Intensivist time allocation: economic and ethical issues surrounding how intensivists use their time

Intensivists' time is a fundamentally constrained resource. Many factors can put intensivists under conditions in which demands for their time outstrip the amount of time available. The importance of intensivist time strain is increasing both because demand for intensivists exceeds supply and because the roles that intensivists are being asked to take on are constantly expanding. There is strong evidence that time strain affects the decisions that intensivists make; evidence about whether it impacts patient outcomes is mixed. In deciding how to allocate their time, intensivists face many challenges. This article highlights two of these challenges: (1) How should intensivists approach two common scheduling-related issues (24/7 intensive care unit coverage and long blocks of service time that promote continuity but sacrifice weekends off) and balance these issues with the very real workforce concern of accelerated professional burnout? (2) What are the hidden financial impacts of intensivist participation in quality improvement programs, given current reimbursement systems?