Clinical Investigations

Workforce, Workload, and Burnout Among Intensivists and Advanced Practice Providers: A Narrative Review

Pastores, Stephen M. MD, MACP, FCCP, FCCM¹; Kvetan, Vladimir MD, FCCM^†; Coopersmith, Craig M. MD, FACS, FCCM³; Farmer, J. Christopher MD, FCCM⁴; Sessler, Curtis MD, FCCP, FCCM⁵; Christman, John W. MD⁶; D’Agostino, Rhonda ACNP, FCCP, FCCM⁷; Diaz-Gomez, Jose MD, FCCM⁸; Gregg, Sara R. MHA³; Khan, Roozehra A. DO, FCCP⁹; Kapu, April N. ACNP-BC¹⁰; Masur, Henry MD, MCCM¹¹; Mehta, Gargi PA-C, MSHS²; Moore, Jason MD¹²; Oropello, John M. MD, FACP, FCCP, FCCM¹³; Price, Kristen MD¹⁴

Author Information

¹Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.

²Jay B. Langner Critical Care System, Montefiore Medical Center, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY.

³Department of Surgery, Emory Critical Care Center, Emory University, Atlanta, GA.

⁴Department of Critical Care Medicine, Mayo Clinic, Phoenix, AZ.

⁵Division of Pulmonary Diseases and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA.

⁶Division of Pulmonary, Allergy, Critical Care and Sleep, The Ohio State University Wexner Medical Center, Columbus, OH.

⁷Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.

⁸Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL.

⁹Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.

¹⁰Vanderbilt University School of Nursing, Vanderbilt University Medical Center, Nashville, TN.

¹¹Department of Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, MD.

¹²Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.

¹³Division of Critical Care Medicine, Department of Surgery, Mount Sinai Medical Center, New York, NY.

¹⁴Department of Critical Care Medicine, MD Anderson Cancer Center, Houston, TX.

^†Deceased.

Drs. Pastores and Kvetan are the cochairs of the Academic Leaders in Critical Care Medicine Task Force of the Society of the Critical Care Medicine.

Dr. Coopersmith’s institution received funding from the Society of Critical Care Medicine (past president). Dr. D’Agostino received funding from Vanderbilt (speaker presentation). Dr. Price received funding from Springer Publishing (coeditor of in-press book Oncologic Critical Care). The remaining authors have disclosed that they do not have any potential conflicts of interest.

A full list of members of the Academic Leaders in Critical Care Medicine (ALCCM) Task Force of the Society of the Critical Care Medicine are listed in Appendix 1.

For information regarding this article, E-mail: [email protected]

Critical Care Medicine 47(4):p 550-557, April 2019. | DOI: 10.1097/CCM.0000000000003637

Abstract

Objectives:

To assess—by literature review and expert consensus—workforce, workload, and burnout considerations among intensivists and advanced practice providers.

Design:

Data were synthesized from monthly expert consensus and literature review.

Setting:

Workforce and Workload section workgroup of the Academic Leaders in Critical Care Medicine Task Force.

Measurements and Main Results:

Multidisciplinary care teams led by intensivists are an essential component of critical care delivery. Advanced practice providers (nurse practitioners and physician assistants) are progressively being integrated into ICU practice models. The ever-increasing number of patients with complex, life-threatening diseases, concentration of ICU beds in few centralized hospitals, expansion of specialty ICU services, and desire for 24/7 availability have contributed to growing intensivist staffing concerns. Such staffing challenges may negatively impact practitioner wellness, team perception of care quality, time available for teaching, and length of stay when the patient to intensivist ratio is greater than or equal to 15. Enhanced team communication and reduction of practice variation are important factors for improved patient outcomes. A diverse workforce adds value and enrichment to the overall work environment. Formal succession planning for ICU leaders is crucial to the success of critical care organizations. Implementation of a continuous 24/7 ICU coverage care model in high-acuity, high-volume centers should be based on patient-centered outcomes. High levels of burnout syndrome are common among intensivists. Prospective analyses of interventions to decrease burnout within the ICU setting are limited. However, organizational interventions are felt to be more effective than those directed at individuals.

Conclusions:

Critical care workforce and staffing models are myriad and based on several factors including local culture and resources, ICU organization, and strategies to reduce burden on the ICU provider workforce. Prospective studies to assess and avoid the burnout syndrome among intensivists and advanced practice providers are needed.