Part-Time Clinical Anesthesia Practice: a Review of the Economic, Quality, and Safety Issues

Anesthesiology Clinics

Volumn 26, Issue 4, 2008, Pages 707-727

  McIntosh, Catherine A ^a,b,c   Macario, Alex ^d  

^a JOHN HUNTER HOSPITAL   (Australia)

^b Hunter New England Skills and Simulation Centre   (Australia)

^c UNIVERSITY OF NEWCASTLE   (Australia)

^d STANFORD UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

Aging; Generational differences; Minimum clinical activity; Part time; Safety; Workforce

Indexed keywords

ANESTHESIA; CLINICAL COMPETENCE; CLINICAL PRACTICE; DECISION MAKING; ECONOMIC ASPECT; HEALTH CARE QUALITY; HUMAN; PARTTIME EMPLOYMENT; PATIENT SAFETY; REVIEW; SALARY;

AGING; ANESTHESIA; ANESTHESIOLOGY; ATTITUDE OF HEALTH PERSONNEL; CAREER CHOICE; HUMANS; PERSONNEL STAFFING AND SCHEDULING; QUALITY OF HEALTH CARE; TASK PERFORMANCE AND ANALYSIS; TIME FACTORS; WORKLOAD;

EID: 56849087899     PISSN: 19322275     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.anclin.2008.07.004     Document Type: Review

References (75)

