Implications of anesthesiology resident availability on first-case staffing

Abstract

BackgroundAnesthesia departments start an agreed-upon number of locations each workday. For academic departments, variability in the number of anesthesiology residents available to start the first cases each day affects hiring and staff scheduling. These decisions depend on the median number of available residents and variability among days. We analyzed the number of residents starting first-cases of the day over a 13.5-year interval to provide quantitative data to guide long-term decision-making related to hiring other anesthesia providers (e.g., nurse anesthetists, anesthesia assistants). MethodsWe obtained electronic data from an academic hospital's anesthesia information management system to determine the number of cases started by anesthesiology residents and other anesthesia providers. We assessed variability among days using quartile regression with clustering by 6-month period. ResultsFrom 2006 through 2018, the annual number of anesthetics increased progressively from 31,559 to 44,981. The percentage of all cases started by residents decreased from 38.4% to 21.4%, as did the number of cases started during regular workdays (-9.7 [SE 2.9] cases per year, P = 0.008). The number of resident days starting a first-case was unchanged. On half the days (0.5 quartile), the percentage of full-time equivalent residents who started a first-case was 36.5% during July to December periods and 32.8% during January to June periods (difference = 3.7%, SE 0.7%, P < 0.0001). The average coefficient of quartile deviation among days within these 6-month periods was 9.5% (SE 0.5%) full-time equivalent residents. ConclusionsThe fraction of anesthesiology residents starting first-cases on regular workdays remained stable over 13.5 years, but there was considerable day to day variability. For long-term staffing purposes, we suggest relying on the first quartile of residents starting first-cases (rounded down) as a strategy to calculate the number of anesthesia providers required each day to staff the first cases of the day.