Over the past couple of years, the population of San Diego has been steadily increasing. This has reversed a slight downward trend in annual census in area EDs. At the primary training site (UCSDMC), we have been averaging from 100 – 130 patients per day, the majority of which are level 1 or 2 acute patients, and approximately 30 patients will be seen in our urgent care area which is staffed by one of our residents. We cover the acute care area of the ED with three senior ED residents over a 24-hour period, and two junior residents. The senior residents are expected to oversee, or primarily see all of these patients except for urgent care which calculates out to be approximately 25 – 30 patients per shift. The junior residents will see primarily half to two-thirds of the level 1 or 2 patients (20-25 patients per shift). At the other training sites there is typically one resident assigned per month and schedules are adjusted so little overlap occurs with residents from other services. Mercy Hospital sees approximately 45, 000 patients per year, Tri-City 48, 000 – 50,000 annually, Palomar between 42, 000 and 46, 000 per year, and Children’s Hospital approximately 30, 000 per year. The combined volume of all these ED’s integrated into the residency is over 200,000 patients per year drawing from the very diverse patient population of the entire County of San Diego. This provides a very rich clinical experience, a high degree of patient acuity, and a high per capita volume of patient pathology for each resident.