Workforce demographics and unit structure in paediatric cardiac critical care in the United States

Abstract

Objective: To assess current demographics and duties of physicians as well as the structure of paediatric cardiac critical care in the United States. Design: REDCap surveys were sent by email from May till August 2019 to medical directors (“directors”) of critical care units at the 120 United States centres submitting data to the Society of Thoracic Surgeons Congenital Heart Surgery Database and to associated faculty from centres that provided email lists. Faculty and directors were asked about personal attributes and clinical duties. Directors were additionally asked about unit structure. Measurements and main results: Responses were received from 66% (79/120) of directors and 62% (294/477) of contacted faculty. Seventy-six percent of directors and 54% of faculty were male, however, faculty <40 years old were predominantly women. The majority of both groups were white. Median bed count (n = 20) was similar in ICUs and multi-disciplinary paediatric ICUs. The median service expectation for one clinical full-time equivalent was 14 weeks of clinical service (interquartile range 12, 16), with the majority of programmes (86%) providing in-house attending night coverage. Work hours were high during service and non-service weeks with both directors (37%) and faculty (45%). Conclusions: Racial and ethnic diversity is markedly deficient in the paediatric cardiac critical care workforce. Although the majority of faculty are male, females make up the majority of the workforce younger than 40 years old. Work hours across all age groups and unit types are high both on- and off-service, with most units providing attending in-house night coverage.

High variability in cardiac education and experiences during United States paediatric critical care fellowships

“…Combining website and survey-based data, we demonstrated that United States paediatric critical care medicine fellowships provide vastly different cardiac Prior literature reporting the landscape of cardiac ICU care modelsdesignated cardiac ICU versus mixed paediatric ICUs is sparse, with a recent study reporting 67% designated cardiac ICUs. 2,5,13 Our study demonstrates that 76% (31/41) of responding programmes now have a dedicated cardiac ICU. The learner experience is different in these dedicated cardiac ICUs by nature of unit organisation.…”

“…18,19 There is no standard Accreditation Council of Graduate Medical Education-recommended cardiac curriculum for paediatric critical care medicine fellowships and variable cardiac ICU training pathways post-paediatric critical care medicine fellowship. 2,3,20 However, according to the Pediatric Cardiac Intensive Care Society, either the 1-year paediatric cardiac critical care fellowship or dual boarding in Cardiology and paediatric critical care medicine are now the national standard for training for current fellows undergoing training and expecting to care for cardiac critical care patients. 21 Cardiac ICU experiences during paediatric critical care medicine fellowship also vary in terms of time spent on service (for those with separate units) and institution-specific cardiac didactics.…”

“…As paediatric cardiology and cardiovascular surgery evolve, the complexity of children with congenital and acquired heart disease increases substantially and the technology available continues to advance. 1,2 Consequently, paediatric cardiac critical care medicine has become progressively more sub-specialised. [1][2][3][4] Many hospitals have formed dedicated cardiac ICUs separated from the general paediatric ICUs.…”

“…1,2 Consequently, paediatric cardiac critical care medicine has become progressively more sub-specialised. [1][2][3][4] Many hospitals have formed dedicated cardiac ICUs separated from the general paediatric ICUs. [1][2][3]5,6 However, the impact of a dedicated cardiac ICU on cardiac exposure and education during paediatric critical care medicine fellowship has not been wellinvestigated.…”

“…[1][2][3][4] Many hospitals have formed dedicated cardiac ICUs separated from the general paediatric ICUs. [1][2][3]5,6 However, the impact of a dedicated cardiac ICU on cardiac exposure and education during paediatric critical care medicine fellowship has not been wellinvestigated. Historically, when units were combined, paediatric critical care medicine fellows were exposed to cardiac patients for similar clinical time as other paediatric ICU patients.…”