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Neonatologist staffing models: urgent change is needed

Journal of Perinatology volume 42, pages 1556–1557 (2022)Cite this article

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Many current neonatologist staffing models do not support the needs of the evolving neonatology workforce, administrative obligations, and patient population. Decades ago, NICU coverage involved daily rounds by a neonatologist followed by night coverage using a home-call model [1]. Due to increasing patient volume and acuity, adequate NICU coverage now often requires 24-hour in-house neonatologists [2] in both private practice and academic settings. Since the same neonatologist may round before and after an overnight shift, shifts may last up to 36 h [3]. Weekends have always been expected, but are now compounded by frequency, in-hospital requirements, weekend conferences, and not balanced by commensurate days off. Meanwhile, expectations of academic productivity, teaching, quality improvement work, and administrative obligations are unchanged or increased, and must be done during increasingly scarce “non-clinical” time.

These factors tend to affect hospital-based practices, pediatricians in intensive care subspecialties, and women most frequently [4, 5]. Lack of standardized staffing models further contributes to workforce dissatisfaction and difficulty advocating for changes with institutional leadership and payors. Additionally, staffing models often do not have sufficient reserve for the inevitable needs that arise for medical, personal, and family leave that all neonatologists encounter at multiple points during their career. This, coupled with medical and academic cultures that discourage taking leave due to effects on career advancement or causing extra work for colleagues, has progressively contributed to workforce burnout and attrition [6]. The COVID-19 pandemic has amplified these issues, increased burnout in health care providers [7,8,9,10] and widened the workforce gender gap [11]. These collective issues are particularly concerning as the neonatology workforce is both aging and majority female [12,13,14].

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA

    Milenka Cuevas Guaman

  2. Cincinnati Children’s Hospital Medical Center, Division of Neonatology, Perinatal Institute, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Emily R. Miller

  3. Department of Pediatrics, Tufts Medical Center, Boston, MA, USA

    Christiane E. L. Dammann

  4. Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Christine E. Bishop

  5. Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Kerri Z. Machut

Authors
  1. Milenka Cuevas Guaman
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  2. Emily R. Miller
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  3. Christiane E. L. Dammann
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  4. Christine E. Bishop
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  5. Kerri Z. Machut
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Contributions

MCG conceptualized and drafted the initial manuscript. ERM, CELD, CEB and KZM reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Milenka Cuevas Guaman.

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Cuevas Guaman, M., Miller, E.R., Dammann, C.E.L. et al. Neonatologist staffing models: urgent change is needed. J Perinatol 42, 1556–1557 (2022). https://doi.org/10.1038/s41372-022-01527-x

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