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August 2001
Volume 65 |
Number 8
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| Estimating
Staffing Requirements: How Many Anesthesia Providers Does
Our Group Need? |
Amr E. Abouleish, M.D.
Mark H. Zornow, M.D.
A recurring issue for most anesthesia groups is the need to estimate
accurately how many providers need to be recruited in order to
meet current and future clinical obligations. When this estimate
is not met or is miscalculated, the anesthesia group may be put
in a position where it has to make compromises on staffing guidelines,
cancel vacations or force members of the group to work additional
days. In this article, we provide a simple methodology for estimating
staffing needs. We have also made available on the ASA Web site
a downloadable Excel™ workbook that we developed which facilitates
calculation of personnel needs. 1
Limitations
The example described below and the Excel workbook accompanying
this article on the Web were created for a staffing model of a
single-shift operating room (O.R.) coverage and a single on-call
shift for after-hours coverage. A discussion of alternative staffing
models, cost-effectiveness, O.R. utilization or scheduling efficiency
is beyond the scope of this article, but references related to
more complex analyses are noted. 2-5
Based on a hypothetical academic anesthesiology department, the
example detailed below illustrates one way to handle nonclinical
time and multiple clinical settings, including pain management
clinics and critical care services.
Staffing Assumptions
In order to estimate staffing needs, several assumptions must
be made regarding the number of clinical sites staffed daily,
the medical direction ratio, the amount of vacation and meeting
time allotted for each provider and the amount of nonclinical
time allocated to each provider. Furthermore, an estimate of potential
new hires and departures should be included.
An Example Group Practice
Group A is an academic anesthesiology department currently staffed
with 30 full-time faculty anesthesiologists, 36 residents (12
in each of the clinical anesthesia [CA] years) and 10 nurse anesthetists
and anesthesiologist assistants (AAs). The group provides clinical
care for a 21-room O.R. suite (Main O.R.), a labor and delivery
suite (L&D) with two O.R.s, a day-surgery preoperative clinic
(Preoperative Clinic), a surgical intensive care unit (SICU) and
an acute and chronic pain management clinic with consult service
(Pain Management). In addition to the sites in the O.R. suite,
anesthesia care is usually delivered to at least one remote site
per day.
Although the group has members who take specialty call from home
(pediatric, cardiac, critical care and pain management), the group
also has two faculty members who are in-house every night and
on weekends — one for the Main O.R. and one for the L&D.
In addition, six residents take in-house call, with three in the
Main O.R., two in the L&D and one in the SICU. All in-house
call providers are dismissed the next morning after call without
any clinical obligation to provide care on the post-call day.
Nurse anesthetists and AAs do not take call.
Because the group is involved in training residents, it has chosen
a 1:2 faculty-to-provider ratio for medical direction. The anesthesiologist
in charge of scheduling on a given day (i.e., the schedule runner)
is usually assigned to one medical-direction O.R. Because there
may be cases where the faculty must be one-on-one with the resident/nurse
anesthetist/AA due to the complexity of the surgery or status
of the patient (e.g., neonatal surgery), the scheduling template
allows for one room to handle one-on-one cases. Rooms that cannot
be staffed by residents, nurse anesthetists or AAs are assigned
as a faculty room where the faculty anesthesiologist personally
performs the anesthesia care.
Faculty anesthesiologists have a variety of clinical as well
as nonclinical commitments. Although all are 1.0 full-time equivalent
(FTE), the clinical FTE is calculated by dividing the number of
days scheduled to provide clinical care per week by five.5 The
average clinical FTE for the faculty is 0.75. Nurse anesthetists
and AAs work four 10-hour days per week and hence have a clinical
FTE of 0.8. All the residents work five days a week, but there
are always four residents on rotation outside the department;
hence, the average clinical FTE for residents is 0.89.
To estimate the number of providers who are nonclinical on any
given day, one must calculate the nonclinical FTEs needed. Based
on the total clinical FTEs estimated, the total number of FTEs
needed is calculated by dividing the total clinical FTEs by the
average clinical FTEs. In this example, the clinical FTEs needed
for faculty is estimated at 19.0. If the average clinical FTE
is 0.75, then a total of 25.5 FTEs are needed. To estimate nonclinical
FTEs, clinical FTEs are subtracted from the total FTEs —
in this case resulting in 6.5 FTEs. This means that, on any day,
it is estimated that 6.5 (six to seven) faculty members are nonclinical.
Meeting time availability for faculty, residents and nurse anesthetists/AAs
is two weeks, 0.33 weeks and one week per year, respectively.
Vacation time is four weeks, two weeks and four weeks, respectively.
These values are used to calculate the average number of faculty,
residents and nurse anesthetists/AAs away from the department
in any given week. For this example, this results in averages
of 3.46, 1.59 and 0.98, respectively [Table
1].
Final results of the calculations for Group A are found in Table
1. The initial estimates were done based on no faculty rooms.
When this was completed, the calculations showed an excess number
of faculty but an inadequate number of residents and nurse anesthetists/AAs
available. Hence, adjustment of coverage in the Main O.R. was
done to arrive at the results shown in [Table
1].
If the results had shown deficits in any of the provider categories
without a surplus in other categories, then staffing guidelines
(discussed above) and the estimates of the hires and departures
would have needed adjustment so that no deficit in staffing was
estimated. Interestingly, the staffing guidelines and the recruitment
and retention of providers are the variables that anesthesiology
groups must manipulate to meet clinical obligations when a group
finds itself facing staffing shortages.
To utilize a similar methodology for your group, you will
need to download
the Excel file here.
(Right-click on link and save to your computer.)
Detailed instructions appear on the first worksheet. Clearly,
the Excel file will need to be customized to your group,
and the instructions should address most adjustments.
References:
1. American Society of Anesthesiologists Web site
<www.ASAhq.org/NEWSLETTERS/2001/8_01/toc_0801.htm>.
2. Strum DP, Vargas LG, May JH. Surgical subspecialty
block utilization and capacity planning: A minimal cost analysis
model. Anesthesiology. 1999; 90:1176-1185.
3. Dexter F, Marcario A, O’Neill L. Scheduling
surgical cases into overflow block time: Computer simulation of
the effects of scheduling strategies on operating room labor costs.
Anesth Analg. 2000; 90:980-988.
4. Dexter F, Epstein RH, Marsh HM. A statistical
analysis of weekday operating room anesthesia group staffing costs
at nine independently managed surgical suites. Anesth Analg. 2001;
92:1493-1498.
5. Abouleish AE, Zornow MH, Levy RS, et al. Measurement
of individual clinical productivity in an academic anesthesiology
department. Anesthesiology. 2000; 93:1509-1516.
Mark H. Zornow, M.D., is Professor of Anesthesiology and Vice
Chair for Clinical Affairs, Department of Anesthesiology, University
of Texas Medical Branch, Galveston, Texas.
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Amr E. Abouleish,
M.D. is Associate Professor, Department of Anesthesiology,
University of Texas Medical Branch, Galveston, Texas. |
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