Intensivists in U.S. Acute Care Hospitals

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.

Figure 1.

There were a total of 4862 American Hospital Association (AHA) registered community hospitals located in the 50 states. 3985 (82%) responded to the AHA survey. Of these, 2814 (71%) met inclusion criteria (>10 hospital beds and > 1 ICU bed) and were divided fairly evenly with 1469 hospitals (52%) having privileged intensivists and 1345 (48%) without privileged intensivists.

Figure 2.

Approximately 52% of hospitals with ICU beds had privileged intensivists (left bars). However, 78% of ICU beds were in hospitals with privileged intensivists (right pars).