Study: Emergency Medicine Tops Healthcare’s Most Complex Physician Schedules

Hospital operations leaders in emergency departments balance more monthly requests and scheduling rules than any other medical specialty, according to Lightning Bolt research

New research on physician shift scheduling trends shows that emergency medicine departments in the U.S. balance the most complex sets of staffing rules and monthly requests of any specialty in the medical sector. The report, 2016 Physician Scheduling Complexity by Specialty, analyzed rules and requests used in 5,547 department schedules across 57 medical specialties.

Physician schedules in emergency medicine departments apply an average of 62 repeating scheduling rules (i.e., physicians can’t work two 12-hour shifts in a row) and 276 monthly schedule requests, which are not pattern-based like rules and can include vacation time or be used in staffing locum tenens or moonlighters with variable schedules. Compare emergency medicine to pulmonology, which has the most repeating scheduling rules (at 134, more than double emergency medicine) but far fewer monthly schedule requests. Schedules for office-based physician specialties, including primary care, pediatrics, and nephrology, were less complicated.

“Emergency medicine department schedulers are juggling more variables than there are atoms in the universe,” said Suvas Vajracharya, Ph.D., founder and CEO of Lightning Bolt Solutions.

“Keeping emergency rooms staffed with the right balance of physicians and locum tenens to meet patient demand 24/7 is essentially rocket science,” continued Vajracharya. “Our technology platform, built out of operations research technology used in the airline industry, professional sports, and manufacturing industries, is helping to meet these needs while also promoting physician work-life balance and preventing burnout.”

Top 11 Most Complex Physician Specialties to Schedule

  1. Emergency medicine

  2. Hospital medicine

  3. OB-GYN

  4. Pulmonology

  5. Anesthesiology

  6. Surgery

  7. Radiology

  8. Primary care

  9. Cardiology

  10. Pediatrics

  11. Nephrology

“Emergency department scheduling is complex for many reasons, beginning with patient demand and facility configuration,” said Dr. Brian Lahmann, emergency medicine physician at Reading Hospital, part of Reading Health System, in West Reading, Pennsylvania. Emergency departments must be staffed 24 hours a day, every day, 365 days a year, and they must adapt to what Dr. Lahmann describes as typically cyclical patient volume patterns and variable patient acuity. To meet such demand, many emergency departments staff separate lower and higher acuity areas. “Thus,” he said, “emergency departments have to schedule multiple providers who may have similar and different skills and abilities to care for all of these patients in various areas.”

Full details on how the specialties compare can be accessed in the free 2016 Physician Scheduling Complexity by Specialty report online. This report includes analysis of rules and request trends as well as commentary from physician and department administrators on the factors involved. Efficiency in hospital department shift scheduling is becoming increasingly important as the medical sector faces physician shortages and burnout, increased patient demand, and the national shift to value-based care.


Methodology: The 2016 Physician Scheduling Complexity by Specialty report was conducted by analyzing rules and monthly requests in 5,547 real department schedules on the Lightning Bolt platform across 57 medical specialties. The results exclude outliers representing the top and bottom 10% of the mean.