Effects Of Attending Physician Workload In Academic Intensive Care Units: A National Survey Of Training Program Directors

Abstract

Increases in the size and number of American intensive care units (ICUs) have not been accompanied by a comparable Background: increase in the critical care physician workforce, raising concerns that intensivists are becoming overburdened by workload. This is especially concerning in academic ICUs where attending physicians must couple teaching duties with patient care.We performed an in-person and electronic survey of the membership of the Association of Pulmonary and Critical Care Methods: Medicine Program Directors (APCCMPD) soliciting information about patient work load, other hospital and medical education duties, and perceptions of the workplace and teaching environment of their ICUs.Seventy eight out of a total 121 possible responses were received from program directors or their delegates, resulting in a Results: response rate of 64%. The average daily (SD) census (as perceived by the respondents) was 18.8±8.9 patients and average (SD) maximum service size recalled was 24.1 (9.9) patients. Twenty-seven % reported no policy setting an upper limit for the daily census. All ICU teams had additional duties outside the ICU such as code teams or triaging. Over half had two such duties and 28% had three. Twenty eight % of respondents felt the average census was "too many" and 71% felt the maximum size was "too many". The median (IQR) patient to attending physician ratio was 13 (10-16). When categorized according to this median, respondents from ICUs with high patient-physician ratios (n=31) perceived significantly more time constraints, more stress, difficulty hiring and retaining staff, and difficulties with teaching trainees than respondents with low patient-physician ratios (n=40). The total number of non-nursing healthcare workers per patient was similar in both groups, suggesting that having more non-attending physician staff does not alleviate perceptions of over-work and stress in the attending physician. Finally, 38% of respondents reported their ICU has plans to expand with an average of 6.8 additional beds.Academic ICU physicians that direct fellowship programs frequently perceived being overburdened in the ICU. Conclusions:Understaffing ICUs with attending physicians may have a negative impact on teaching, patient care and workforce stability. This abstract is funded by: none Am J Respir Crit Care Med 183;2011:A1022 Internet address: www.atsjournals.org Online Abstracts Issue

Psychosocial Workload of Swedish Ambulance and Emergency Room Personnel with High Prevalence of Dying, Death and Grieving Relatives. A Descriptive and Comparison Study

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Provider to Patient Ratios for Nurse Practitioners and Physician Assistants in Critical Care Units

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“…A descriptive study design was used with a Web-based survey adapted from a previous national survey 17 of intensivists on provider to patient ratios in ICUs. The Society of Critical Care Medicine Taskforce on ICU Staffing was charged with providing recommendations for intensivists and hospitals on maximum patient workloads.…”

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