{"pk":19241,"title":"The Impact of Emergency Physician Turnover on Planning for Prospective Clinical Trials","subtitle":null,"abstract":"Introduction: Emergency physician (EP) turnover is a significant issue that can have strong economic impact on hospital systems, as well as implications on research efforts to test and improve clinical practice. This work is particularly important to researchers planning randomized trials directed toward EPs because a large degree of turnover within a physician group would attenuate the effectiveness of the desired intervention. We sought to determine the incidence and factors associated with EP workforce changes.\nMethods: In an attempt to determine EP turnover and workforce change, data from the INSTINCT (INcreasing Stroke Treatment through INterventional behavior Change Tactics) trial were used. The INSTINCT trial is a prospective, cluster-randomized, controlled trial evaluating a targeted behavioral intervention to increase appropriate use of tissue plasminogen activator in acute ischemic stroke. Individual EPs staffing each of the study hospitals were identified at baseline and 18 months. Surveys were sent to EPs at both intervals. Models were constructed to investigate relationships between physician/hospital characteristics and workforce change.\nResults: A total of 278 EPs were identified at baseline. Surveys were sent to all EPs at baseline and 18 months with a response rate of 72% and 74%, respectively. At 18 months, 37 (15.8%) had left their baseline hospital and 66 (26.3%) new EPs were working. Seven EPs switched hospitals within the sample. The total number of EPs at 18 months was 307, a 10.8% overall increase. Among the 24 hospitals, 6 had no EP departures and 5 had no new arrivals. The median proportion of EP workforce departing by hospital was 16% (interquartile range [IQR] ¼ 4%–25%; range ¼ 0%–73%), and the median proportion added was 21% (IQR ¼ 7%–41%; range ¼ 0%–120%). None of the evaluatedcovariates investigating relationships between physician/hospital characteristics and workforce change were significant.\nConclusion: EP workforce changes over an 18-month period were common. This has implications for emergency department directors, researchers, and individual EPs. Those planning research involvinginterventions upon EPs should account for turnover as it may have an impact when designing clinical trials to improve performance on healthcare delivery metrics for time-sensitive medical conditions suchas stroke, acute myocardial infarction, or trauma. [West J Emerg Med. 2013;14(1):16–22.]","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial  4.0","short_name":"CC BY-NC 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc/4.0"},"keywords":[{"word":"Emergency Medicine"},{"word":"Hospital-Physician Relations"},{"word":"Cohort studies"},{"word":"Health Care Surveys"},{"word":"Health and Medical Administrative Services"}],"section":"Population Health Research Design","is_remote":true,"remote_url":"https://escholarship.org/uc/item/8pd8503j","frozenauthors":[{"first_name":"William","middle_name":"J","last_name":"Meurer","name_suffix":"","institution":"University of Michigan Medical School, Department of Emergency Medicine, Ann\nArbor, Michigan; University of Michigan Medical School, Department of Neurology, Ann Arbor,\nMichigan","department":"None"},{"first_name":"Cemal","middle_name":"B","last_name":"Sozener","name_suffix":"","institution":"University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"},{"first_name":"Zhenzhen","middle_name":"","last_name":"Xu","name_suffix":"","institution":"University of Michigan School of Public Health, Department of Biostatistics, Ann Arbor, Michigan","department":"None"},{"first_name":"Shirley","middle_name":"M","last_name":"Frederiksen","name_suffix":"","institution":"University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"},{"first_name":"Allison","middle_name":"M","last_name":"Kade","name_suffix":"","institution":"University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"},{"first_name":"Michael","middle_name":"","last_name":"Olgren","name_suffix":"","institution":"Saint Mary’s Healthcare, Department of Emergency Medicine, Grand Rapids, Michigan","department":"None"},{"first_name":"Sanford","middle_name":"J","last_name":"Vieder","name_suffix":"","institution":"Botsford Hospital, Department of Emergency Medicine, Farmington Hills, Michigan","department":"None"},{"first_name":"John","middle_name":"D","last_name":"Kalbfleish","name_suffix":"","institution":"University of Michigan School of Public Health, Department of Biostatistics, Ann Arbor, Michigan","department":"None"},{"first_name":"Phillip","middle_name":"A","last_name":"Scott","name_suffix":"","institution":"University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"}],"date_submitted":"2011-05-16T16:47:33Z","date_accepted":"2011-05-16T16:47:33Z","date_published":"2012-11-17T07:19:52Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/19241/galley/9522/download/"}]}