The neonatology specialty is currently facing significant challenges because of the growing imbalance between the demand for neonatal care and the availability of qualified neonatologists. This discrepancy compromises patient safety, the long-term viability of the professional neonatologist workforce, and individual physician well-being. Intense work patterns like 24/7 in-hospital coverage contribute to poor quality of care, increased burnout, and workforce attrition. Neonatologists’ work environment may vary greatly, and patient acuity and volume may vary significantly. The neonatologist profession must prioritize the quality and safety of patient care and ensure reasonable work effort, career satisfaction, and a healthy work-life balance.
Demographic trends further complicate workforce sustainability. A significant portion of neonatologists are over the age of 60, and a large number are women of reproductive age. These demographic factors emphasize the urgent need for equitable and sustainable staffing solutions.
A study published by the American Academy of Pediatrics aimed to develop recommendations for the optimal and sustainable staffing practices in neonatal care across U.S. A consensus study methodology was selected by using a modified Delphi approach with diverse expert stakeholders including leaders from organizations such as the Association of Academic Neonatal Division Directors, SWAN Task Force, AAP SoNPM Executive Committee, and AllPathways Group.
This study was coordinated by five academic neonatologists and supported by an expert advisory team of 10 neonatology leaders with staffing expertise. This study began with the creation of 60 potential recommendation statements, which were divided into subcategories of clinical allocations, shift characteristics, nonclinical allocations, and variability and flexibility.
This study was conducted from May to September 2024 with panelists to assess their level of agreement with each statement. The study included a small pilot panel of 17 neonatologists who met in person to discuss results at the Improving Neonatal Staffing Summit to review and refine initial results. Statements that did not reach consensus underwent further discussion and revision after each round.
A Delphi study involved 34 panelists with 51 statements achieving consensus, including 48 that were strong. The final recommendations were grouped into 24 statements, with clarity being a high priority. During the Delphi process, many statements generated significant discussion and affected the refinement of final recommendations. The final recommendations aim to support advocacy efforts and guide implementation across various practice settings, with the goal of achieving 80% or higher agreement and 90% or higher consensus.
Statements related to specific hours or time limitations were more difficult to adapt for consensus. This study acknowledged that existing state laws and institutional policies could affect the application of the recommendations. This study consistently developed and discussed the recommendations in a standardized manner, prioritizing equity and supporting all neonatologists at varying career levels and work environments.
This study, involving neonatology leaders, stakeholders, and experts, developed consensus-based recommendations to guide sustainable staffing practices in the U.S. Key points include measuring all clinical work in hours when determining full-time equivalents (FTE), balancing clinical assignments to optimize patient safety and physician well-being, providing differential compensation for shifts that impact physical and mental health, and offering flexible clinical work arrangements.
This study suggests that a culture shift in neonatology staffing is urgently needed to improve patient safety and physician well-being. These findings highlight that significant changes at the individual, divisional, institutional, and national levels are needed to ensure the long-term health and sustainability of the neonatology workforce.
Reference: Cuevas Guaman M, Bishop CE, Miller ER, et al. Consensus Recommendations for Sustainable and Equitable Neonatology Staffing: A Delphi Approach. Pediatrics. 2025; 155(6):e2024069943. doi:10.1542/peds.2024-069943
