Leadership and management of academic anesthesiology departments in the United States

Study ObjectiveTo characterize the approach of academic chairs of anesthesiology in leading and managing their departments, and to gain insights into what they considered the most difficult challenges as chairs.DesignInternet-based survey instrument conducted during July and August of 2006.SettingAcademic medical center.MeasurementsDepartment chairs of 132 academic anesthesiology programs who were listed on the Society of Academic Anesthesiology Chairs Listserv, were surveyed. The overall number of respondents were reported. However, as all questions were voluntary, not all were answered by each respondent. Observations are therefore reported as absolute numbers and percentages on a question-by-question basis. Respondents were asked to rank responses to some questions in order of importance (eg, 1 = most important). These data are presented as rank ordered median values, determined by the Kruskal-Wallis Test. Significant differences between groups were determined by Dunn's post test. A P-value < 0.05 was regarded as significant throughout.Main ResultsThe overall response rate was 55%. Chairs spent 36% of their time in leading, managing, and administration. They ranked Visionary and Coaching styles of leadership as most important. Seventy-nine percent had developed “Vision” statements for the department and 64% of respondents had set goals for divisions. To communicate within departments, 74% of Chairs had at least monthly faculty meetings and 50% held at least yearly faculty retreats. Chairs preferred communicating contentious issues face to face. Ninety-five percent of Chairs held at least yearly performance appraisals and 85% had an established incentive system in the department. Academic productivity (73%) and clinical time (68%) were the most common components of the incentive system. In 65% of departments, Chairs delegated the program directorship and in 73%, the running of the National Residency Matching Program. The financial state of the department was shared at least annually in 93% of departments. In most departments (77%), faculty salary ranges were known but individual faculty salaries were not shared.ConclusionsChairs considered the most important leadership challenge to be setting direction for the department, and the most difficult management challenges as “fostering research and scholarship” and “maintaining revenue to support faculty”.     

Evaluation and evolution of the scientific production by Spanish anesthesiology departments

OBJECTIVES: To count the scientific publications coming from Spanish departments of anesthesiology and rank them by productivity using various bibliometric tools. To examine the evolution of productivity between 1992 and 2001. METHOD: Abstracts of articles from Spanish anesthesiology departments were located on Medline. Hospital departments were ranked by productivity based on number of publications. Other classifications were established based on the international impact of articles measured by "net" impact factor (IF) of the journals and "relative" IF (according to the category assigned by Journal Citation Reports [JCR]). The evolution of scientific productivity was analyzed by five-years periods. RESULTS: We located 644 entries for articles published in Spanish journals and 182 for articles in journals outside Spain. Ten departments of anesthesiology produced 68% of the articles in non-Spanish journals. Hospital Clinic i Provincial in Barcelona was the most productive (55 publications, 27 in foreign journals). Hospital del Mar published articles in journals with the highest IF (mean 2.63). When IF results were adjusted by JCR category, Hospital Clinic i Provincial had the best quantitative and qualitative indexes. Hospital Torrecardenas had the best evolution in scientific productivity in the last five years. CONCLUSION: The scientific productivity of Spanish anesthesiology departments has evolved favorably over the past 10 years, led by Hospital Clinic i Provincial.     

The impact of new-generation physicians on the function of academic anesthesiology departments

PURPOSE OF REVIEW: Academic departments of anesthesiology have had to adapt a wide variety of clinical and educational work functions to the viewpoints, values and normative expectations of the newer generations of physicians who now present themselves for training as well as for faculty employment. This commentary will elaborate on key points that academic departments must recognize and incorporate into their functional and organizational imperatives in order to remain successful with regard to physician recruitment and retention. RECENT FINDINGS: Recognition of differences between newer-generation vs. established physician issues and concerns include differences in: learning style, teaching style, approach to clinical schedules and the concept of life-work balance, academic and personal motivation, desire for control of their work experience, effective productivity incentives, as well as communication style issues and implications thereof. The spectrum of physicians who contribute to the impact of these factors on contemporary academic anesthesiology departments include faculty, nonfaculty staff physicians, residents and medical students. SUMMARY: Academic departments of anesthesiology which can successfully incorporate the changes and most importantly the functional and organizational flexibility needed to respond to the newer generations' worldview and so-called balanced goals will be able to best attract high-caliber housestaff and future faculty.     

