U.S. Attending Anesthesiologist Burnout in the Postpandemic Era

Involvement of anesthesiologists in pediatric sedation and analgesia outside the operating room in Japan: is it too late, or is there still time?

The global COVID-19 pandemic highlighted significant existing supply-demand imbalances in anesthesia workforce, particularly impacting non-operating room anesthesia. Despite documented risks and mortality rates associated with pediatric procedural sedation and analgesia (PPSA) outside the operating room (OR), there is a pressing need for improvements in safety infrastructure. Comparative analysis with international practices reveals that anesthesiologists' involvement is associated with fewer adverse events and improved outcomes. However, lower reimbursement rate for sedation and anesthesia workforce shortage, and decentralized health resources are contributing factors to limit their participation in PPSA outside the OR in Japan. Enhancing the involvement of anesthesiologists through the public health frameworks such as "high-risk approach" and "population approach" can contribute to improvement of the safety and quality of PPSA. By tackling these challenges and implementing effective solutions, anesthesiologists can play a key role in ensuring safer and more effective PPSA outside the OR. Future challenges include enhancing training, addressing reduced clinical exposure due to work style reform, and developing effective educational systems. Research on improved educational approaches and fundamental outcome indices is crucial for improving PPSA practices outside the OR.

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.

Anaesthesia practice in Europe: A survey of the National Anaesthesiologists Societies Committee of the European Society of Anaesthesiology and Intensive Care

BACKGROUND

Similar to other continents, Europe is experiencing a shortage of anaesthesia workforce, which profoundly impacts the national healthcare systems of affected countries.

OBJECTIVE

To assess the current landscape of the anaesthesia workforce, organisational practices, rules and responsibilities of anaesthesiologists and other anaesthesia providers in operating rooms.

DESIGN

Survey.

SETTING

Thirty-nine out of 41 European countries were surveyed between April 2022 and April 2023.

PARTICIPANTS

Delegates of the National Anaesthesiologists Societies Committee (NASC) of the European Society of Anaesthesiology and Intensive Care (ESAIC).

INTERVENTION

A faculty of experts from France, Germany and Italy, selected by the Chair of NASC, developed a survey consisting of 16 questions, which was sent to the NASC delegates of all European countries.

MAIN OUTCOME MEASURES

Responses from the NASC delegates.

RESULTS

The anaesthesia workforce, composition, roles and duties of anaesthesia teams vary significantly among European countries. The majority of respondents reported a workforce shortage, with variable trends, exacerbated in some cases by an increased loss of anaesthesiologists following the COVID-19 pandemic. Significant differences in anaesthesiologists' salaries exist across countries. A one-to-one anaesthesiologist-to-patient ratio during general anaesthesia maintenance, neuraxial and peripheral blocks is the most common; however, in a notable number of cases, this ratio decreases to one-to-two or even less. In such instances, residents or nonphysician anaesthesia personnel (NPAs) play a crucial role, enabling anaesthesiologists to supervise more than one patient simultaneously. Differences in the training of anaesthesia team members, as well as rules regulating anaesthesia team composition and the autonomy of its members, were also evident.

CONCLUSION

The survey provides data on the current anaesthesia practice in Europe. The availability, composition and organisation of anaesthesia team members differ among European countries. The study highlights areas for further focus in operating room organisation and anaesthesia team composition, particularly regarding safety, efficacy and cost-effectiveness.

The Disabled Anesthesiologist

A significant number of anesthesiologists will experience a disabling illness or injury during their careers. In addition to ethical obligations to patients, physicians have ethical obligations to their colleagues: both to recognize and intervene when disabilities have the potential of interfering with patient care and to try, whenever it is possible and safe, to support colleagues with disabilities in pursuing a successful career. Encouraging and accommodating physicians with disabilities in their practice of medicine benefits patients, by including physicians who may better understand the challenges of the disabled, and also the profession, by promoting acceptance of diversity in practice.

Challenges of Motherhood for Anesthesiologists: A Scoping Review

Despite advancements in gender representation, female anesthesiologists continue to encounter challenges in career advancement that may be further impacted by motherhood. This scoping review examines personal and systemic barriers and facilitators to career advancement for anesthesiologists facing infertility, pregnancy, and childcare. The review identified 22 relevant studies across five themes: the timing of pregnancy and parental leave, breastfeeding and lactation needs, childcare and gender norms, job reentry and career advancement opportunities, and work-life balance and physician well-being. Recommendations from these studies include establishing clear parental leave policies, providing adequate lactation spaces and protected break times, addressing gender disparities in leadership roles, and prioritizing physician well-being. To implement these recommendations effectively, institutions and departments should develop and disseminate role-specific policies that promote career advancement and satisfaction through equitable support of pregnant and parent anesthesiologists.

