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.
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.

Amr E. Abouleish, M.D. is Associate Professor, Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas.