From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Anesth Analg. 2023 Feb 1;136(2):295-307. doi: 10.1213/ANE.0000000000006160. Epub 2022 Aug 10.
Despite the growing contributions of critical care anesthesiologists to clinical practice, research, and administrative leadership of intensive care units (ICUs), relatively little is known about the subspecialty-specific clinical practice environment. An understanding of contemporary clinical practice is essential to recognize the opportunities and challenges facing critical care anesthesia, optimize staffing patterns, assess sustainability and satisfaction, and strategically plan for future activity, scope, and training. This study surveyed intensivists who are members of the Society of Critical Care Anesthesiologists (SOCCA) to evaluate practice patterns of critical care anesthesiologists, including compensation, types of ICUs covered, models of overnight ICU coverage, and relationships between these factors. We hypothesized that variability in compensation and practice patterns would be observed between individuals.
Board-certified critical care anesthesiologists practicing in the United States were identified using the SOCCA membership distribution list and invited to take a voluntary online survey between May and June 2021. Multiple-choice questions with both single- and multiple-select options were used for answers with categorical data, and adaptive questioning was used to clarify stem-based responses. Respondents were asked to describe practice patterns at their respective institutions and provide information about their demographics, salaries, effort in ICUs, as well as other activities.
A total of 490 participants were invited to take this survey, and 157 (response rate 32%) surveys were completed and analyzed. The majority of respondents were White (73%), male (69%), and younger than 50 years of age (82%). The cardiothoracic/cardiovascular ICU was the most common practice setting, with 69.5% of respondents reporting time working in this unit. Significant variability was observed in ICU practice patterns. Respondents reported spending an equal proportion of their time in clinical practice in the operating rooms and ICUs (median, 40%; interquartile range [IQR], 20%-50%), whereas a smaller proportion-primarily those who completed their training before 2009-reported administrative or research activities. Female respondents reported salaries that were $36,739 less than male respondents; however, this difference was not statistically different, and after adjusting for age and practice type, these differences were less pronounced (-$27,479.79; 95% confidence interval [CI], -$57,232.61 to $2273.03; P = .07).
These survey data provide a current snapshot of anesthesiology critical care clinical practice patterns in the United States. Our findings may inform decision-making around the initiation and expansion of critical care services and optimal staffing patterns, as well as provide a basis for further work that focuses on intensivist satisfaction and burnout.
尽管危重病麻醉医师对临床实践、研究和重症监护病房（ICU）的行政领导做出了越来越多的贡献，但对于这个亚专业的具体临床实践环境，人们的了解相对较少。了解当代临床实践对于认识危重病麻醉所面临的机遇和挑战、优化人员配置模式、评估可持续性和满意度以及战略性地规划未来的活动、范围和培训至关重要。本研究调查了重症监护麻醉医师协会（SOCCA）的重症监护医师，以评估危重病麻醉医师的实践模式，包括薪酬、涵盖的 ICU 类型、夜间 ICU 覆盖模式以及这些因素之间的关系。我们假设，个体之间的薪酬和实践模式存在差异。
使用 SOCCA 会员名单确定在美国执业的认证重症监护麻醉医师，并邀请他们于 2021 年 5 月至 6 月期间参加一项自愿性在线调查。使用多项选择题和单项及多项选择选项回答分类数据，自适应提问用于澄清基于主题的回答。受访者被要求描述其所在机构的实践模式，并提供有关其人口统计学、薪酬、在 ICU 中的工作投入以及其他活动的信息。
共有 490 名参与者被邀请参加这项调查，其中有 157 名（应答率为 32%）完成并分析了调查。大多数受访者为白人（73%）、男性（69%）和 50 岁以下（82%）。心胸/心血管 ICU 是最常见的实践场所，69.5%的受访者报告在此单位工作。ICU 实践模式存在显著差异。受访者报告称，他们在手术室和 ICU 中花费相同比例的时间进行临床实践（中位数 40%；四分位间距[IQR] 20%-50%），而比例较小的一部分人——主要是那些在 2009 年之前完成培训的人——报告了行政或研究活动。女性受访者的薪酬比男性受访者低 36739 美元；然而，这一差异并不具有统计学意义，并且在调整年龄和实践类型后，这些差异并不明显（-37479.79 美元；95%置信区间[CI] -57232.61 美元至 2273.03 美元；P =.07）。
这些调查数据提供了美国麻醉重症监护临床实践模式的最新快照。我们的研究结果可能为启动和扩展重症监护服务以及优化人员配置模式提供决策依据，并为关注重症监护医师满意度和倦怠的进一步工作提供基础。