Incidence and Factors Associated With Burnout Among Cardiac Anesthesiologists in India

OBJECTIVE

Many previous surveys have demonstrated a high incidence of burnout among anesthesiologists. The current survey was designed to estimate the incidence and understand the factors associated with burnout among cardiac anesthesiologists in India.

DESIGN

Members of the Indian Association of Cardiovascular and Thoracic Anaesthesiologists (IACTA) were invited to participate. The survey consisted of two sections: the initial section collected demographic data, work patterns, and factors associated with burnout perception. The second part assessed emotional exhaustion (EE), depersonalization (DP), and low personal accomplishment (LPA) using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS).

SETTING

Web-based survey.

PARTICIPANTS

Members of IACTA.

INTERVENTIONS

None.

MEASUREMENT AND RESULTS

A high score on EE (≥27 and/or DP ≥10) identified those at high risk for burnout. A high risk of burnout in addition to LPA ≤33 was defined as burnout syndrome. Of the 2,262 IACTA members surveyed, 325 (14.35%) responded. Among them, 162 (49.8%) were classified as at high risk of burnout, and 91 (28%) met the criteria for burnout syndrome. Logistic regression analysis identified factors associated with a high risk of burnout, including <5 years of experience (odds ratio [OR] = 3.53), insufficient external support (OR = 2.87), limited personal time (OR = 1.96), and considering leaving cardiac anesthesia (OR = 3.61). Factors contributing to burnout syndrome were <5 years of experience (OR = 3.83), inadequate workplace colleague support (OR = 1.84), and considering leaving cardiac anesthesia (OR = 2.43).

CONCLUSIONS

The burden of burnout syndrome is high among Indian anesthesiologists. Risk factors included younger age, inadequate workplace and external support, limited personal time, and contemplation of leaving cardiac anesthesia. There is a need for various stakeholders to be sensitized and institute necessary measures to reduce the burden and impact of burnout.

Looking Across the Drape: A Novel Quality Improvement Approach to Understanding Surgeon and Anesthesiologist Burnout

OBJECTIVE

To identify well-being threats for surgeons and anesthesiologists and develop interventions using the quality of life improvement (QOLI) approach.

BACKGROUND

Developing feasible perioperative well-being interventions requires identifying shared and specialty-specific well-being needs. The QOLI framework integrates human-centered design, implementation science, and quality improvement to address well-being needs.

METHODS

Anesthesia and surgery faculty in 8 perioperative departments at an academic medical center completed cross-sectional surveys containing validated measures of well-being and workplace satisfaction, and open-ended questions about professional motivations, pain points, strategies for improvement, and well-being priorities. Using template analysis, we analyzed open-ended survey data and presented resulting themes at a joint-specialty town hall for live voting to identify well-being priorities.

RESULTS

One hundred four perioperative faculty completed the survey. Across specialties, higher Mental Health Continuum-Short Form scores (representative of individual global well-being) were associated with higher satisfaction with workplace control, values, decision latitude, and social support. Anesthesiologists reported lower satisfaction and control than surgeons across multiple domains. Template analysis yielded 5 areas for intervention: (1) work culture, (2) work environment/resources, (3) sources of fulfillment, (4) work/life harmony, and (5) financial compensation. Surgeons and anesthesiologists both prioritized high-quality patient care but differed in their other top priorities. The most frequently cited well-being threats for surgeons were operating room inefficiencies/delays and excessive workload, whereas anesthesiologists cited understaffing and unpredictable work hours.

CONCLUSIONS

Surgeons and anesthesiologists share many needs and priorities, with pain points that are often negatively synergistic. Applying the QOLI approach across specialties allows for well-being interventions that honor complexity and promote the development of feasible solutions.

Burnout among veterinary anaesthesia specialists: time to 'rock the boat' (part 1)

OBJECTIVE

To determine the prevalence of burnout among veterinary anaesthesia specialists and explore correlations with sociodemographic variables.

STUDY DESIGN

Cross-sectional, online, anonymous, voluntary survey.

POPULATION

A total of 530 worldwide veterinary anaesthesia specialists affiliated to American (ACVAA) and/or European (ECVAA) Veterinary Anaesthesia and Analgesia Colleges.

