Clinical duties and compensation for U.S. emergency medicine fellows at academic centers: A descriptive, cross-sectional survey

Objective

Fellowship training is increasingly popular among residency graduates and critical to the advancement of academic emergency medicine (EM). Little is known about the clinical hours worked and financial compensation received by fellows during training. We sought to describe the clinical duties and financial compensation of EM fellows at U.S. academic centers.

Methods

This cross-sectional study surveyed U.S. academic EM department administrators who were members of the Society for Academic Emergency Medicine's Academy of Administrators in Academic Emergency Medicine (AAAEM) regarding their fellowship programs and fellows. We electronically distributed the validated survey instrument to 73 member sites between October 2022 and January 2023. Survey domains included fellow and fellowship demographics, base and total annual clinical hours, and base and total annual compensation. We calculated descriptive statistics and compared fellows by accreditation (Accreditation Council for Graduate Medical Education [ACGME] or non-ACGME) using chi-square and Wilcoxon rank-sum testing. We conducted a secondary analysis of base and total salary by gender and accreditation using Wilcoxon rank-sum testing.

Results

We received 38 institutional responses (response rate 52%), which represented 217 individual fellows. Nearly three-fourths (n = 158, 72.8%) of fellows enrolled in non-ACGME fellowships, worked 33% more base hours annually than ACGME fellows (median 571 h vs. 768 h, p < 0.001), and received base compensation 20% higher than ACGME fellows ($88,540 vs. $70,777, p < 0.001). Accounting for additional compensation, the median total annual compensation for non-ACGME fellows remained 11% higher than ACGME fellows ($105,000 vs. $93,853, p = 0.004). We observed no significant differences salary when stratified by gender.

Conclusions

Most EM fellows at U.S. academic institutions enrolled in non-ACGME fellowships with significantly higher base hours and financial compensation than ACGME fellowships. These results represent the first description of the clinical hours and financial compensation of academic EM fellows and should be considered in ongoing benchmarking efforts by AAAEM.

The Impact of Selecting Specific Cohorts for Benchmarking and Interpretation of Emergency Department Patient Satisfaction Scores

OBJECTIVES

Emergency departments (EDs) patient satisfaction metrics are highly valued by hospitals, health systems, and payers, yet these metrics are challenging to analyze and interpret. Accurate interpretation involves selection of the most appropriate peer group for benchmark comparisons. We hypothesized that the selection of different benchmark peer groups would yield different interpretations of Press Ganey (PG) patient satisfaction scores.

METHODS

Emergency department PG summary ratings of "doctors section" and "likelihood-to-recommend" raw scores and corresponding percentiles were derived for three benchmark peer groups from three academic years (2016, 2017, and 2018). The three benchmarks are: 1) the PG Large database; 2) the PG University HealthSystem Consortium (UHC) database; and 3) the Academy of Administrators in Academic Emergency Medicine (AAAEM) database, which is composed only of EDs from academic health centers with emergency medicine residency training programs. Raw scores were converted to percentile ranks for each distribution and then compared using Welch's ANOVA and Games-Howell pairwise comparisons.

RESULTS

For both patient satisfaction raw scores evaluated, the AAAEM database was noted to have significantly higher percentile ranks when compared to the PG Large and PG UHC databases. These results were consistent for all three time frames assessed.

CONCLUSIONS

Benchmarking with different peer groups provides different results, with similar patient satisfaction raw scores resulting in higher percentile ranks using the AAAEM database compared to the two PG databases. The AAAEM database should be considered the most appropriate peer group for benchmarking academic EDs.