Evolution of Anesthesiologist practicing in public hospitals according to years
Seance of wednesday 14 february 2024 (Apport de la médecine polyvalente hospitalière dans un service de chirurgie)
DOI number : 10.26299/nnch-8x86/emem.2024.06.01
Abstract
1. The facts
a. Physician's salaries were half those in the private sector in 1990, a third in 2010 and a quarter today.
b. Vacancies currently reach up to 27%, leading to the closure of beds and operating theatres everywhere and the recruitment of foreign doctors from outside Europe, even when they fail the exam to control their knowledge. The emergence of and demand for temporary medical staff, who can earn much higher incomes.
c. The introduction in 2003 of the 35-hour working week in France and the 39-hour working week for Anesthesiologists, which means 20 days' leave with a maximum of 48 hours, including on-call duty ....
e. Increased administrative pressure with many meetings, drafting of projects to obtain equipment, etc.
f. Mortality today is essentially postoperative (ratio 1/1000 between block and post-op), so the importance of postoperative medical follow-up.
g. Staff numbers are gradually being reduced due to increased demand for anesthetic procedures in other departments (interventional cardiology with TAVI, radiology, gastroenterology, pneumology, etc.) and the departure or secondment of many physicians to work on an interim basis.)
h. The ratio of surgeons to anesthesiologists remains a major problem and is important for freeing up time outside the OR.
i. Only very few physicians have an office close to the operating theatres, yet publications by PHs were the most important, with a ratio 0.4% of University Physicians
j. The COVID crisis demonstrated the total mobilization of the MARs, transforming all the SSPI beds into intensive care units... eg. and making it possible to cope with the influx of COVID patients.
h. Only a handful of Hospital Physician have an office close to the operating room, yet publications were the most important. (with a ratio of 2-3 University Physician / 40-50 Hospital Physicians)
2. How to recruit, attract and retain Anesthesiologists
a. Organization and versatility of anesthetist’s work
A permanent schedule over 1 year or more with fixed days in the operating theatre, in specific rooms, enabling the patients to be seen in consultation and above all encouraging postoperative follow-up, by working with the same surgeons most of the time. This organization makes it possible to determine the block time to allow other activities, staff, teaching, clinical research, etc. to be carried out.
b. Urge the public authorities to move forward with "enhanced care" sectors, which have become essential. The establishment or maintenance of reinforced care units at the heart of the surgical or specialized medical care sectors, based on an adaptation of article D 6124-117 of the Public Health Code, would be a way of better responding to the care needs, both in the usual mode of activity and in crisis situations. This type of unit is characterized by an adapted number of beds allowing short-term care for patients who have undergone complex surgical procedures and require close monitoring and specific post-operative care, but whose condition is stable, without acute visceral failure, and therefore without the need for hospitalization in critical care units.
The establishment or maintenance of reinforced care units at the heart of the surgical or specialized medical care sectors, based on an adaptation of article D 6124-117 of the Public Health Code, would be a way of better responding to the care needs, both in the usual mode of activity and in crisis situations.
This type of unit is characterized by an adapted number of beds allowing short-term care for patients who have undergone complex surgical procedures and require close monitoring and specific post-operative care, but whose condition is stable, without acute visceral failure, and therefore without the need for hospitalization in critical care units.
c. Increase salaries through on-call duty to avoid increasing the salaries of all hospital Anesthesiologists (cardiologists, pneumologists, etc.) who have little or no recruitment problems.
d. Respect and communication are essential to good teamwork, for example by providing doctors with offices close to the operating theatres.
e. Delegation of medical activity already granted as opposed to transfer of tasks, which lead to increase morbidity to diagnostic delay
f. Sector 2 for all doctors?
a. Physician's salaries were half those in the private sector in 1990, a third in 2010 and a quarter today.
b. Vacancies currently reach up to 27%, leading to the closure of beds and operating theatres everywhere and the recruitment of foreign doctors from outside Europe, even when they fail the exam to control their knowledge. The emergence of and demand for temporary medical staff, who can earn much higher incomes.
c. The introduction in 2003 of the 35-hour working week in France and the 39-hour working week for Anesthesiologists, which means 20 days' leave with a maximum of 48 hours, including on-call duty ....
e. Increased administrative pressure with many meetings, drafting of projects to obtain equipment, etc.
f. Mortality today is essentially postoperative (ratio 1/1000 between block and post-op), so the importance of postoperative medical follow-up.
g. Staff numbers are gradually being reduced due to increased demand for anesthetic procedures in other departments (interventional cardiology with TAVI, radiology, gastroenterology, pneumology, etc.) and the departure or secondment of many physicians to work on an interim basis.)
h. The ratio of surgeons to anesthesiologists remains a major problem and is important for freeing up time outside the OR.
i. Only very few physicians have an office close to the operating theatres, yet publications by PHs were the most important, with a ratio 0.4% of University Physicians
j. The COVID crisis demonstrated the total mobilization of the MARs, transforming all the SSPI beds into intensive care units... eg. and making it possible to cope with the influx of COVID patients.
h. Only a handful of Hospital Physician have an office close to the operating room, yet publications were the most important. (with a ratio of 2-3 University Physician / 40-50 Hospital Physicians)
2. How to recruit, attract and retain Anesthesiologists
a. Organization and versatility of anesthetist’s work
A permanent schedule over 1 year or more with fixed days in the operating theatre, in specific rooms, enabling the patients to be seen in consultation and above all encouraging postoperative follow-up, by working with the same surgeons most of the time. This organization makes it possible to determine the block time to allow other activities, staff, teaching, clinical research, etc. to be carried out.
b. Urge the public authorities to move forward with "enhanced care" sectors, which have become essential. The establishment or maintenance of reinforced care units at the heart of the surgical or specialized medical care sectors, based on an adaptation of article D 6124-117 of the Public Health Code, would be a way of better responding to the care needs, both in the usual mode of activity and in crisis situations. This type of unit is characterized by an adapted number of beds allowing short-term care for patients who have undergone complex surgical procedures and require close monitoring and specific post-operative care, but whose condition is stable, without acute visceral failure, and therefore without the need for hospitalization in critical care units.
The establishment or maintenance of reinforced care units at the heart of the surgical or specialized medical care sectors, based on an adaptation of article D 6124-117 of the Public Health Code, would be a way of better responding to the care needs, both in the usual mode of activity and in crisis situations.
This type of unit is characterized by an adapted number of beds allowing short-term care for patients who have undergone complex surgical procedures and require close monitoring and specific post-operative care, but whose condition is stable, without acute visceral failure, and therefore without the need for hospitalization in critical care units.
c. Increase salaries through on-call duty to avoid increasing the salaries of all hospital Anesthesiologists (cardiologists, pneumologists, etc.) who have little or no recruitment problems.
d. Respect and communication are essential to good teamwork, for example by providing doctors with offices close to the operating theatres.
e. Delegation of medical activity already granted as opposed to transfer of tasks, which lead to increase morbidity to diagnostic delay
f. Sector 2 for all doctors?