Cross-sectional observational study.

Anesthetists graduated from Colombian or foreign institutions who practice in Colombia.

Following approval by the institutional Ethics Committee, a convenience non-probabilistic sampling was used, including all the anesthetists in the S.C.A.R.E. database. A snowball sampling was used for the professionals in the databases of the society and of the departmental association leaders, as well as of attendance at national academic events, where the instrument was completed on site (XXXI Colombian Congress of Anaesthesiology and Resuscitation and I International Congress of Paediatric Anaesthesia).

The data collection tool was designed and reviewed based on indicators collected by the S.C.A.R.E work observatory, trying to identify those characteristics with a high potential of impact on the health (occupational and mental) and academic development of the professionals. The tool was administered through interactive electronic media, ensuring anonymity of the information and data confidentiality, and this was clearly explained to the participants. Data collection took place between June and November 2015. Completion of the electronic data was verified in the final database. Each of the questions or sections was adjusted according to the number of respondents. In the end, a total of 662 forms were completed.

Data regarding the professional profile and personal characteristics were analyzed using descriptive statistics, frequency measurements such as proportions and 2 x 2 tables for categorical variables and their intersections, and means and medians for continuous variables with their respective scatter measurement (standard deviation [SD] or interquartile range [IQR]). Bivariate statistics were used for the analysis, using x² or Fisher exact test and the Mann-Whitney U test for median differences. Income values were taken in Colombian pesos and converted to US dollars based on the average exchange rate for 2015.⁷⁾ All analyses were conducted using the STATA 13 software package (Statacorp, Colege Station, TX).

A total of 702 anesthetists responded some section of the survey. The majority were males (70%; n = 494), and the mean age was 45 ± 11 years. Table 1 shows the distribution by age groups.

Table 1

Source: Authors.

In terms of the department of origin, there was a significant participation from Bogotá DC, followed by Antioquia, Valle del Cauca and Atlántico; while there was a marginal representation from Vichada, Guaviare, Casanare and San Andrés & Providencia. The majority of the respondents reported that they practiced in capital cities (89%; n = 628). In terms of marital status, the majority (62%) of the anesthetists were married, 22% were single and 11% reported a de facto marital union; 4% were divorced and 1% were widowed; and 81% have 2 or more children.

Overall, 82% (n = 566) of the anesthetists were home owners, and almost half of them were in the process of paying for their homes (55%).

Of the anesthetists who participated in the study, 47% (n = 326) had graduated from a public university in Colombia, while 39% (n = 275) had graduated from a private university; the remaining 14% (n = 101) had done their graduate training abroad.

Regarding time since graduating from the graduate program, 31% (n = 216) had less than 5 years of specialized practice, while 27% (n = 190) had more than 20 years of experience. Out of a total of 698 anesthetists, 89% reported that they would specialize in anesthesia again (86% of the women and 90% of the men; x², P > 0.05), while 11% (n = 78) would not choose that specialty again. The reasons stated by the latter group included work overload (41%), compensation below their expectations (36%), complex work schedule (14%), and dissatisfaction with the profession (9%).

In terms of additional academic training, 20% (n = 143) of the anesthetists reported having some training in a second clinical specialty (17% of the women and 21% of the men; Fisher, P >0.05), the most common being cardiovascular anesthesia, intensive care, and pain (Table 2). Reports of a subspecialty were more frequent from anesthetists with more than 11 years of practice since graduating (Fisher, P <0.05).

Table 2

Source: Authors.

On the other hand, 23% (n = 161) of the anesthetists had other academic degrees (24% of the women and 22% of the men; P > 0.05), including the following: management (n = 61), higher education teaching (n = 38), epidemiology (n = 16), auditing (n=15), and ethics (n=9). Less frequent was training in software development and information technology, legal liability, project management, engineering, finance, family medicine, pharmaceutical chemistry, public health, alternative medicine, and occupational health, among others.

In terms of foreign language proficiency, anesthetists had a greater mastery of English, French, and Portuguese. One-hundred percent reported some degree of knowledge of the English language, although only 12% were in an advanced level (Table 3). Other languages reported less frequently were Italian (n = 6), German (n = 5), Catalonian (n = 2), Russian (n = 2), Rumanian (n = 1), Mandarin (n = 1), Swedish (n = 1), Yiddish-Hebrew (n = 1), Latin (n = 1), Arabic (n = 1), and even indigenous dialects such as Wayunaiki (n = 1), with different levels of proficiency.

Table 3

Source: Authors.

Regarding the number of hours/year devoted to continuing medical training, 18% of the anesthetists devoted less than 20 hours to this activity per year; 24% between 21 and 40 hours; 22% between 41 and 60hours; 13% between 61 and 80hours; 9% between 81 and 100hours; and 14% devoted more than 100h/year. There were no differences between men and women regarding the time devoted to training (x², P >0.05). Approximately 10% of the anesthetists reported that they belonged to a research group recognized by Colciencias, 11% men and 7% women; 17.5% acknowledged their participation in research work that resulted in academic output such as lectures during scientific events, scientific papers, poster presentations, books, and participation in Clinical Practice Guidelines (CPG).

