The Burden of the U.S. Crisis in the Surgical Critical Care Workforce and Workflow

Abstract

There will be a 46 per cent shortage of intensivists by 2030. Currently, only 3 per cent of U.S. critical care is provided by surgeon-intensivists. Measurement of the current workload is needed to understand the ramifications of the expected shortage of surgeon-intensivists. The purpose of this study is to evaluate the self-reported workload of U.S. surgeon-intensivists. Over a 2-month period, a voluntary and anonymous survey of the surgery section of the Society of Critical Care Medicine was performed using Survey Monkey. Only surgeons were invited to participate. We assessed personnel resources and surgeon-intensivists workload in the intensive care unit (ICU) and on their postcall day. Two hundred sixty-two persons responded. Sixty-nine per cent had administrative responsibilities and 42 per cent covered bed allocation/transfer center duties while in the ICU. Seventy-six per cent covered trauma and general surgery call and 72 per cent covered the outpatient clinic or had elective surgery cases while responsible for the ICU. Only 14 per cent had no other responsibilities. Twenty-one per cent did not round with residents and 50 per cent did not round with a fellow. Thirty-six per cent did not work with advanced practitioners. The majority of surgeon-intensivists have significant responsibilities in addition to providing ICU care. This workload should be factored into the expected shortage of surgical intensivists relative to the expected increase in critical care demand.

Excellence of the closed intensive care unit system in critically ill surgical patients

“…According to a study investigating the reasons why surgeons are reluctant to become intensivists for critically ill surgical patients, it was reported that this was because of a decrease in satisfaction due to mismatch with the specialty of “surgery” as surgeons had fewer surgical opportunities. Moreover, the pressure of work continuously exposed to critically ill patients and the conflicts that may arise in the process of managing critically ill patients were reasons for the reluctance to become intensivists [ 7 ].…”

Undergraduate medical education in the U.S. and Israel: contrasts and common challenges

“…The CHE Report points out correctly that workforce planning in the U.S. is “highly fragmented” and experts cannot agree whether there is an actual physician shortage or whether the problem can be solved by better geographic distribution and an increase in the percentage of medical school graduates who pursue careers in primary care [ 2 ]. The latter view fails to recognize that an aging population requires not only primary care physicians but subspecialists who have expertise in caring for patients that have diseases that are over-represented in an aged population: degenerative joint disease, age-related macular degeneration, coronary artery disease, heart failure, critical care medicine, neurodegenerative diseases and cancer [ 3 , 4 ].…”

Advocacy efforts in trauma and acute care surgery: learning to walk

“… 5 6 Recognizing that each year often brings an increase in productivity targets, it is increasingly difficult to engage in advocacy efforts amidst the myriad of other responsibilities—a process not limited to general surgeons. 7 8 The apparent comfort in being unengaged in advocacy work may be related to a sense of comfort that others will or should shoulder this activity set for them, perhaps being able to point to the success of the American Association for the Surgery of Trauma (AAST) at bringing ACS to fruition; this effort hinged on the dedicated work of a smaller subset of individuals on behalf of the entire organization. Despite the potential capacity of professional organizations to engage in advocacy, such efforts are often focused within a particular committee or committees on behalf of the membership rather than a more global membership-based approach.…”