title: Characterizing critical care physician staffing in rural America: a description of Iowa intensive care unit staffing.
abstract: OBJECTIVE
  This study aimed to characterize intensive care unit (ICU) physician staffing patterns in a predominantly rural state.
  
  
  METHODS
  A prospective telephone survey of ICU nurse managers in all Iowa hospitals with an ICU was conducted.
  
  
  RESULTS
  Of 122 Iowa hospitals, 64 ICUs in 58 (48%) hospitals were identified, and 46 (72%) responded to the survey. Most ICUs (96%) used an open admission model and cared for undifferentiated medical and surgical patients (88%), and only 27% of open ICUs required critical care or pulmonary consultation for admitted patients. Most (59%) Iowa ICUs had a critical care physician or pulmonologist available, and high-intensity staffing was practiced in 30% of ICUs. Most physicians identified as practicing critical care (63%) were not board certified in critical care. Critical care physicians were available in a minority of hospitals routinely for inpatient intubation and cardiac arrest management (29% and 10%, respectively), and emergency physicians and other practitioners commonly responded to emergencies throughout the hospital.
  
  
  CONCLUSIONS
  Many Iowa hospitals have ICUs, and staffing patterns in Iowa ICUs mirror closely national staffing practices. Most ICUs are multispecialty, open ICUs in community hospitals. These factors should inform training and resource allocation for intensivists in rural states.
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA; Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA. Electronic address: nicholas-mohr@uiowa.edu.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Mohr
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA.
authors.forename: John
authors.initials: J
authors.lastname: Collier
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hassebroek
authors.affiliation: Department of Emergency Medicine, University of Virginia, PO Box 800699, Charlottesville, VA 22908, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Groth
mesh_terms: D000328:Adult; D002568:Certification / Q000706:statistics & numerical data; D003422:Critical Care / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004635:Emergency Medicine; D006764:Hospitals, Community; D006801:Humans; D007362:Intensive Care Units / Q000600:supply & distribution; D007484:Iowa; D008505:Medical Staff, Hospital / Q000600:supply & distribution*; D010561:Personnel Staffing and Scheduling; D011446:Prospective Studies; D015272:Pulmonary Medicine; D019035:Rural Health Services / Q000600:supply & distribution; D000078329:Workforce
keywords: Critical care; Critical illness; Intensive care units; Personnel staffing and scheduling; Rural health services