1. Lemaitre G., Marianna P., and van Bastelaer A. International comparisons of part-time work: OECD economic studies No.29. Available at:. http://www.oecd.org/dataoecd/22/18/2733470.pdf Accessed January 7, 2008
2. Jaumotte F. Female labour force participation: past trends and main determinants in OECD countries. Economics department working paper No. 376. Available at:. http://www.oecd.org/dataoecd/25/5/31743836.pdf Accessed January 7, 2008
3. US Department of Labor, Women's Bureau. Women in the labor force in 2006. Available at:. http://www.dol.gov/wb/factsheets/Qf-laborforce-06.htm Accessed January 7, 2008
4. Cull W.L., Mulvey H.J., O'Connor K.G., et al. Pediatricians working part-time: past, present and future. Pediatrics 109 (2002) 1015-1020
5. Australian Medical Workforce Advisory Committee. The specialist anaesthesia workforce in Australia: AMWAC Report. Sydney (Australia): Australian Medical Workforce Advisory Committee; 2001.
6. ANZCA Workforce Taskforce. ANZCA workforce report (2005), Australian and New Zealand College of Anaesthetists, Melbourne (Australia)
7. Australian Medical Workforce Advisory Committee. Career decision-making by doctors in their postgraduate years: a literature review: AMWAC Report. Sydney (Australia): Australian Medical Workforce Advisory Commitee; 2002.
8. Cooper R.A. There's a shortage of specialists: is anyone listening?. Acad Med 77 (2002) 761-766
9. Zuger A. Dissatisfaction with medical practice. N Engl J Med 350 (2004) 69-75
10. Jeffe D.B., Andriole D.A., Hageman H.L., et al. The changing paradigm of contemporary U.S. allopathic medical school graduates' career paths: analysis of the 1997-2004 national AAMC graduation questionnaire database. Acad Med 82 (2007) 888-894
11. Mulvey H, Kopriva PR, Cull WL. Physicians working part-time: implications for the workforce and the workplace. Available at: http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102274322.html. Accessed October 14, 2008.
12. Australian Medical Association. Position statement: definition of part-time work within the medical work force-1997. Available at:. http://www.ama.com.au/web.nsf/doc/SHED-5EYFKA Accessed January 7, 2008
13. Schubert A., Eckhout G., and Tremper K.K. An updated view of the national anesthesia personnel shortfall. Anesth Analg 96 (2003) 207-214
14. Population by age and sex, Australia. Available at: (2006). http://www.abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/3235.0Main%20Feat ures32006?opendocument&tabname=Summary&prodno=3235.0 Accessed December 20, 2008
15. Pasko T., and Smart D. Physician characteristics and distribution in the US, 2006 edition (2005), American Medical Association, Chicago p. xix-xx
16. US Census Bureau. Population finder facts sheet. Available at:. www.census.gov Accessed December 20, 2008
17. Eckhout G., and Schubert A. Where have all the anesthesiologists gone? Analysis of the national anesthesia worker shortage. ASA Newsl 65 4 (2001) 16-19
18. Australian Medical Workforce Advisory Committee & Australian Institute of Health and Welfare. Female participation in the Australian Medical Workforce: AMWAC Report 1996.7. Sydney (Australia): Australian Medical Workforce Advisory Committee & Australian Institute of Health and Welfare; 1996.
19. Roberts L.J., and Khursandi D.C. Career choice influences in Australian anaesthetists. Anaesth Intensive Care 30 (2002) 355-359
20. Australian Medical Workforce Advisory Committee. Career decision making by doctors in vocational training: summary of findings. AMWAC Report 2003.2. Sydney (Australia): Australian Medical Workforce Advisory Committee; 2003.
21. Etzioni D., and Liu J. The aging population and its impact on the surgery workforce. Ann Surg 238 (2003) 170-177
22. Birrell B., Hawthorne L., and Rapson V. The outlook for surgical services in Australasia. Available at:. http://www.surgeons.org/Content/NavigationMenu/WhoWeAre/Workforce/Discus sionpapers/OutlookforSurgicalServicesinAustraliaBirrellreport/birrell_06 03.pdf Accessed January 3, 2008
23. American Society of Anesthesiologists. Estimation of physician work force requirements in anesthesiology (1994), Abt Associates, Inc, Bethesda (MD)
24. Miller R.D. The shortage of anesthesiologists: an unwelcome lesson for other medical specialties. Mayo Clin Proc 76 (2001) 969-970
25. Schubert A., Eckhout G., Cooperider T., et al. Evidence of a current and lasting national anesthesia personnel shortfall: scope and implications. Mayo Clin Proc 76 (2001) 995-1010
26. Families and Work Institute. Generation and gender in the workplace: an issue brief. Available at:. http://familiesandwork.org/site/research/reports/genandgender.pdf Accessed January 3, 2008
27. Dorsey E.R., Jarjoura D., and Rutecki G.W. Influence of controllable lifestyle on recent trends in specialty choice by US medical students. JAMA 290 (2003) 1173-1178
28. Turner G., Goldacre M.J., Lambert T., et al. Career choices for anaesthesia: national surveys of graduates of 1974-2002 from UK medical schools. Br J Anaesth 95 (2005) 332-338
29. Wass C.T., Long T.R., Randle D.W., et al. Recruitment of house staff into anesthesiology: a re-evaluation of factors responsible for house staff selecting anesthesiology as a career and individual training program. J Clin Anesth 15 (2003) 289-294
30. Wass C.T., Rose S.H., Faust R.J., et al. Recruitment of house staff into anesthesiology: factors responsible for house staff selecting anesthesiology as a career and individual training program. J Clin Anesth 11 (1999) 150-163
31. Rose S.H., Burkle C.M., and Ellliott B.A. Trends in gender distribution among anesthesiology residents: do they matter?. Anesth Analg 103 (2006) 1209-1212
32. Graduate medical education. JAMA 294 (2005) 1129-1131
33. Baerlocher M.O., Hussain R., and Bradley J. Gender patterns amongst Canadian anesthesiologists. Can J Anaesth 53 (2006) 437-441
34. Macken D. Is there a doctor in the house? ...At any price. Australian Financial Review, August 25-26, (2007) 21-23
35. Mechaber H.F., Levine R.B., Baier Manwell L.B., et al. Part-time physicians...prevalent, connected and satisfied. J Gen Intern Med 23 (2008) 300-303
36. Fairchild D.G., Sax McLoughlin K., Gharib S., et al. Productivity, quality and patient satisfaction: comparison of part-time and full-time primary care physicians. J Gen Intern Med 16 (2001) 663-667
37. Parkerton P.H., Wagner E.H., Smith D.G., et al. Effect of part-time practice on patient outcomes. J Gen Intern Med 18 (2003) 717-724
