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Fundamentals in neonatologist staffing: transparency, autonomy, and partnership

Journal of Perinatology volume 43, pages 973–974 (2023)Cite this article

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In the Journal of Perinatology, two recent commentaries from Lakshminrusimha et al. and Cuavas Guaman et al. described the clinical demands placed on today’s neonatologists. Both make strong arguments that the status quo is no longer sustainable [1, 2]. With regulated trainee workhours, less experienced learners, advanced practitioner shortages and more complex patients, present-day NICUs require more on-site attending hours. In academic centers, the attending, once restricted to teacher and supervisor, now performs substantial front-line patient care. In all settings, neonatologists also spend more time in less billable activities [1, 3].

The methodology used to finance most groups remains based on collections and/or relative value units (RVU), or a clinical full time equivalent (cFTE) salaried model. Without restructuring, neonatologists either spend less time per patient to realize historical revenues [4], or groups hire more attendings resulting in reduced compensation per provider [1]. The negative impact on quality, patient experience, job satisfaction, and physician well-being should motivate leaders to pay attention. For departments relying on neonatology revenue to subsidize other divisions, current economics have even broader implications.

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References

  1. Lakshminrusimha S, Olsen SL, Lubarsky DA. Behavioral economics in neonatology—balancing provider wellness and departmental finances. J Perinatol. 2022;42:683–8.

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Author information

Authors and Affiliations

  1. Rady Children’s Hospital, San Diego, CA, USA

    Denise Suttner, Karen Mestan & Robin Steinhorn

  2. Department of Pediatrics, University of California San Diego, La Jolla, CA, USA

    Denise Suttner, Karen Mestan & Robin Steinhorn

Authors
  1. Denise Suttner
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  2. Karen Mestan
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  3. Robin Steinhorn
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Contributions

DS conceptualized the response, drafted the initial document, and finalized the response. KM contributed to content and edited the document. RS conceptualized the response, contributed to content, and edited the document.

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Correspondence to Denise Suttner.

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Suttner, D., Mestan, K. & Steinhorn, R. Fundamentals in neonatologist staffing: transparency, autonomy, and partnership. J Perinatol 43, 973–974 (2023). https://doi.org/10.1038/s41372-023-01656-x

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