Consensus Recommendations for Sustainable and Equitable Neonatology Staffing: A Delphi Approach

The specialty of neonatology faces significant and growing challenges related to patient safety, physician well-being, and workforce sustainability that highlight the necessity for innovative work models. Our objective was to develop consensus recommendations to improve neonatologist staffing practices in the United States.

We used a modified Delphi process with 32 diverse subject-matter expert stakeholders to reach consensus. We derived 60 initial potential recommendations for improved staffing from the literature and our 2 previous studies of physician leaders. We defined consensus as 80% or higher agreement and strong consensus as 90% or higher agreement. We ultimately eliminated statements that achieved less than 80% consensus from the recommendations.

Fifty-one individual statements reached consensus and were grouped into 24 final recommendations to improve neonatology staffing. Topics of focus included clinical allocations (eg, clinic work is counted in hours/year), shift characteristics (eg, clinical work after 24 hours is minimized), allocation of nonclinical work (eg, nonclinical work is accounted for in full-time equivalent), and staffing flexibility (eg, options to restructure clinical work are provided for specific circumstances such as aging and pregnancy). Significant discussion on many statements focused on ensuring that recommendations were both feasible and not overly prescriptive for individual institutions.

We reached consensus on a set of neonatologist staffing recommendations that emphasize the critical issues related to patient safety and physician well-being. Future work will focus on advocating for widespread implementation of these recommendations and evaluating their effect on patient safety, physician well-being, and sustainability of the neonatal workforce.