Surgeon-Intensivists Workload and Patient Safety

A 2001 report predicted a 46% shortage of intensivists by 2030, and in the intervening years, studies have continued to predict workplace shortages. In the United States, approximately 3% of critical care is provided by surgeon-intensivists. A study in The American Surgeon looked at workforce shortage predictions with respect to surgeon-intensivists, and weighed the expected increase in critical care demand against the expected shortage.

This study used surgeon-intensivists’ voluntary, anonymous self-reported workload of more than 2 months. Surgeons were recruited via the Society of Critical Care Medicine. The researchers assessed personnel resources and surgeon-intensivists’ workload in the intensive care unit (ICU) and on their post-call day.

Among 262 surgeons working in the ICU, the researchers found the following:

• 14% were solely responsible for surgery cases in the ICU
• 42% covered bed allocation/transfer center duties
• 69% had administrative responsibilities
• 76% covered trauma and general surgery call
• 72% covered the outpatient clinic or had elective surgery cases while responsible for the ICU
• 21% did not round with residents and half did not round with a fellow

The majority of surgeon-intensivists reported responsibilities of considerable scope beyond the primary responsibility of caring for critically ill surgical patients. The authors note that expanded responsibilities are in direct conflict with the surgeon-intensivist’s purported role. Surgeon-intensivist reported working on post-call days often, and indicated that a typical work day exceeds the 7:00 AM to 5:00 PM standard. Staying awake for 34 hours was not unusual when surgeons considered personal or family activities after the post-call workday ended.

The operating suite is a large source of revenue for hospitals, and hospital management often expects surgeon-intensivists to cover general surgery, trauma, and in some cases, maintain elective practices. Experts estimate that adequate intensivist staffing could save 54,000 lives every year.