We sought to identify physician and environmental factors (eg, crowding) associated with emergency physician productivity, measured as patients per hour. We also assessed whether physician productivity is associated with higher emergency department (ED) return rates.

We used data from 184 EDs in 24 states staffed by a national ED group from January 2021 to December 2022. Clinical outcomes were 72-hour returns and returns with admission. We performed multivariable linear regression models that included physician, shift, and facility characteristics.

We examined 234,146 shifts among 2,099 physicians. The mean number of patients per hour was 1.94 (SD = 0.57). Physician factors associated with a higher number of patients per hour included younger age and longer tenure at a site, with the number of patients per hour increasing even after 60+ months at a site. Longer tenure at a site was associated with a higher number of patients per hour (0.06 [95% confidence interval {CI} 0.02 to 0.09] at 6 months and 0.11 [95% CI 0.07 to 0.15] at 12 months). The number of patients per hour was weakly associated with shifts worked in the prior 3 to 30 days (0.003 number of patients per hour [95% CI 0.002 to 0.004] for each additional shift). Overnight shifts, non-Monday shifts, more physicians working on shift, and longer shift lengths were associated with a lower number of patients per hour. The number of patients with ED length of stay more than 6 hours (boarding patients) was negatively associated with the number of patients per hour. The higher number of patients per hour, both within site and within physician, was associated with slightly decreased 72-hour returns but no meaningful difference in returns with admission.

Both physician- and shift-level factors are associated with emergency physician number of patients per hour. Higher number of patients per hour is not associated with increased 72-hour returns with admission.