P2.F106: Current State of Neonatology Staffing Practices – An In-Depth Exploration of US Neonatology Leaders’ Perspectives

Background: Current neonatology staffing models do not meet the needs of the evolving patient population and workforce. Outdated neonatology staffing practices with long clinical hours in intensive 24/7 environments are unsustainable and negatively impact quality of patient care and the health and well-being of the evolving physician workforce. The nuances and inter-center variability of staffing practices have not been well described and hinder the ability to make needed improvements.

Methods: To classify neonatology leaders’ descriptions of current staffing practices, including clinical work hour definitions, non-clinical roles, shift characteristics, and flexibility.

Results: Table 1 shows participant and center characteristics. Leaders described wide variability in current staffing practices, work metrics, compensation for non-clinical roles, and shift characteristics (Table 2). Leaders noted local nuances of their physician group and center structure, financial barriers, and generational differences in work expectations as challenges. All participants agreed the field of neonatology was at an inflection point needing staffing improvement.

One leader stated “We're at the cusp of a crisis. Leadership has advocated that we don't advocate for higher salary. Cost of living is skyrocketing. There's less money coming into the hospitals and the departments to pay people and we want to give them a better lifestyle, but we have more demands because the level of care guidelines now demand higher amounts of staffing with more in-house clinicians. I don't really know how we're going to answer that question…We, the senior team have done an awful job of addressing this because we've been stuck in our ways.”

Conclusion: Neonatology leaders recognize challenges with current staffing models and support transitioning to more flexible models. Standardizing a clinical full-time equivalent (cFTE) definition and its components will be essential to provide an objective and clear accounting of time and work, reduce variability in staffing assignments, promote a sense of value amongst physicians, and limit overwork. Competing interests and complexities drive maintenance of the status quo and make change difficult for healthcare organizations and academic departments. This calls for future work to create and measure optimal, standardized, and transparent staffing models and adjustments for clinical, administrative, teaching, and scholarly obligations. To quote one leader: “For the good of our field and for the provision of our workforce, we can’t do things the way they’ve just ‘always been done.’ We can contribute to creating a better future.”