EXPLANATION


In the last decade there has been increasing focus on the training and workforce of pediatric cardiac anesthesiologists domestically and worldwide. While the recent addition of the subspecialty to the Accreditation Council for Graduate Medical Education (ACGME) aims to formalize education and training, there is still a question of the adequacy of the current and future workforce. In 2022, to address this dearth of information, Nasr et al. conducted a survey of 113 pediatric cardiac anesthesiology programs in the United States. Analysis of the fifty-nine respondent programs with complete data provides insight into the current practice of pediatric cardiac anesthesiology in the United States.


Institutions that took part in the survey provided data for 50,463 cases of the Society of Thoracic Surgeons Congenital Surgery Database (STS-CHD) over the two year time frame (before the COVID pandemic) representing 63% of the STS-CHD reported cases for the study. Across the fifty-nine institutions, the total practicing pediatric cardiac anesthesiologists numbered 307, with a median of five per institution. Pediatric cardiac anesthesiologists reported spending 35% of their time in the cardiac operating room (OR), 25% of their time in the catheterization lab, and 25% of their time in imaging/other sites. The respondents reported that the median number of OR cases per year with and without cardiopulmonary bypass was 60 and 26 respectively.


The predominant practice model for pediatric cardiac anesthesiology was an academic institution with trainees (71.4%) at free-standing children’s hospitals (42.9%). The staffing model for OR cases was overwhelmingly (90%) 1:1 supervision while 2:1 supervision was more common in the catheterization labs (40%). Supervised providers were most commonly pediatric anesthesia fellows (59.3%) followed by nurse anesthetists (54.2%), residents (33.9%), and pediatric cardiac anesthesia fellows (25.4%).


Thirty-eight percent of pediatric anesthesiologists caring for children with congenital heart disease reported having completed a fellowship in pediatric cardiac anesthesia. An additional 17% pursued other training pathways such as adult cardiac anesthesiology fellowships and pediatric critical care fellowships. The remaining 44% learned the practice through on the job training. Thirty-four percent of institutions had a pediatric cardiac anesthesia fellowship at the time of the survey.


Nearly half (49.2%) of the fifty-nine institutions surveyed reported they were actively recruiting pediatric cardiac anesthesiologists. Impending retirement of staff was reported by 10 (17%) of 59 institutions. About one third of institutions expected no immediate changes in staffing levels.


This survey helps to illustrate the heterogeneity of the practice, training, and staffing of the pediatric cardiac anesthesiology workforce in the United States. It also shows that there is a current and future need for anesthesiologists trained in the care of children with congenital heart disease. The combination of decreasing pediatric anesthesiology fellowship applicants and the pediatric cardiac anesthesiology subspecialty combined with impending retirement of senior practitioners may soon lead to a workforce crisis in the field.


REFERENCES


Nasr VG, Staffa SJ, Vener DF, et al. The practice of pediatric cardiac anesthesiology in the United States. Anesth Analg. 2022;134(3):532-539.