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EDs Have the Most Complex Work Schedules to Balance

SAN FRANCISCO – While this might not come as any surprise to emergency medicine physicians trying to remember when they next need to show up for work, new research on medical shift scheduling trends shows that EDs in the United States must balance the most complex sets of staffing rules and monthly requests of any specialty in the medical industry.

The report, 2016 Physician Scheduling Complexity by Specialty, analyzed rules and requests used in 5,547 department schedules across 57 medical specialties. The analysis was created by Lightning Bolt Solutions, which develops scheduling software.

Here’s how complex physician schedules in EDs can be: The software must apply an average of 62 repeating scheduling rules (i.e., physicians can’t work two 12-hour shifts in a row) and 276 monthly schedule requests, which are not pattern-based like rules and can include vacation time or the staffing of locum tenens or moonlighters with variable schedules.

The report notes that pulmonology has the most repeating scheduling rules, 134, more than double that of emergency medicine, but far fewer monthly schedule requests. Schedules for office-based physician specialties were less complicated in general, according to the report.

“Emergency medicine department schedulers are juggling more variables than there are atoms in the universe,” explained Suvas Vajracharya, PhD, founder and CEO of Lightning Bolt Solutions. “Keeping emergency rooms staffed with the right balance of physicians and locum tenens to meet patient demand 24/7 is essentially rocket science.”

The issue, Brian Lahmann, emergency medicine physician at Reading Hospital, part of Reading Health System, in West Reading, PA, added in a Lightning Bolt press release, is that EDs must be staffed 24 hours a day, 365 days a year, taking into account cyclical patient volume patterns and variable patient acuity. To meet such demand, many emergency departments staff separate lower and higher acuity areas.

“Thus,” Lahmann emphasized, “emergency departments have to schedule multiple providers who may have similar and different skills and abilities to care for all of these patients in various areas.”

After emergency medicine, the most complex physician specialties to schedule were hospital medicine, OB-GYN, pulmonology, anesthesiology, surgery, radiology, primary care, cardiology, pediatrics, and nephrology.