Survey of Annual Staffing Workloads for Adult Critical Care Physicians Working in the United States

Sevransky, Jonathan; Chai, Z.; Cotsonis, George; Cobb, J. Perren; Pastores, Stephen M.

doi:10.1513/annalsats.201508-502le

Cited by 23 publications

(16 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While there are little data in surgery, EM and critical care medicine can both provide insight into what is reasonable work for physicians caring for sick patients. A survey of physicians responsible for creating ICU schedules found that an average FTE worked 24 weeks per year, including 24 weekend days and zero overnight calls 10 . This is very similar to the ideal state described by our qualitative analysis.…”

Section: Discussionsupporting

confidence: 73%

“…While beyond the scope of the current work, the design of ACS services is an evolving topic. The “safe” ratio of residents, APPs, and staff per patient has not been established but would inform a rationale design of ACS services 10 …”

Section: Discussionmentioning

confidence: 99%

“…The "safe" ratio of residents, APPs, and staff per patient has not been established but would inform a rationale design of ACS services. 10 Call is a large part of ACS practice regardless of location and level of trauma center. It is often the most grueling aspect of an ACS FTE.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A national study defining 1.0 full-time employment in trauma and acute care surgery

Murphy

Coleman

Karam

et al. 2021

J Trauma Acute Care Surg

View full text Add to dashboard Cite

BACKGROUND:Trauma and acute care surgery (ACS) staffing models vary widely across the United States, resulting in large discrepancies in staffing, compensation, schedule, and clinical/nonclinical expectations. An urgent need exists to define clinical, academic, and schedule expectations for a full-time employment (FTE) of a trauma and ACS surgeon in the United States. METHODS:A survey was distributed to departmental leaders at Levels I, II, III trauma centers across the United States regarding current workload.Variables concerning the responsibilities of surgeons, compensation models, and clinical expectations were collected. This was followed by virtual semistructured interviews of agreeable respondents. A thematic analysis was used to describe current staffing challenges and "ideal" staffing and compensation models of trauma centers. RESULTS:Sixty-eight of 483 division chiefs/medical directors responded (14%), the majority (66%) representing Level I centers. There were differences in clinical responsibilities, elective surgery coverage as well as number of and reimbursement for call. The median description of an FTE was 26 weeks (interquartile range, 13 weeks) with a median of 8 (interquartile range, 8) 12-hour call shifts per month.Level III centers were more likely to perform elective surgery and covered more call shifts, typically from home. In our qualitative interviews, we identified numerous themes, including inconsistent models and staffing of services, surgeon-administration conflict and elective surgery driven by productivity and desire. CONCLUSION:Defining the workload of a full-time trauma and ACS surgeon is nuanced and requires consideration of local volume, acuity and culture. Between the quantitative and qualitative analysis, a reasonable workload for a 1.0 FTE acute care surgeon at a Level I center is 24 to 28 service weeks per year and four to five in-house calls per month. Nighttime and daytime staffing needs can be divergent and may lead to conflict with administration. Future research should consider the individual surgeon's perspective on the definition of an FTE.

show abstract

Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A national study defining 1.0 full-time employment in trauma and acute care surgery

Murphy

Coleman

Karam

et al. 2021

J Trauma Acute Care Surg

View full text Add to dashboard Cite

show abstract

“…In pediatric and adult pulmonology, there are no accepted standards for a cFTE, and it may be determined by the institution or department. 15,16 When determining cFTE, a faculty member may have funded or unfunded protected time for research or education. Program directors, fellowship directors, and those who direct medical student teaching often receive FTE support to lead these activities.…”

