Gender Differences in Compensation in Anesthesiology in the United States: Results of a National Survey of Anesthesiologists.

BACKGROUND: A gender-based compensation gap among physicians is well documented. Even after adjusting for age, experience, work hours, productivity, and academic rank, the gender gap remained and widened over the course of a physician's career. This study aimed to examine if a significant gender pay gap still existed for anesthesiologists in the United States. METHODS: In 2018, we surveyed 28,812 physician members of the American Society of Anesthesiologists to assess the association of compensation with gender and to identify possible causes of wage disparities. Gender was the primary variable examined in the model, and compensation by gender was the primary outcome. Compensation was defined as the amount reported as direct compensation on a W-2, 1099, or K-1, plus all voluntary salary reductions (eg, 401[k], health insurance). The survey directed respondents to include salary, bonuses, incentive payments, research stipends, honoraria, and distribution of profits to employees. Respondents had the option of providing a point estimate of their compensation or selecting a range in $50,000 increments. Potential confounding variables that could affect compensation were identified based on a scoping literature review and the consensus expertise of the authors. We fitted a generalized ordinal logistic regression with 7 ranges of compensation. For the sensitivity analyses, we used linear regressions of log-transformed compensation based on respondent point estimates and imputed values. RESULTS: The final analytic sample consisted of 2081 observations (response rate, 7.2%). This sample represented a higher percentage of women and younger physicians compared to the demographic makeup of anesthesiologists in the United States. The adjusted odds ratio associated with gender equal to woman was an estimated 0.44 (95% confidence interval, 0.37-0.53), indicating that for a given compensation range, women had a 56% lower odds than men of being in a higher compensation range. Sensitivity analyses found the relative percentage difference in compensation for women compared to men ranged from -8.3 to -8.9. In the sensitivity analysis based on the subset of respondents (n = 1036) who provided a point estimate of compensation, the relative percentage difference (-8.3%; 95% confidence interval, -4.7 to -11.7) reflected a $32,617 lower compensation for women than men, holding other covariates at their means. CONCLUSIONS: Compensation for anesthesiologists showed a significant pay gap that was associated with gender even after adjusting for potential confounding factors, including age, hours worked, geographic practice region, practice type, position, and job selection criteria.

A Collaborative Initiative for Reducing Operating Room Waste of Unused Refrigerated Medication.

BACKGROUND: Inappropriate management of anesthetic medications requiring refrigeration creates waste and increases costs of intraoperative care. At Tampa General Hospital, pharmacy personnel refill medications in cardiovascular operating rooms (CVOR) nightly and noticed large amounts of unattended medications at room temperature for unknown periods of time. Per protocol, these medications were disposed. OBJECTIVE: To effectively decrease pharmaceutical waste in the CVOR. METHODS: A pharmacy-led anesthesia committee identified the most used intraoperative medications requiring refrigeration and implemented changes to decrease waste. As a result, norepinephrine intravenous piggyback (IVPB), norepinephrine vials, nitroglycerin vials, and epinephrine IVPB were physically relocated into preexisting mini-refrigerators inside each CVOR. Vasopressin vials and phenylephrine syringes/vials were relocated into automated anesthesia cabinets. Amounts and cost of wasted medication were analyzed before and after protocol implementation. RESULTS: Average weekly cost of wasted medication was significantly reduced (preintervention: US$1188.59 vs postintervention: US$322.96; P < .001), despite a consistent caseload. CONCLUSION: Recorded weekly savings of US$865.63 (∼annual savings of >US$45 000) reflect only the explicit cost of waste. True savings are higher when including opportunity costs such as salary of pharmacy personnel and supplies needed to replace wasted medications. We demonstrate the benefits of a collaborative approach to improving inefficiencies in health care.