Bio

Clinical Focus


  • Anesthesia

Academic Appointments


Professional Education


  • Medical Education:University of California at San Francisco School of Medicine (1980) CA
  • Board Certification: Pediatric Anesthesia, American Board of Anesthesiology (2014)
  • Fellowship:Children's Hospital of Philadelphia (1984) PA
  • Fellowship:UCSF Graduate Division - Fellowships (1984) CA
  • Residency:UCSF House Staff Office (1983) CA
  • Internship:Univ Of Michigan Hospitals (1981) MI
  • Board Certification: Anesthesia, American Board of Anesthesiology (1986)

Publications

All Publications


  • The Pediatric Anesthesiology Workforce: Projecting Supply and Trends 2015-2035 ANESTHESIA AND ANALGESIA Muffly, M. K., Singleton, M., Agarwal, R., Scheinker, D., Miller, D., Muffly, T. M., Honkanen, A. 2018; 126 (2): 568–78

    Abstract

    A workforce analysis was conducted to predict whether the projected future supply of pediatric anesthesiologists is balanced with the requirements of the inpatient pediatric population. The specific aims of our analysis were to (1) project the number of pediatric anesthesiologists in the future workforce; (2) project pediatric anesthesiologist-to-pediatric population ratios (0-17 years); (3) project the mean number of inpatient pediatric procedures per pediatric anesthesiologist; and (4) evaluate the effect of alternative projections of individual variables on the model projections through 2035.The future number of pediatric anesthesiologists is determined by the current supply, additions to the workforce, and departures from the workforce. We previously compiled a database of US pediatric anesthesiologists in the base year of 2015. The historical linear growth rate for pediatric anesthesiology fellowship positions was determined using the Accreditation Council for Graduate Medical Education Data Resource Books from 2002 to 2016. The future number of pediatric anesthesiologists in the workforce was projected given growth of pediatric anesthesiology fellowship positions at the historical linear growth rate, modeling that 75% of graduating fellows remain in the pediatric anesthesiology workforce, and anesthesiologists retire at the current mean retirement age of 64 years old. The baseline model projections were accompanied by age- and gender-adjusted anesthesiologist supply, and sensitivity analyses of potential variations in fellowship position growth, retirement, pediatric population, inpatient surgery, and market share to evaluate the effect of each model variable on the baseline model. The projected ratio of pediatric anesthesiologists to pediatric population was determined using the 2012 US Census pediatric population projections. The projected number of inpatient pediatric procedures per pediatric anesthesiologist was determined using the Kids' Inpatient Database historical data to project the future number of inpatient procedures (including out of operating room procedures).In 2015, there were 5.4 pediatric anesthesiologists per 100,000 pediatric population and a mean (±standard deviation [SD]) of 262 ±8 inpatient procedures per pediatric anesthesiologist. If historical trends continue, there will be an estimated 7.4 pediatric anesthesiologists per 100,000 pediatric population and a mean (±SD) 193 ±6 inpatient procedures per pediatric anesthesiologist in 2035. If pediatric anesthesiology fellowship positions plateau at 2015 levels, there will be an estimated 5.7 pediatric anesthesiologists per 100,000 pediatric population and a mean (±SD) 248 ±7 inpatient procedures per pediatric anesthesiologist in 2035.If historical trends continue, the growth in pediatric anesthesiologist supply may exceed the growth in both the pediatric population and inpatient procedures in the 20-year period from 2015 to 2035.

    View details for DOI 10.1213/ANE.0000000000002535

    View details for Web of Science ID 000425664900030

    View details for PubMedID 29116973

  • In Response. Anesthesia and analgesia Muffly, M., Honkanen, A., Singleton, M. 2017

    View details for DOI 10.1213/ANE.0000000000002037

    View details for PubMedID 28319513

  • The Geographic Distribution of Pediatric Anesthesiologists Relative to the U.S. Pediatric Population. Anesthesia and analgesia Muffly, M. K., Medeiros, D., Muffly, T. M., Singleton, M. A., Honkanen, A. 2016: -?

