Anesth Analg 2009 Apr 18

Incentive payments to academic anesthesiologists for late afternoon work did not influence turnover times.

Masursky D, Dexter F, Garver MP, Nussmeier NA

Abstract
BACKGROUND: Anesthesiologists are often paid extra for hours worked in the late afternoon and evening. Although anesthesiologists have little influence on their operating room (OR) assignments and workloads late in the afternoon, they can influence turnover times. METHODS: OR turnover times on workdays were reviewed for n = 30 mo before there was incremental pay, for n = 15 mo with incremental pay for work past 3:30 pm, and for n = 8 mo with pay for work past 4:00 pm. The end point was the percentage of turnovers that were prolonged, defined as longer than 1 h. Turnovers straddling 3:30 pm (n = 3945), 4:00 pm (n = 3602), and 5:00 pm (n = 2834) were studied, as were those straddling 2:00 pm (n = 4407) as a control. In addition, qualitative (survey) assessment of n = 30 anesthesiologists was performed the last month to learn about their opinions on working late on weekdays. RESULTS: Most respondents considered an OR to run late if it finished after a specific time of day (87%, P < 0.001), unrelated to the room''s type of procedures (90%, P < 0.001) or to the payment for working after 4:00 pm (100%, P < 0.001). There was no significant effect of implementation or changes to the incentive program on the incidences of prolonged turnover times at each of the studied times in the afternoon (all P > 0.14). CONCLUSION: Our results suggest that hospital administrators, deans, and other executives need not be especially concerned about disincentives produced by methods of internal compensation of anesthesiologists on highly visible OR turnover times late in afternoons.