Section: Clinical Carementioning

confidence: 99%

Basic Primer for Finances in Academic Adult and Pediatric Pulmonary Divisions

Schnapp

Steiner²,

Davis

2020

Chest

View full text Add to dashboard Cite

The finances of academic medical centers (AMCs) are complex and rapidly evolving. This financial environment can have important effects on faculty expectations, compensation, and the work environment. This article describes the commonly used concepts and models related to financial decision-making in Pulmonology and Critical Care divisions across AMCs in the United States. Faculty clinical productivity is often measured by work relative value units, which are set nationally for a discrete piece of physician work and attempt to equilibrate aspects of care across specialties. The expected clinical productivity and salary for a given faculty member are often determined relative to one or more national benchmarks developed from data submitted by departments and schools across the country. The most commonly used benchmarks include those from the Association of American Medical Colleges and the Medical Group Management Association. Changes to the paradigm of fee for service reimbursement are beginning to change physician compensation and incentive structures. In addition, research and education are key academic missions for faculty. It is important to understand the limitations of extramural research funding and implications for the support of research infrastructure. Measurements of productivity within education have been less codified, but some centers are attempting to create educational relative value units similar to those used in clinical productivity. In summary, faculty should understand basic concepts of finances. This knowledge includes a common set of terms and concepts that can help all faculty understand basic financial considerations in their work and lead to success for their divisions.

show abstract

“…When clinician-level measures were included, time was emphasized (e.g. working hours (n ¼ 2), anticipated overtime (n ¼ 1), the amount and frequency of unpaid over-time (n ¼ 1) and shift number in a given sequence (n ¼ 1)), but also included number and type of tasks unable to be completed in paid hours (n ¼ 1) number of procedures performed (n ¼ 1), number of patients managed by a physician simultaneously (n ¼ 1), number of days and weekends required to work to support a physician (n ¼ 1), and seniority level of nurses (n ¼ 1) (Hoi et al, 2010;Simmons and Kuys, 2011;Levin et al, 2006;Liu et al, 2012;Sevransky et al, 2016;Thongsanit et al, 2016;Wrenn et al, 2010). In one study, anticipated overtime was found to be associated with stress while overcrowding did not have an effect on stress (Wrenn et al, 2010).…”

mentioning

confidence: 99%

Objective measures of workload in healthcare: a narrative review

Fishbein

Nambiar

McKenzie

et al. 2019

IJHCQA

View full text Add to dashboard Cite

Purpose Workload is a critical concept in the evaluation of performance and quality in healthcare systems, but its definition relies on the perspective (e.g. individual clinician-level vs unit-level workload) and type of available metrics (e.g. objective vs subjective measures). The purpose of this paper is to provide an overview of objective measures of workload associated with direct care delivery in tertiary healthcare settings, with a focus on measures that can be obtained from electronic records to inform operationalization of workload measurement. Design/methodology/approach Relevant papers published between January 2008 and July 2018 were identified through a search in Pubmed and Compendex databases using the Sample, Phenomenon of Interest, Design, Evaluation, Research Type framework. Identified measures were classified into four levels of workload: task, patient, clinician and unit. Findings Of 30 papers reviewed, 9 used task-level metrics, 14 used patient-level metrics, 7 used clinician-level metrics and 20 used unit-level metrics. Key objective measures of workload include: patient turnover (n=9), volume of patients (n=6), acuity (n=6), nurse-to-patient ratios (n=5) and direct care time (n=5). Several methods for operationalization of these metrics into measurement tools were identified. Originality/value This review highlights the key objective workload measures available in electronic records that can be utilized to develop an operational approach for quantifying workload. Insights gained from this review can inform the design of processes to track workload and mitigate the effects of increased workload on patient outcomes and clinician performance.

show abstract

Survey of Annual Staffing Workloads for Adult Critical Care Physicians Working in the United States

Cited by 23 publications

References 15 publications

A national study defining 1.0 full-time employment in trauma and acute care surgery

A national study defining 1.0 full-time employment in trauma and acute care surgery

Basic Primer for Finances in Academic Adult and Pediatric Pulmonary Divisions

Objective measures of workload in healthcare: a narrative review

Contact Info

Product

Resources

About