METHODS

An electronic questionnaire, incorporating the Maslach Burnout Inventory-Human Services Survey for Medical Personnel [MBI-HSS (MP)] and a sociodemographic questionnaire, was used. The MBI-HSS (MP) assessed the three burnout dimensions: emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA) using 22 questions, each with a 7-point Likert-type scale answer option, to compute a total score for each dimension. Thresholds for high levels of EE ≥ 27, DP ≥ 10 and for low level of PA ≤ 33. Responders were categorized as high risk for burnout with EE ≥ 27 and DP ≥ 10, and as having burnout syndrome with EE ≥ 27, DP ≥ 10 and PA ≤ 33. Data were investigated with descriptive statistical and regression analysis; p-value < 0.05.

RESULTS

Participation rate was 54% (286/530 Diplomates); 65% were identified as women; mean age was 44 years; 59% were married/civil partnership; 52% were ACVAA affiliated; 50% were working in North America; and 51% in academia. The prevalence of high risk for burnout was 42.6% (122/286), and for burnout syndrome was 24.5% (70/286). Number of hours worked per week positively correlated with EE (p < 0.0001) and DP (p = 0.02). Out-of-hours duty positively correlated with EE (p = 0.01) and DP (p = 0.04) and negatively correlated with PA (p = 0.04). Higher burnout prevalence was identified among younger Diplomates, those working ≥ 40 hours per week, in academia/research, and in North America.

CONCLUSIONS AND CLINICAL RELEVANCE

Concerted effort is required to address the unacceptably high risk of developing burnout and burnout syndrome observed among ACVAA/ECVAA Diplomates.

The impact of current pediatric anesthesiology fellows shortfall on freestanding children's hospitals and practices

The pediatric anesthesiology workforce is currently facing a critical shortage, which will have significant consequences for patient care and the healthcare system as a whole. The workforce is aging, and despite increasing numbers of anesthesiology residents, fewer graduates are entering the field of pediatrics. It should also be noted that fewer medical school graduates are entering pediatrics as well. This situation raises concerns about the availability of specialists and the training of future physicians. To address this shortage, a comprehensive strategy is urgently needed, including outreach, mentorship, financial incentives, and policy changes to attract and retain new talent in pediatric anesthesiology. Immediate intervention is necessary to prevent a severe impact on the availability and quality of pediatric anesthesia care.

Where have all the pediatric anesthesiology fellows gone in the USA? Anesthesiology fellowship trends

BACKGROUND

Recent consternation over the number of unfilled Pediatric Anesthesiology fellowship positions in the United States compelled us to assess the change in the ratio of Pediatric Anesthesiology fellows to the number of graduating anesthesiology residents over the 14-year period between 2008 and 2022. We also sought to report the total ratio of anesthesiology fellows to graduating residents and trends in the annual number of fellowship applicants relative to the number of Accreditation Council for Graduate Medical Education (ACGME)-accredited anesthesiology fellowship positions by specialty.

METHODS

We used publicly available resources, including ACGME Data Resource Books, National Resident Matching Program (NRMP) data, San Francisco (SF) Match data, and American Board of Medical Specialties (ABMS) data, to determine the ratio of anesthesiology fellows to graduating anesthesiology residents and to compare the number of fellowship applicants to fellowship positions for Adult Cardiothoracic Anesthesiology, Critical Care Anesthesiology, Obstetric Anesthesiology, Pain Medicine and Pediatric Anesthesiology.

RESULTS

Since 2008, the ratio of ACGME-accredited anesthesiology fellows to graduating residents increased from 0.36 in 2008 (2007 residency graduates) to 0.59 in 2022 (2021 residency graduates) and the ratio of Pediatric Anesthesiology fellows to graduating residents remained relatively stable from 0.10 to 0.11. The number of unmatched positions in Pediatric Anesthesiology increased from 17 in 2017 to 86 in 2023, and all ACGME-accredited fellowships had more positions available than applicants in 2023.

CONCLUSION

In the USA, while the ratio of Pediatric Anesthesiology fellowship graduates to anesthesiology residency graduates remained relatively constant from 2008 to 2022, this is likely a lagging indicator that has not yet accounted for the recent decrease in fellowship applicants. These findings refute prior estimates for a surplus in Pediatric Anesthesia supply in the USA and have significant implications for the future.

