The American Academy of Emergency Medicine (AAEM) supports the safe staffing of emergency departments (EDs) and the right of patients to be seen by a board-certified emergency physician. Recent literature suggests that emergency physicians believe that balancing the priorities of clinical productivity, safe staffing, and appropriate supervision permits them to see an estimated 1.5-3 patients per hour. Patient acuity, use of scribes or documentation assistance, and ancillary department staff including ED technicians and secretaries may all contribute to productivity estimates.
In addition, AAEM supports the use of physician assistants and nurse practitioners in the ED under a direct onsite supervision model, in which a board-certified attending emergency physician supervises clinical care and personally evaluates and examines patients, in a 1 to 1 physician to non-physician practitioner ratio. Based on current literature, emergency physicians should NOT supervise more than 2 non-physician practitioners at a given time to ensure appropriate clinical care. The AAEM understands that staffing considerations can vary from site to site, and while these are recommended staffing ratios, they may not always be the model employed due to site volume, workforce shortages, acuity, etc. However, at all times staffing should be determined by onsite, practicing emergency physicians and not by business interests.
AAEM believes that safe staffing and supervision of EDs is a priority for emergency physicians, patients, and policymakers, and supports the development of legislation to ensure safe emergency care, including mandating a physician be onsite in every emergency department 24/7.
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Schreyer, Kraftin E., Kuhn, Diane, and Norton, Vicki. “Physician Productivity and Supervision.” Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, vol. 24, no. 3, 2023, pp. 372–376. eScholarship, https://escholarship.org/uc/item/66727153.
Schreyer, Kraftin, Kuhn, Diane, and Norton, Vicki. “Emergency Physician Assessment of Productivity and Supervision Practices.” Western Journal of Emergency Medicine, vol. 26, no. 2, 2025, https://escholarship.org/uc/item/23x4c198.