Clinical Investigations

Intensivists in U.S. Acute Care Hospitals*

Halpern, Neil A. MD, MCCM, FACP, FCCP¹; Tan, Kay See PhD²; DeWitt, Meghan BA³; Pastores, Stephen M. MD, MACP, FCCP, FCCM¹

Author Information

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

²Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.

³Strategic Initiatives Manager, Strategy & Innovation, Memorial Sloan Kettering Cancer Center, New York, NY.

*See also p. 604.

Drs. Halpern, Tan, and Pastores contributed to study design, analysis, and data interpretation, writing and revising of the article, and approval of the final article. Ms. Dewitt contributed to data acquisition, analysis, and approval of the final article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by the Core Grant (P30 CA008748) and the Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.

Dr. Halpern received funding from Instrumentation Lab, Cardiopulmonary Corp, and stock options from Pronia Medical and Airstrip. Dr. Tan received support for article research from the National Institutes of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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

Critical Care Medicine 47(4):p 517-525, April 2019. | DOI: 10.1097/CCM.0000000000003615

Abstract

Objectives:

To determine the total numbers of privileged and full-time equivalent intensivists in acute care hospitals with intensivists and compare the characteristics of hospitals with and without intensivists.

Design:

Retrospective analysis of the American Hospital Association Annual Survey Database (Fiscal Year 2015).

Setting:

Two-thousand eight-hundred fourteen acute care hospitals with ICU beds.

Patients:

None.

Interventions:

None.

Measurements and Main Results:

Of the 2,814 acute care hospitals studied, 1,469 (52%) had intensivists and 1,345 (48%) had no intensivists. There were 28,808 privileged and 19,996 full-time equivalent intensivists in the 1,469 hospitals with intensivists. In these hospitals, the median (25–75th percentile) numbers of privileged and full-time equivalent intensivists were 11 (5–24) and 7 (2–17), respectively. Compared with hospitals without intensivists, hospitals with privileged intensivists were primarily located in metropolitan areas (91% vs 50%; p < 0.001) and at the aggregate level had nearly thrice the number of hospital beds (403,522 [75%] vs 137,146 [25%]), 3.6 times the number of ICU beds (74,222 [78%] vs 20,615 [22%]), and almost twice as many ICUs (3,383 [65%] vs 1,846 [35%]). At the hospital level, hospitals with privileged intensivists had significantly more hospital beds (median, 213 vs 68; p < 0.0001), ICU beds (median, 32 vs 8; p < 0.0001), a higher ratio of ICU to hospital beds (15.6% vs 12.6%; p < 0.0001), and a higher number of ICUs per hospital (2 vs 1; p < 0.0001) than hospitals without intensivists.

Conclusions:

Analyzing the intensivist section of the American Hospital Association Annual Survey database is a novel approach to estimating the numbers of privileged and full-time equivalent intensivists in acute care hospitals with ICU beds in the United States. This methodology opens the door to an enhanced understanding of the current supply and distribution of intensivists as well as future research into the intensivist workforce.

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Intensivists in U.S. Acute Care Hospitals*