If current trends continue to 2005, the study’s authors estimate a shortfall of anesthesiologists in the United States will number 1,000 to 4,500.
"It appears now that, in addition to focusing on the financial resources needed to support the health care needs of an aging population, national health policymakers need to reexamine whether the number of health care professionals is sufficient to care for the elderly, in particular when they require surgery, are afflicted by painful conditions, or become critically ill," says Armin Schubert, M.D., M.B.A., of the Department of General Anesthesiology at the Cleveland Clinic, and the primary author of the study.
Other authors of the paper include: Gifford Eckhout, M.D., of the Department of General Anesthesiology and Alan Kuhel, M.D., of the Department of Regional Practice Anesthesiology, both of the Cleveland Clinic; and Todd Cooperider, M.D., of the Department of Anesthesia, Toledo Children’s Hospital.
The continuation of the shortage will be fueled by changing population demographics and population health trends. Paradoxically, the accelerating advancements in surgical technology may initially produce a further taxation on anesthesia resources, simply because the period of introduction of these technologies may not initially provide as efficient delivery of care compared with existing practices. Further, the growth in ambulatory and office-based surgery, pain medicine, and intensive care will potentially add to the workload of anesthesiologists, outside the traditional hospital operating room setting, the authors write.
The authors calculated the rates of demand and the number of anesthesiologists needed in the future by analyzing data from a number of government and physician association sources that helped the group come up with a range. The authors of the special article offer some solutions to reverse the current direction:
*Training more personnel -- By 2010, almost twice the number of resident graduates are needed compared with the number who graduated in 2000.
*Embracing diversity in anesthesiology training programs -- Some programs only allow graduates from United States medical schools. Instead, they should maintain their high standards, but also consider accepting qualified graduates of international medical training programs.
*Anesthesia as a national health resource -- Lawmakers need to be convinced that anesthesiologists are a national resource needed for the efficient functioning of medical centers.
*Government immigration policy -- Visa allocations should be increased to allow well-trained international medical graduates access to the specialty, just as has been done for computer programmers and other highly trained professionals.
*Payment for services -- A fair and thorough overhaul of government fee schedules as they relate to anesthesia services is one health policy mechanism by which the supply of anesthesia personnel can be increased in the near term.
An editorial in the same issue of Mayo Clinic Proceedings attributes the shortfall of anesthesiologists to faulty projections in the early and mid 1990s regarding the need for medical specialists, including anesthesiologists. These projections were embraced my medical educators and others who encouraged medical students to move away from specialty practices and into general medical practices. The editorial warns that the study of Schubert and colleagues provides a lesson for what could happen to specialties other than anesthesiology.
"Changes influenced by policymakers, independent of proper baseline data and appropriate models, can have a devastating effect on the well-being of a specialty," write the editorialists. "This has been experienced firsthand in anesthesiology. It can happen in other specialties as well. Ultimately, the erosion of any important component specialty will do harm to the future intellectual and service missions of all of medicine and unfortunately, the patients we serve."
Authors of the editorial are Ronald D. Miller, M.D., chairman of the Department of Anesthesia and Perioperative Care, University of California, San Francisco, and Editor-in-Chief of Anesthesia and Analgesia, and William L. Lanier, M.D., Editor-in-Chief of Mayo Clinic Proceedings and consultant in the Department of Anesthesiology, Mayo Clinic.
The editorialists further concluded that current debate about using certified registered nurse anesthetists (graduate nurses specially trained to provide anesthetics and whose interval from secondary school to clinical practice is less than that of anesthesiologists) to partially offset the workload of physicians is misdirected, in some measure because fewer nurses are currently training in anesthesia.
Mayo Clinic Proceedings is a peer-reviewed and indexed general internal medicine journal, published for 75 years by Mayo Foundation, with a circulation of 130,000 nationally and internationally.
Journal
Mayo Clinic Proceedings