Addressing Clinical Productivity in Academic Anesthesiology Departments Abouleish et al.(page 1509)

For private-practice and academic anesthesiologists alike, the ability to measure productivity has become increasingly important in individual compensation and in justification of budgets and staffing levels. However, the practice and billing of anesthesia services complicate the ability to quantify individual productivity, especially at teaching hospitals, where anesthesia is often administered in a team model (concurrency) and where clinicians may be obligated to staff all clinical settings, despite daily or weekly variations in workload.

Accordingly, Abouleish et al. compared various measures of individual productivity to define the methods best suited to academic anesthesiology. The team collected and analyzed all billing and scheduling data for clinical activities of faculty members of the anesthesiology department at their university medical center for the 1998 fiscal year. Unless they spent less than 20% of their time providing clinical care, all clinical sites and all clinical faculty anesthesiologists were included in the analysis. Thirty-five faculty anesthesiologists were identified, but nine were excluded from all of the measurements because their clinical full-time equivalent was less than 0.2. Except for one member, all of the excluded faculty were new faculty who had joined the department in July during the fiscal year.

The team examined several methods of measuring individual productivity, including normalized clinical days per year, time units per operating room (OR) day worked, normalized time units per year, total American Society of Anesthesiologists (ASA) units per OR day, and normalized total ASA units per year. Means and medians were reported for each measurement, and different groups of outliers were identified. Each of the measurements valued certain types of productivity more than others. For example, normalized clinical days per year identified faculty who worked more than their clinical full-time equivalent predicted. Time units per OR day and total ASA units per OR day identified apparently low-productivity faculty as those who worked a large portion of their time in obstetric anesthesia or in the ambulatory surgicenter. Total ASA units per OR day identified specialized anesthesiologists (cardiac anesthesia) as apparently high-productivity faculty. The authors determined that, in their department, normalized clinical days per year is the most useful measure of individual productivity because it measures individual anesthesiologists’ contributions to daily staffing, includes all clinical sites, is independent of nonanesthesia factors, and is easy to collect and determine.