as a patient advocate and was witness to the impact of social forces and systems on health. She is interested in emergency medicine with a dedication to advancing equitable healthcare for individuals from low-income areas. This drove her to Dr. Arjun Venkatesh and Dr. Hazar Khidir's research, focusing on health services and health policy projects that address overlapping geographic and socioeconomic health inequities.

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