Revista Colombiana de Anestesiología (the Colombian Journal of Anaesthesiology) was the academic publication with the highest recognition, followed in order of preference by Anaesthesiology, Anestesia, & Analgesia, Anaesthesiology Clinics ofNorth America, British Journal of Anaesthesia, Current Opinion in Anesthesiology, Revista Española de Anestesiología, Critical Care Medicine, Anaesthesia, ASA Newsletter, European Journal of Anaesthesiology, Paediatric Anaesthesia, Acta Anaesthesiologica Scandinavica, Canadian Journal of Anaesthesia.

Close to 99% of the anesthetists (total = 696) work with a Healthcare Provider Institution (IPS in Spanish). Of them, 41% work in a Level III Healthcare Provider, 35% in a Level IV institution, and 24% in a Level II institution. These healthcare providers are mainly private institutions (59%) and, to a lesser extent public (22%) or mixed (19%) (total n = 696).

The predominant form of work relation was through a service agreement, reported by 47% of the anesthetists. Work relations through associations (unions, cooperatives, simplified stock partnerships) were reported by 33%, and employment by 20%. Regarding form of payment, hourly payment is the most prevalent (50%), followed by payment for procedure (27%), and wages (23%) (total n = 698). No differences were found between women and men regarding the form of payment for their services (x², P> 0.05); however, a difference was found regarding time since graduation, where hourly payment was more frequent among those who had graduated less than 5 years before (x², P <0.05). On the other hand, there was a trend towards hourly payment among Level II institutions (x², P=0.052).

Of the anesthetists surveyed, 28% were not happy with their current jobs and 32% stated their wish to change jobs (total n = 690). There were statistical differences between satisfaction and the desire to change jobs as related to the form of payment, hourly payment being the factor in both cases (x², P < 0.05).

Regarding the number of work days per week, 49% (n = 340) worked 6 days, while close to 7% worked all the days of the week; and 67% worked 12 or more hours per day (total n = 697). In terms of the number of hours per month, 71% (n = 496) of the anaesthetists (total n = 697) work more than 200h/month. Men worked more hours per month (x², P < 0.05) and worked more frequently more than 12 hours per day as compared to women (55% vs 41%; x², P <0.05).

On-site night shifts were done by 61% (n = 429) of the anesthetists (n total = 699), with 45% doing 4 to 6 night shifts per month and 28% doing 1 to 3 night shifts per month. Among those who did on-site night shifts, 72% continued working after the shift. The difference again was in favor of the men who did on-site night shifts more frequently than women (65% vs 50%), and worked more after the night shift (76% vs 58%). For all these cases, the difference was statistically significant (x², P <0.05).

The majority of the anesthetists (64%) earn between USD$18.23 and $27.34 per hour, close to 21% earn between USD$27.34 and $36.45, nearly 6% earn less than $18.23, and close to 8.5% earn more than $36.45 (Table 4). Wage differences were proportionally higher for men than for women (x², P <0.05).

Table 4

Note: 2015 Exchange rate: 2,743.39 (Central Bank).

In terms of satisfaction with the hiring and compensation system, the majority of the anesthetists report an intermediate or low level of satisfaction (72%). In terms of satisfaction with their professional practice, the majority report a high or superior level of satisfaction (73%) (Table 5). There were no differences between men and women in relation to the level of satisfaction with compensation, hiring or professional practice (x², P > 0.05).

Table 5

Source: Authors.

Regarding coverage under the General Social Security System in Health (SGSSS), the majority of the anesthetists surveyed have additional coverage under the Mandatory Health Plan (POS); 61% of the professionals have pre-paid medicine insurance plans, and 12% are covered by special health insurance policies (total n = 698).

Of the anesthetists who participated in the study, 93% make their contributions to the mandatory pension plan; 34% also make payments towards voluntary retirement funds (total n = 698). In terms of the percentage of payment reported, the majority of the anesthetists pay on the basis of 40% or less of their income (53%); 23% pay on the basis of a salary range between 41% and 75%. Of the respondents, 12% had no knowledge of the percentage on which they based their payments to the Social Security System in Health (total n = 700). Regarding affiliation to Work Hazard Insurance (ARL), ARL SURA insurance company is at the top, with a total of 44% of the anaesthetists covered, followed by Positiva ARL, with 19%.

Regarding vacation time, anaesthetists take an average of 17 ± 10 days of vacation per year (based on data derived from their estimates for the past 2 years at the time of completing the questionnaire) (total n = 694). There were no differences between men and women regarding vacation time (Mann-Whitney, P > 0.05). A different approach to analyze the data shows that close to 50% of the anaesthetists take between 15 and 25 days of vacations in the year, 17% take more than 15 days, and 33% take 14 days or less. It is worth noting that there are reports from professionals who do not take vacations. Likewise, the average number of months since the last vacation was 7 ± 6 months at the time of completing the questionnaire, but it is worth highlighting that the upper range for this variable was found to be 36 months, that is, 3 years since the last vacation.

Anaesthetists report an average of 1.86 ± 1.04hours of leisure time in the week, with no differences found between men and women (Mann-Whitney, P > 0.05). The main leisure activity was cinema/TV, followed by sports, reading and music. Other less frequent activities included outdoors (farming or gardening, pet training, horseback riding), cooking, writing, sharing with the family, sewing, carpentry, puzzles, eating out, tourism, video games, yoga or meditation, dancing, photography, and extreme sports.