Recruitment of house staff into anesthesiology: a longitudinal evaluation of factors responsible for selecting a career in anesthesiology and an individual training program.

STUDY OBJECTIVE: To re-evaluate factors responsible for selecting a career in anesthesiology and for selecting an anesthesiology training program. The perceptions of anesthesiology residents about employment opportunities and future job security were also re-examined. Novel data on the impact of duty hour restrictions on residency training were obtained. DESIGN: Survey instrument. SETTING: Academic medical center. SUBJECTS: 63 residents enrolled in the anesthesiology residency at Mayo Clinic in Rochester, MN (clinical base year and clinical anesthesia years 1-3) during the 2010-11 academic year. All responses were anonymous. MEASUREMENTS: Current study data were compared to data from two similar studies published by the authors (1995-96 and 2000-01) using an f-exact test. A P-value ≤ 0.05 was considered significant. MAIN RESULTS: 55 of 63 (87%) residents responded to the survey. The most frequently cited reasons for selecting a career in anesthesiology were: anesthesiology is a "hands-on" specialty (49%), critical care medicine is included in the scope of training/practice (33%), anesthesiology provides opportunities to perform invasive procedures (31%), and the work is immediately gratifying (31%). When current data were compared with data from the 1995-96 survey, respondents reported significant decreases in interest in physiology/pharmacology (42% vs 21%; P = 0.03), opportunities to conduct research (13% vs 2%; P = 0.05) and opportunities to train in pain medicine (13% vs 0%; P = 0.01) as reasons for selecting anesthesiology. When current data were compared with data from the 2000-2001 survey, respondents reported a significant increase in critical care medicine (7% vs 33%, P = 0.01), significant decreases in time off (36% vs 11%; P = 0.01) and work time mostly devoted to patient care (20% vs 2%; P = 0.01) as factors in selecting anesthesiology as a career. Nearly all (94%) respondents reported a high level of satisfaction with their specialty choice and would choose anesthesiology again if currently graduating medical school. When current data were compared with those from the 2000-2001 survey, a significant increase in respondents who anticipated difficulty securing employment (0% vs 14%; P = 0.01) was noted. However, anticipation of difficulty in securing employment remained significantly lower than what was reported on the 1995-96 survey (54% vs 14%; P = 0.01). Thirty-eight percent of residents reported that implementation of duty hour restrictions had a positive impact on resident education, and 43% of residents reported that duty hour restrictions improved their quality of life. However, most respondents (69%) did not support further duty hour restrictions, and many (43%) expected to work longer hours after graduation. CONCLUSIONS: Residents in this study remain highly satisfied with anesthesiology as a career choice and with their training program. However, a resurgence of concern about employment after program completion and about future job security is apparent. The impact of critical care medicine training has significantly increased as a factor in selecting anesthesiology as a career, and the impact of training in pain medicine has significantly decreased. Although work hour restrictions were viewed as having a positive impact on training and well-being by 48% of residents, a majority of respondents in this study (76%) disagreed with further duty hour restrictions.

Association between chronic kidney disease and blood transfusions for knee and hip arthroplasty surgery.

The study aim is to assess associations between chronic kidney disease (CKD) and blood transfusions during hospitalization for joint arthroplasty. Patients with Stage IV-V CKD who underwent elective total knee or hip arthroplasty from 2007 to 2010 were matched 2:1 with age, gender, and surgery type controls without kidney disease. Multivariable analyses for transfusion risk with preoperative hemoglobin, body mass index, cardiovascular disease, and surgical complexity as explanatory variables were performed. Ninety CKD patients were identified and had lower preoperative hemoglobin, higher incidence of cardiovascular disease and blood transfusions. CKD was independently associated with increased odds of transfusions (2.88, 95% confidence interval 1.33-6.23, P=0.007). Preoperative optimization of CKD patients should be considered to reduce transfusion rates.