38. Haas J.S., Cook E.F., Puopolo A.L., et al. Is the professional satisfaction of general internists associated with patient satisfaction?. J Gen Intern Med 15 (2000) 122-128
39. Epstein C.F., Seron C., Oglensky B., et al. Part-time work as deviance: stigmatization and its consequences. In: Epstein C. (Ed). The part-time paradox: time norms, professional lives, family and gender (1999), Routledge, New York 29-37
40. Bailyn L. Time in organizations: constraints on, and possibilities for, gender equity in the workplace. In: Burke R.J., and Nelson D.L. (Eds). Advancing women's careers: research in practice (2002), Blackwell, Oxford (United Kingdom) 262-272
41. Hochschild A.R. The time bind: when work becomes home and home becomes work (1997), Henry Holt and Company, New York p. 92
42. Olmsted B., and Smith S. Creating a flexible workplace: how to select and manage alternative work options (1994), AMACOM, New York p. 97
43. Judge T.A., Thoresen C.J., Bono J.E., et al. The job satisfaction-job performance relationship: a qualitative and quantitative review. Psychol Bull 127 (2001) 376-407
44. NSW Health Policy Directive. Salary packaging policy and procedure manual. Available at:. www.health.nsw.gov.au/policies/pd/2007/pdf/PD2007_076.pdf Accessed December 20, 2007
45. Landrigan C.P., Rothschild J.M., Cronin J.W., et al. Effect of reducing interns' work hours on serious medical errors in intensive care units. N Engl J Med 351 (2004) 1838-1848
46. Federal Aviation Authority Statement on Pilot Retirement Age, December 2007. Available at:. http://www.faa.gov/news/press_releases/news_story.cfm?newsId=10072 Accessed January 20, 2008
47. Schroeder DJ, Broach D. Pilot age and performance: an annotated bibliography (1990-1999). Oklahoma City (OK): Civil Aeromedical Institute; 2000.
48. Larson Jr. C.P., and Steadman R.H. An advanced specialty training program in anesthesiology: a special educational fellowship designed to return community anesthesiologists to clinical practice. Anesth Analg 103 (2006) 126-130
49. ANZCA Professional Standard PS 50 recommendations on practice re-entry for a specialist anaesthetist: 2004. Available at:. http://www.anzca.edu.au/resources/professional-documents/professional-st andards/ps50.html Accessed November 10, 2007
50. Saalwachter A.R., Freischlag J.A., Sawyer R.G., et al. Part-time training in general surgery: results of a web-based survey. Arch Surg 141 (2006) 977-982
51. Weeks W.B., Wallace A.E., and Mackenzie T.A. Gender differences in anesthesiologists' annual incomes. Anesthesiology 106 (2007) 806-811
52. Bierstein K. Creative scheduling for anesthesiologists: physician retention in a tight market. Part II. Designing a part-time work system. Available at: http://www.asahq.org/Newsletters/2003/05_03/pracMgmt05_03.html. Accessed October 10, 2007.
53. Blough GG, Scott SJ. Creative scheduling for anesthesiologists: accommodating the workforce in 2007. Presented at the American Society of Anesthesiologists 2007 conference on practice management. Phoenix (AZ), January 26-28, 2007.
54. Blackburn R.M., and Jarman J. Stratification and gender. GeNet working paper No. 4, January 2005. Available at:. http://www.genet.ac.uk/workpapers/GeNet2005p4.pdf Accessed January 8, 2008
55. AMGA provider satisfaction benchmarking program. Available at:. http://www.amga.org/QMR/PROSAT/survey_prosat.asp Accessed January 20, 2008
56. Petersen L.A., Brennan T.A., O'Neil A.C., et al. Does housestaff discontinuity of care increase the risk for preventable adverse events?. Ann Intern Med 121 (1994) 866-872
57. Petersen L.A., Orav E.J., Teich J.M., et al. Using a computerized sign-out program to improve continuity of inpatient care and prevent adverse events. Jt Comm J Qual Improv 24 (1998) 77-87
58. Cooper J.B., Long C.D., Newbower R.D., et al. Critical incidents associated with intraoperative exchanges of anesthesia personnel. Anesthesiology 56 (1982) 456-461
59. Arbous M.S., Meursing A.E.E., van Kleef J.W., et al. Impact of anesthesia management characteristics on severe morbidity and mortality. Anesthesiology 102 (2005) 257-268
60. Cooper J.B. Do short breaks increase or decrease anesthetic risk?. J Clin Anesth 1 (1989) 228-231
61. Cooper J.B., Newbower R.D., Long C.D., et al. Preventable anesthesia mishaps: a study of human factors. Anesthesiology 49 (1978) 399-406
62. Australian and New Zealand College of Anaesthetists. Guidelines on consent for anesthesia or sedation: professional standard 26. Available at:. http://www.anzca.edu.au/resources/professional-documents/professional-st andards/ps26.html Accessed January 20, 2008
63. Ericsson K.A. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med 79 (2004) S70-S81
64. Volpp K.G., Rosen A.K., Rosenbaum P.R., et al. Mortality among hospitalized Medicare beneficiaries in the first 2 years following ACGME resident duty hour reform. JAMA 298 (2007) 984-992
65. Volpp K.G., Rosen A.K., Rosenbaum P.R., et al. Mortality among patients in VA hospitals in the first 2 years following ACGME resident duty hour reform. JAMA 298 (2007) 984-992
66. Shetty K.D., and Bhattacharya J. Changes in hospital mortality associated with residency work-hour regulations. Ann Intern Med 147 (2007) 73-80
67. Calman K.C. Hospital doctors: training for the future: the report of the working group on specialist medical training (1993), HMSO, London
68. Morris Stiff G.J., Clarke D., Torkington J., et al. Training in the Calman era: what the consultants say. Ann R Coll Surg Engl 84 Suppl (2002) 345-347
69. Kizer K.W. The volume-outcome conundrum. N Engl J Med 349 (2003) 2159-2161
70. Weinger M.B. Experience expertise: can simulation be used to tell the difference?. Anesthesiology 107 (2007) 691-694
71. Woman BA pilot wins flexible working fight. Available at:. http://www.guardian.co.uk/money/2007/mar/10/britishairways.workandcareer s Accessed December 17, 2007
72. ANZCA Regulation 15: training in anaesthesia. Available at:. http://www.anzca.edu.au/resources/regulations/regulation-15.html Accessed January 9, 2008
73. Burke M.E. Generational differences survey report (2004), Society for Human Resource Management, Alexandria (VA). http://www.shrm.org/hrresources/surveys_published/Generational%20Differe nces%20Survey%20Report.asp#TopOfPage Accessed January 2, 2008
74. Miller R.D., and Cohen N.H. The impact of productivity-based incentives on faculty salary-based compensation. Anesth Analg 101 (2005) 195-199
75. Abouleish A., Apfelbaum J., Prough D., et al. The prevalence and characteristics of incentive plans for clinical productivity among academic anesthesia departments. Anesth Analg 100 (2005) 493-501