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.

Mobile Integrated Health Care Roles of US EMS Clinicians: A Descriptive Cross-Sectional Study.

OBJECTIVE: Mobile integrated health care (MIH) leverages emergency medical services (EMS) clinicians to perform local health care functions. Little is known about the individual EMS clinicians working in this role. We sought to describe the prevalence, demographics, and training of EMS clinicians providing MIH in the United States (US). METHODS: This is a cross-sectional study of US-based, nationally certified civilian EMS clinicians who completed the National Registry of Emergency Medical Technicians (NREMT) recertification application during the 2021-2022 cycle and completed the voluntary workforce survey. Workforce survey respondents self-identified their job roles within EMS, including MIH. If an MIH role was selected, additional questions clarified the primary role in EMS, type of MIH provided, and hours of MIH training received. We merged the workforce survey responses with the individual's NREMT recertification demographic profile. The prevalence of EMS clinicians with MIH roles and data on demographics, clinical care provided, and MIH training were calculated using descriptive statistics, including proportions with associated binomial 95% confidence intervals (CI). RESULTS: Of 38,960 survey responses, 33,335 met inclusion criteria and 490 (1.5%; 95%CI 1.3-1.6%) EMS clinicians indicated MIH roles. Of these, 62.0% (95%CI 57.7-66.3%) provided MIH as their primary EMS role. EMS clinicians with MIH roles were present in all 50 states and certification levels included emergency medical technician (EMT) (42.8%; 95%CI 38.5-47.2%), advanced emergency medical technician (AEMT) (3.5%; 95%CI 1.9-5.1%), and paramedic (53.7%; 95%CI 49.3-58.1%). Over one-third (38.6%; 95%CI 34.3-42.9%) of EMS clinicians with MIH roles received bachelor's degrees or above, and 48.4% (95%CI 43.9%-52.8%) had been in their MIH roles for less than 3 years. Nearly half (45.6%; 95%CI 39.8-51.6%) of all EMS clinicians with primary MIH roles received less than 50 hours (h) of MIH training; only one-third (30.0%; 95%CI 24.7-35.6%) received more than 100 h of training. CONCLUSION: Few nationally certified US EMS clinicians perform MIH roles. Only half of MIH roles were performed by paramedics; EMT and AEMT clinicians performed a substantial proportion of MIH roles. The observed variability in certification and training suggest heterogeneity in preparation and performance of MIH roles among US EMS clinicians.

Addition of community paramedics to a physician home-visit program: A prospective cohort study.

BACKGROUND: Home-based primary care promotes aging in place but is not immediately responsive to urgent needs. Community paramedicine leverages emergency medical services clinicians to expedite in-home care, though limited evidence supports this model. We evaluated the primary care and acute care use of older adults evaluated urgently by a community paramedic with telemedicine physician compared to a physician home visit model. METHODS: This prospective cohort study enrolled older adults in home-based primary care who requested an urgent evaluation. We allocated participants to the physician home visit model or physician home visit plus community paramedic model by ZIP code. We observed primary care and acute care use for 6 months following enrollment. The primary outcome was the median number of primary care and acute care visits per participant. Secondary outcomes included 30-day readmission rates, median wait times, and physician productivity. Data analysis included descriptive statistics, comparison of means and proportions, and negative binomial regression modeling reported as incidence rate ratios (IRR). RESULTS: We screened 255 participants, determined 203 eligible, allocated 199, and completed observation for 167 (84 community paramedicine, 83 physician home visit). Participants were mostly female, age 76-86 years, with 3-5 comorbidities, living in a home/apartment. Community paramedic participants had 29% more primary care visits (IRR 1.29, 95% confidence interval [CI] 1.06-1.57) and shorter wait times for urgent evaluations (1 vs. 5 days, p < 0.001) without increasing acute care use (IRR 0.75, 95% CI 0.48-1.18) or 30-day readmissions (IRR 1.32, 95% CI 0.49-3.55). Physician productivity increased 81% (40 vs. 22 visits/week, p < 0.001). CONCLUSION: Older adults evaluated by a community paramedic for urgent needs were seen sooner, used acute care similarly to patients evaluated by a physician home visit, and nearly doubled physician efficiency. This suggests that older adults may benefit from combining emergency medical services and primary care resources for urgent evaluations.