Anesthesiology is an important medical specialty provided by highly skilled anesthesiologists. Anesthesia care also is provided by certified registered nurse anesthetists (CRNAs) and anesthesiologist assistants (AAs). There are approximately 35,000 anesthesiologists, an equal number of CRNAs, and 1,300 AAs actively practicing in the United States. In most states, CRNAs must work under a physician’s supervision. However, 16 states now have opted out of this requirement. Anesthesiologists typically are anesthesia care team leaders and either personally provide anesthesia or oversee CRNAs and AAs. Anesthesiologists have the medical training to manage the overall health of patients when they are at their most vulnerable.
There has been growing concern over whether the U.S. is facing a shortage of anesthesia providers. The ramifications of such a shortage are significant. “A shortage of anesthesiologists could limit access to high-quality care, especially in light of the growing demand for surgical and interventional procedures for our aging society,” says Mark A. Warner, MD. Markets for highly specialized medical services are difficult to balance, but understanding current and future demand and supply for anesthesia services may help policymakers, regulators, and professional groups in addressing the problem before it gets out of control. Many factors can play a role in national or local shortages, especially poor workforce planning. This may include limits on the number of training positions, regulations of permission to practice, and limits on earning capacity, especially for anesthesiologists who wish to work in rural areas but have payment limited by Medicare rules that do not apply to CRNAs.
New Survey Data
A recent study from the RAND Corporation was conducted to assess whether there is currently a shortage or surplus of anesthesia providers. It also examined demographic patterns, employment arrangements, usage of time across different procedures, and working patterns that currently exist in the labor markets for anesthesiologists and CRNAs. Investigators conducted a national survey of anesthesiologists, CRNAs, and hospital anesthesiology directors, and used an econometric model that drew data from these surveys. It incorporated state-level variables to estimate the supply of and demand for anesthesiologist and CRNA services. It did not evaluate AA services.
“The projected shortage of anesthesiologists suggests that the U.S. will soon face a gap in anesthesiology services that will be just as important to Americans’ health as the projected physician gap for primary care services.”
Data from the RAND survey showed that the U.S. has a current shortage of about 3,800 anesthesiologists and 1,280 CRNAs, representing 9.6% and 3.8% of the total anesthesiologist and CRNA workforce, respectively. Importantly, a dramatic shortage of anesthesiologists and a significant surplus of CRNAs are projected by 2020 if current trends continue. The study projected a shortage of about 4,500 anesthesiologists and a surplus approximately 8,000 CRNAs within 10 years. If the growth in demand is assumed to be 3%, accounting for the aging population, the shortage of physician anesthesiologists may reach as high as 12,500 by 2020, while the supply of nurse CRNAs would be at equilibrium. Shortages of anesthesiologists were spread evenly across all regions in the country. Shortages of CRNAs were more pronounced in the Northeast, while some states in the West showed surpluses (Figure).
“The projected shortage of anesthesiologists suggests that the U.S. will soon face a gap in anesthesiology services that will be just as important to Americans’ health as the projected physician gap for primary care services,” says Dr. Warner. “As more and more patients are projected to become older and sicker, healthcare facilities will need more anesthesiologists to provide the full scope of care that patients will need before, during, and after their surgeries and procedures.”
Comparing Work Patterns
The RAND study also found that the total work hours for anesthesiologists are 50% more than CRNAs (Table). “Anesthesiologists provide more services to critically ill patients and those with acute and chronic pain,” explains Dr. Warner. “They oversee a broad range of anesthesiology practices in hospitals and ambulatory surgery centers. They also provide critical knowledge and expertise that is needed to keep a complete watch over patients’ health and intervene when necessary in their most critical hours. The findings of the RAND survey highlight the need to find ways to expand opportunities for young physicians. This is critical to ensuring that anesthesiologists are available to provide the complex care that is needed by our growing population of elderly and critically ill patients.”
The results of the RAND study have important implications for workforce planning, Dr. Warner says. “To address the shortage of anesthesiology specialists, there are strategies that healthcare facilities should explore. For example, residency positions for anesthesiologists and certifications for CRNAs are typically controlled by professional decision-making bodies. Hospital and healthcare facility leaders should consider increasing the number of anesthesiologists; their medical education, training, and expertise in patient safety will make them the preferred providers to an increasing number of patients undergoing complex procedures. Offering more medical education on anesthesiology during training and making strides toward proper workforce planning may enable our healthcare system to respond appropriately to market conditions.”
Rand Corporation. Is there a shortage of anesthesia providers in the United States? Available at:http://www.rand.org/pubs/research_briefs/2010/RAND_RB9541.pdf.
Daugherty L, Fonseca R, Kumar KB, Michaud P-C. An analysis of the labor markets for anesthesiology. Santa Monica, Calif. RAND Corporation. TR-688-EES. 2010. Available athttp://www.rand.org/pubs/technical_reports/TR688/.
Cromwell J, Rosenbach ML, Pope GC, Butrica B, Pitcher JD. CRNA manpower forecasts: 1990–2010. Med Care. 1991;29:628-644.
Miller RD, Lanier WL. The shortage of anesthesiologists: an unwelcome lesson for
other medical specialties. Mayo Clin Proceed. 2001;76:969-970.