    Abstract

    The geographic relationship between pediatric anesthesiologists and the pediatric population has potentially important clinical and policy implications. In the current study, we describe the geographic distribution of pediatric anesthesiologists relative to the U.S. pediatric population (0-17 years) and a subset of the pediatric population (0-4 years).The percentage of the U.S. pediatric population that lives within different driving distances to the nearest pediatric anesthesiologist (0 to 25 miles, >25 to 50 miles, >50 to 100 miles, >100 to 250 miles, and >250 miles) was determined by creating concentric driving distance service areas surrounding pediatric anesthesiologist practice locations. U.S. Census block groups were used to determine the sum pediatric population in each anesthesiologist driving distance service area. The pediatric anesthesiologist-to-pediatric population ratio was then determined for each of the 306 hospital referral regions (HRRs) in the United States and compared with ratios of other physician groups to the pediatric population. All geographic mapping and analysis was performed using ArcGIS Desktop 10.2.2 mapping software (Redlands, CA).A majority of the pediatric population (71.4%) lives within a 25-mile drive of a pediatric anesthesiologist; however, 10.2 million U.S. children (0-17 years) live greater than 50 miles from the nearest pediatric anesthesiologist. More than 2.7 million children ages 0 to 4 years live greater than 50 miles from the nearest identified pediatric anesthesiologist. The median ratio of pediatric anesthesiologists to 100,000 pediatric population at the HRR level was 2.25 (interquartile range, 0-5.46). Pediatric anesthesiologist geographic distribution relative to the pediatric population by HRR is lower and less uniform than for all anesthesiologists, neonatologists, and pediatricians.A substantial proportion of the U.S. pediatric population lives greater than 50 miles from the nearest pediatric anesthesiologist, and pediatric anesthesiologist-to-pediatric population ratios by HRR vary widely across the United States. These findings are important given that the new guidelines from the American College of Surgeons Children's Surgery Verification™ Quality Improvement Program state that pediatric anesthesiologists must care for a subset of pediatric patients. Because of the geographic distribution of pediatric anesthesiologists relative to the pediatric population, access to care by a pediatric anesthesiologist may not be feasible for all children, particularly for those with limited resources or in emergent situations.

    View details for PubMedID 27984248

  • The Current Landscape of US Pediatric Anesthesiologists: Demographic Characteristics and Geographic Distribution ANESTHESIA AND ANALGESIA Muffly, M. K., Muffly, T. M., Weterings, R., Singleton, M., Honkanen, A. 2016; 123 (1): 179-185

    Abstract

    There is no comprehensive database of pediatric anesthesiologists, their demographic characteristics, or geographic location in the United States.We endeavored to create a comprehensive database of pediatric anesthesiologists by merging individuals identified as US pediatric anesthesiologists by the American Board of Anesthesiology, National Provider Identifier registry, Healthgrades.com database, and the Society for Pediatric Anesthesia membership list as of November 5, 2015. Professorial rank was accessed via the Association of American Medical Colleges and other online sources. Descriptive statistics characterized pediatric anesthesiologists' demographics. Pediatric anesthesiologists' locations at the city and state level were geocoded and mapped with the use of ArcGIS Desktop 10.1 mapping software (Redlands, CA).We identified 4048 pediatric anesthesiologists in the United States, which is approximately 8.8% of the physician anesthesiology workforce (n = 46,000). The median age of pediatric anesthesiologists was 49 years (interquartile range, 40-57 years), and the majority (56.4%) were men. Approximately two-thirds of identified pediatric anesthesiologists were subspecialty board certified in pediatric anesthesiology, and 33% of pediatric anesthesiologists had an identified academic affiliation. There is substantial heterogeneity in the geographic distribution of pediatric anesthesiologists by state and US Census Division with urban clustering.This description of pediatric anesthesiologists' demographic characteristics and geographic distribution fills an important gap in our understanding of pediatric anesthesia systems of care.

    View details for DOI 10.1213/ANE.0000000000001266

    View details for Web of Science ID 000378083300024

    View details for PubMedID 27049856

  • In Reply. Anesthesiology Singleton, M. A., Apfelbaum, J. L., Connis, R. T., Nickinovich, D. G. 2015; 123 (4): 977-978

    View details for DOI 10.1097/ALN.0000000000000827

    View details for PubMedID 26372136

  • American Society of Anesthesiologists on Children's Surgical Care. Journal of the American College of Surgeons Fitch, J. C., Singleton, M. A. 2014; 219 (2): 326-?

    View details for DOI 10.1016/j.jamcollsurg.2014.05.004

    View details for PubMedID 25038962