The question
When volume grows or a position is open, a locum shift is the fastest fix. Before you book it, you want to know what it will do to waits, and whether the same money would do more at a different time of day or with a different provider type.
Worked example
Example assumptions, not benchmarks. An emergency department grows to about 97 patients a day, busiest from late morning into the evening. It has 48 MD hours a day: one MD overnight, two in the early morning and evening, three from 9am to 6pm. MD visits average 20 minutes, locum MDs 22 minutes and PAs 25 minutes. Rates are the app's default examples: $350 an hour for a locum MD and $75 for a PA.
We added one 8-hour shift to that schedule and ran each option for a simulated year.
| Option | Added cost per day | Average wait | Worst hour |
|---|---|---|---|
| No added shift | $0 | 11.8 min | 40 min at 1am |
| Locum MD, 11am–7pm | $2,800 | 8.7 min | 43 min at 2am |
| Locum MD, 7pm–3am | $2,800 | 4.9 min | 11 min at 5am |
| PA, 7pm–3am | $600 | 5.0 min | 10 min at 4am |
Added cost is 8 hours times the example rate. Wait is time from arrival to the first provider, averaged over a simulated year.
Reading the results
The daytime locum lands where waits were already short, a few minutes an hour, because the day already had three MDs. The overnight hours, where one MD works alone, stay the worst of the day. The few minutes of difference from the first row is normal run-to-run variation. The average improves, but the patients who waited longest still do.
The same shift from 7pm to 3am covers the evening and the first hours of the night, when volume is still high and coverage drops. In this example it cuts the average wait to 4.9 minutes and the worst hour to 11 minutes, for the same $2,800 a day.
This is the pattern to look for in your own data: a shift is worth the most in the hours where arrivals are still high and coverage has already stepped down.
Locum or PA?
In this example a PA on the same evening hours gives nearly the same wait at a fraction of the cost. That only holds if a PA can see the patients who arrive in those hours. Acuity, scope of practice and supervision rules decide that, not the model. What the model tells you is how much of the gain depends on having an MD on the shift.
Over a year, the example locum shift costs $1,022,000 and the PA shift $219,000 (daily cost times 365). Your rates go in the app, and every scenario shows cost per day next to its waits.
Running your own
- Enter your arrivals by hour and your current MD, PA or NP schedule.
- Add the locum shift you're considering and save the scenario.
- Move the shift, or swap the locum for a PA, and compare the scenarios side by side.
For how to set the base schedule itself, see emergency department staffing by hour.