Scientific publications from the Spanish anesthesiology departments in 1989-1998. Authorship of the articles

OBJECTIVES: To quantify the scientific publication of Spanish anesthesiologists and analyse article authorship. METHOD: Bibliometric study. On MEDLINE we identified articles from Spanish anesthesiology departments published between 1989 and 1998. An entry for each article was created to record name, number and order of authors, journal source and length of article. The data base also noted where the article was published (Spain or abroad). Several bibliographic indices were calculated (authors per article, pages per article, articles per year, and more). The number of articles published by Spanish anesthesiologists was compared to the number published around the world. RESULTS: We analyzed 604 articles from 12 Spanish journals and 176 from 40 foreign journals. The numbers of authors per article in Spanish publications during the first and last three-year periods were 4.86 and 5.28, respectively (p < 0.05). The numbers of authors per article published abroad for the same periods were 5.73 and 5.01, respectively. The number of pages published in international journals in the last three-year period was four-fold greater than in the first. CONCLUSIONS: The bibliographic indices that reflect publication by Spanish anesthesiologists internationally is evolving positively. Data from Spanish journals allow us to deduce the existence of a certain degree of unjustified addition of authors. A quantitative-qualitative method for rating curriculum vitae is proposed in order to reduce that tendency.     

The impact of longer-than-average anesthesia times on the billing of academic anesthesiology departments.

Academic anesthesiology departments provide clinical services for surgical procedures that have longer-than-average surgical times and correspondingly increased anesthesia times. We examined the financial impact of these longer times in three ways: 1) the estimated loss in revenue if billing were done on a flat-fee system by using industry-averaged anesthesia times; 2) the estimation of incremental operating room (OR) sites necessitated by longer anesthesia times; and 3) the estimated potential gain in billed units if the hours of productivity of current anesthesia time were applied to surgical cases of average duration. Health Care Financing Administration average times per anesthesia procedure code were used as industry averages. Billing data were collected from four academic anesthesiology departments for 1 yr. Each claim billed with ASA units was included except for obstetric anesthesia care. All clinical sites that do not bill with ASA units were excluded. Base units were determined for each anesthesia procedure code. The mean commercial conversion factor (US$45 per ASA unit) for reimbursement was used to estimate the impact in dollar amounts. In all four groups, anesthesia times exceeded the Health Care Financing Administration average. The loss per group in billed ASA units if a flat-fee billing system were used ranged from 18,194 to 31,079 units per group, representing a 5% to 15% decrease (estimated billing decrease of US$818,719 to US$1,398,536 per group). The number of excess OR sites necessitated by longer surgical and anesthesia times ranged from 1.95 to 4.57 OR sites per group. The potential gain in billed units if the hours of productivity of current anesthesia time were applied to surgical cases of average duration was estimated to be from 13,273 to 21,368 ASA units. Longer-than-average anesthesia and surgical times result in extra hours or additional OR sites to be staffed and loss of potential reimbursement for the four academic anesthesiology departments. A flat-fee system would adversely affect academic anesthesiology departments. IMPLICATIONS: We examined the economic impact of longer-than-average anesthesia times on four academic anesthesiology departments in three ways: the estimated loss in revenue under a flat-fee system, the excess operating room sites staffed, and the potential gain in revenue if the surgeries were of average length. These results should be considered both in productivity measurements and strategies for operating room management.     

Local anesthetic-induced cardiac toxicity: a survey of contemporary practice strategies among academic anesthesiology departments

Though new local anesthetics (LA), effective test-dosing, and new regional anesthetic techniques may have improved the safety of regional anesthesia, the optimal management plan for LA-induced cardiac toxicity remains uncertain. Accordingly, we evaluated current approaches to LA cardiotoxicity among academic anesthesiology departments in the United States. A 19-question survey regarding regional anesthesia practices and approaches to LA cardiac toxicity was sent to the 135 academic anesthesiology departments listed by the Society of Academic Anesthesiology Chairs-Association of Anesthesiology Program Directors. Ninety-one anonymously completed questionnaires were returned, at a response rate of 67%. The respondents were categorized into groups according to the number of peripheral nerve blocks (PNBs) performed each month: >70 PNBs (38%), 51-70 PNBs (13%), 31-50 PNBs (20%), 11-30 PNBs (23%), and <10 PNBs (6%). Anesthesia practices administering >70 PNBs were 1.7-times more likely to use ropivacaine (NS), 3.9-times more likely to consider lipid emulsion infusions for resuscitation (P = 0.008), and equally as likely to have an established plan for use of invasive mechanical cardiopulmonary support in the event of LA cardiotoxicity (NS) than low-PNB volume centers. We conclude that there are differences in the management and preparedness for treatment of LA toxicity among institutions, but the safety implications of these differences are undetermined.