Global Cardiac Anesthesia Workforce Assessment: A Cross-Sectional Observational Survey Study.

OBJECTIVE

The primary aim of this survey was to assess the demographics, training background, practice setting, and work environment of cardiac anesthesiologists globally.

DESIGN

Cross-sectional study of the global cardiac anesthesia workforce. A multilingual web-based survey was conducted between June 1 and December 31, 2023.

SETTING

The survey was distributed via cardiac anesthesia societies, special interest groups, and social media using a non-probabilistic sample and with snowballing techniques.

PARTICIPANTS

Anesthesiologists actively practicing cardiac anesthesia.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

In total, 3,430 participants from 99 countries responded. Results were summarized as descriptive data comparing geographical regions, and noticeable differences for individual countries were assessed. Most of the workforce (85.9%, n = 2,913/3,390) that responded to the survey were between 31 and 60 years of age. Australia/New Zealand/Oceania (51.1%, n = 48/94) and Asia (45.2%, n = 606/1,341) had the largest percentages of respondents working in the above 50 years of age group. Globally, 48.4% (n = 1,347/2,780) of respondents reported having completed an accredited adult cardiac fellowship, and 42.7% (n = 918/2,148) replied to have had only informal training "on the job." When it comes to transesophageal echocardiography, 44.6% (n = 1,240/2,780) of the global workforce reports not having had any formal training. Large differences in training background were noticed by country and region. Most of the workforce (43.3%, n = 1,149/2,652) indicated working between 41 and 60 hours per week. However, more than one of four (26.8%, n = 711/2,652) cardiac anesthesiologists work between 61 to 80 hours, and one out of ten (10.5%, n = 279/2,652) has a workload of more than 81 hours per week. A majority (68%, n = 1,778/2,609) of cardiac anesthesiologists evaluated their compensation/salary as less than adequate or just adequate but not enough to save for retirement. Regarding work-life balance, there was a significant variation in how practitioners assessed their personal situations. Almost half (46.3%, n = 1,185/2,560) of the workforce consider making changes to reduce their workload, and only 23.1% (n = 592/2,560) evaluated their work-life balance as just right. A validated, non-proprietary single-question item assessing emotional exhaustion as one of the three established criteria for burnout was incorporated into the survey. The overall prevalence of burnout, i.e. emotional exhaustion, among cardiac anesthesiologists was 31.7% (n = 827/2,609). In the regression analysis, an increase in clinical work hours (OR = 1.28; CI [1.16, 1.42]; p < 0.001), the number (OR = 1.05; CI [1.02, 1.08]; p < 0.001) and type (OR =1.09; CI [1.0, 1.19]; p = 0.03) of cardiac call, all increased the odds for burnout. Compared to taking all cardiac call in the hospital, taking no cardiac call at all, significantly decreased the risk for burnout. Similarly, compared to compensation that was perceived as less than adequate, i.e., even needing a second income, higher compensation assessment was associated with an increasingly lower risk for burnout. Other factors mitigating burnout risk include older age groups (OR = 0.78; CI [0.67, 0.90]; p < 0.001), and a more positive outlook on work-life balance (OR = 0.88; CI [0.85, 0.92]; p < 0.001). The geographical region had a small but significant association with burnout (OR 1.12; CI [1.06, 1.18]; p < 0.001). Asia, as the geographical region of practice, had the highest odds for burnout overall (41.3%, n = 342/829) and also the most respondents (15.6%, n = 129/829) in the highest answer option category, i.e., feeling completely burned out.

CONCLUSIONS

A global survey of the cardiac anesthesia workforce found inconsistency in the training, job satisfaction, and daily practice of cardiac anesthesiologists. The rate of burnout was high, and many respondents would like to make work-related changes to improve work-life balance.