Closing the Chasm: Understanding and Addressing the Anesthesia Workforce Supply and Demand Imbalance

The imbalance in anesthesia workforce supply and demand has been exacerbated post-COVID due to a surge in demand for anesthesia care, especially in non-operating room anesthetizing sites, at a faster rate than the increase in anesthesia clinicians. The consequences of this imbalance or labor shortage compromise healthcare facilities, adversely affect the cost of care, worsen anesthesia workforce burnout, disrupt procedural and surgical schedules, and threaten academic missions and the ability to educate future anesthesiologists. In developing possible solutions, one must examine emerging trends that are affecting the anesthesia workforce, new technologies that will transform anesthesia care and the workforce, and financial considerations, including governmental payment policies. Possible practice solutions to this imbalance will require both short- and long-term multifactorial approaches that include increasing training positions and retention policies, improving capacity through innovations, leveraging technology, and addressing financial constraints.

Embracing Failure: Nurturing Learning and Well-Being in Anesthesiology and Perioperative Medicine

Failure, ubiquitous in life and medical practice, offers myriad opportunities for learning and growth alongside challenges to overall well-being. In this article, we explore the nature of failure, it's sources and impacts in perioperative medicine, and the specific challenges it brings to trainee well-being. With a deeper understanding of the societal, psychological and cognitive determinants and effects of failure, we propose solutions in order to harness the opportunities inherent in failures to create brave and supportive learning environments conducive to both education and well-being.

Enhancing Our Workforce: Recruitment and Retention in Anesthesiology

Increasingly, both healthcare leaders and studies of healthcare outcomes recommend a medical workforce that is representative of the patient population as a method to reduce health disparities and medical costs. Anesthesiology remains a specialty with lower proportions of women and underrepresented in medicine (URiM) physicians as compared to the overall physician workforce, with 26.1% of anesthesiologists identifying as women and 31.3% of anesthesiologists as URiM. Two areas of focus are commonly identified when discussing inadequate representation in the workforce: recruitment into the specialty and retention in the profession. As medical educators, we provide a critical role in the recruitment and retention of women and URiM anesthesiologists, through implementation of processes, programs, and cultural change. Here, we will discuss the current problems of recruitment and retention of women and URiM anesthesiologists and suggest action plans for now and the future to enhance our specialty's diversity.

The Variables Associated with Burnout Among Korean Early Childhood Teachers: A Meta-Analysis

Researchers have done a great deal of research on the variables associated with early childhood teacher burnout, but the findings are numerous and inconsistent. Therefore, this study explored the variables most associated with burnout among early childhood teachers through meta-analysis. The National Assembly Electronic Library in Korea, Riss, the National Electronic Library, and DBpia databases were all thoroughly searched by researchers. Strict inclusion criteria resulted in the inclusion of 201 studies, and 35 variables total—divided into 5 variable groups—were analyzed. The results showed that the most correlated variable group with burnout was the psychological personality protective variable, and the largest effect size variables among the variable groups were age ( r = −.3052), resilience ( r = −.5415), calling ( r = −.526), turnover intention ( r = .5021), and interpersonal relationships ( r = −.4552). However, the variables in the psychological personality risk variable were not statistically significant. Although more thorough validation by follow-up studies is still required, these findings offer a more scientific data reference for the prevention and improvement of burnout among early childhood teachers in Korea and suggest a direction for future research.

Artificial intelligence and regional anesthesiology education curriculum development: navigating the digital noise

Artificial intelligence (AI) has demonstrated a disruptive ability to enhance and transform clinical medicine. While the dexterous nature of anesthesiology work offers some protections from AI clinical assimilation, this technology will ultimately impact the practice and augment the ability to provide an enhanced level of safe and data-driven care. Whether predicting difficulties with airway management, providing perioperative or critical care risk assessments, clinical-decision enhancement, or image interpretation, the indications for AI technologies will continue to grow and are limited only by our collective imagination on how best to deploy this technology.An essential mission of academia is education, and challenges are frequently encountered when working to develop and implement comprehensive and effectively targeted curriculum appropriate for the diverse set of learners assigned to teaching faculty. Curriculum development in this context frequently requires substantial efforts to identify baseline knowledge, learning needs, content requirement, and education strategies. Large language models offer the promise of targeted and nimble curriculum and content development that can be individualized to a variety of learners at various stages of training. This technology has not yet been widely evaluated in the context of education deployment, but it is imperative that consideration be given to the role of AI in curriculum development and how best to deploy and monitor this technology to ensure optimal implementation.