Although the supply of anesthesiologists is tight and a shortage is likely without corrective action, the reality is that cases are not being scrapped and there are some hopeful signs on the supply side.
If you look at the recent Tarrance Group survey of hospital administrators, only a small majority (53 percent) believe that they currently have sufficient anesthesiologist personnel. While the number who fall on the negative scale is disturbingly high, this is more a function of inefficient systems than provider shortages.
The illusion of a shortageInefficiencies are traceable to factors other than a lack of anesthesia providers. One factor is the growth of ASCs and office-based surgery. There is now a variety of different places where anesthesiologists can go, which renders the entire system somewhat less effective. For practitioners in the university setting, the ASC has taken us into two different surgical settings. The ASC or the office is a nice place to work. The cases are shorter, quicker, "cleaner," lower risk and pay good money with better hours. Additionally, most ASCs screen patients and all are paying customers. For the provider, it is a good situation, but the pull to the ASC and the office creates less efficiency within the health care system overall.
A second factor is increased specialization. Many anesthesiology colleagues go into pain management and leave the OR for the pain clinic. These practitioners are not participating in traditional anesthesia in the OR and do not take call at the hospital. Radiology consumes their services. Additionally, a smaller, but not insignificant number of anesthesiologists become OR directors. Anesthesiologists are uniquely suited to the role because we are physicians who also know the ins and outs of nursing.
A resurgence in residentsThe number of anesthesia residents dropped drastically over the last 9 years. Prior to 1993, it was common for 100,000 new anesthesiologists to be turned out each year. Those numbers plummeted during the mid to late 1990s, to the point where resident-matching programs that once had about 1,700 residents dropped to about 150. However, enrollments in anesthesia programs are increasing again. Here at the University of Kansas, we had just three students enter anesthesiology five years ago. This year, we have 21. There is clearly a resurgence. Students see there are good paying jobs and increased career opportunities beyond traditional hospital services.
It's hard to know what the ideal workforce should be. But most facilities haven't had to cancel cases or shuffle schedules, and help may be on the way to fill some vacancies. The system is by no means healthy, but it's not on life support, either.
Dr. Unruh (gunruh@kumc.edu) is associate professor of anesthesiology at the University of Kansas and director of its residency education program.
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