P2.F107: Ideal Neonatology Staffing Practices – A Survey of Physician Stakeholder Perspectives

Background: Current neonatology staffing practices often include long shifts and high-volume clinical hours. These practices increasingly diverge from those of pediatric trainees, related pediatric subspecialties, and reportedly from evolving generational workforce expectations. The important perspectives of practicing neonatologist stakeholders regarding optimal staffing practices, however, have not been formally studied. Our objective was to assess neonatologists’ perspectives on ideal staffing practices, including clinical work hour definitions, models, and shift characteristics.

Methods: With Institutional Review Board approval, we surveyed practicing neonatologists live in five unique conference settings between October 2023 – March 2024. We specifically prioritized capturing perspectives of early-career stakeholders as late-career perspectives were captured in an adjunct study. Neonatologists participated using an anonymous quick-response code interface. Measures included ideal state of various staffing practices (e.g. total clinical hours, shift length, service block length, number of weekends/year) and demographic variables. We analyzed data with descriptive statistics and Pearson’s chi-square and Fisher’s exact tests.

Results: 217 neonatologists participated; 70% were ≤ 10 years post-fellowship, 33% were non-university affiliated/private practice. Responses of ideal staffing practices varied by career level and practice type (Table 1). When queried for ideal total clinical hours/year, many were unsure of ideal hours or were uncertain in calculating this way (36% of all neonatologists, 40% of early-career, and 53% of non-University affiliated neonatologists). For participants that selected a numerical value, responses varied but the top response of all participants was 1600-1799 hours (24%). Top response of ideal yearly hours varied significantly by career level, with early-career respondents selecting lower hours (1400-1599, 26%) and late-career respondents selecting higher hours (1800 – 1999, 38%, Figure 1, p< 0.0001).

The majority said ICU service blocks should be 1-2 weeks (92%) and the maximum consecutive days of service should be < 7 (58%). 86% agreed the maximum shift length should be ≤ 24 consecutive hours (Table 1). The majority (56%) reported neonatologists should not take call on-service and round post call, though 24% responded they should and 19% responded “it depends”.

Conclusion: Practicing neonatologists offer important stakeholder perspectives regarding ideal neonatology staffing practices. The majority support shorter maximum shift length, avoidance of post-call clinical care, and fewer yearly clinical hours than often occur in the current state of staffing. Understanding and aligning generational differences in ideal yearly clinical work expectations will be key to support recruitment and retention in the field. Many neonatologists had uncertainty and variability in determination of ideal total clinical hours, especially for non-University based practices, highlighting a need for clarity and transparency in workload calculations. Future directions of work should compare these perspectives to those of pediatric leaders to design healthy workplaces that meet evolving workforce needs.