Geographics of Anesthesiology Residency
Doctors wishing to pursue anesthesiology must complete a residency program after completing medical school, typically consisting of a one-year internship followed by three years of specialized clinical training. Though not as competitive as other specialties like dermatology and neurosurgery, anesthesiology residency programs are still highly sought after and have become more competitive in recent years. The availability of residency slots determines the number of anesthesiologists entering the physician workforce every year—a figure that is of particular concern given the current anesthesiologist shortage and forecasted growth in surgical needs. Additionally, the geographics of anesthesiology residency programs influence supply on a regional level, and inequities in their geographic distribution can exacerbate inequities in access to care.
The Accreditation Council for Graduate Medical Education (ACGME) is a non-profit organization that gives accreditation to graduate medical training programs.1 A search in their database for anesthesiology residency programs reveals that there are 188 such accredited programs across the US. With 23 programs, New York has the most of any state, followed by California (19), Florida (13), and Texas (11). The ranking of states with the highest number of post-graduate year 1 positions follows a similar pattern: New York leads with 226, followed by California (201), Texas (124), and Massachusetts (123).2 Although programs are densely located within the Northeast, there are competitive programs across the country. The Midwest, for instance, is home to the Mayo Clinic program in Minnesota and Northwestern in Illinois, while highly regarded residency programs in the Southeast include those at Emory in Georgia and Duke in North Carolina.
Nonetheless, there are imbalances in the geographics of anesthesiology residency programs. Eight states currently lack programs, the most populous of which being Idaho.3 Several major metro areas, such as Austin, Charlotte, and Raleigh, lack such programs but, according to one study, likely have the capacity for new programs.4 These absences are especially important to consider in light of the anesthesiologist shortage the US is facing, as a lack of graduate medical education funding for residency programs is often cited as a major cause.5 Despite a 12% increase in residency positions from 2017 to 2021 (from 7,202 to 8,112), more positions are needed to ensure the need for anesthesiologists is fulfilled—a need that is felt acutely and disproportionately in certain parts of the US.
Fortunately, there have been some signs of recent progress towards the establishment of more anesthesiology residency programs. Using ACGME data, a 2025 study analyzed the geographical distribution of residency programs accredited between 2014 and 2024.6 The researchers found that of the 48 newly accredited programs, 23 (or 48%) were established in a designated shortage area for health professionals. A third of them were formed in the Southeast, but this number is skewed by the disproportionate number created in Florida. California and Michigan also had a relatively high density of anesthesiology programs alongside higher health professional shortage scores. Furthermore, 29% of the new programs were established in an area designated as medically underserved. While early steps have been taken, more remains to be done to increase equity in the geographics of anesthesiology residency programs and ensure all can access anesthesia care.
References
1. ACGME – Accreditation Data System (ADS). https://apps.acgme.org/ads/Public.
2. Anesthesiology Residency Programs. https://www.residencyprogramslist.com/anesthesiology.
3. Wallace, C. 8 states with no anesthesia residents. Becker’s ASC https://www.beckersasc.com/anesthesia/8-states-with-no-anesthesia-residents/ (2024).
4. Nadir, Z. S., Hofkamp, M. P., Wolpaw, J. T. & Mootz, A. A. Identification of opportunities for strategic expansion of anesthesiology training programs. Baylor University Medical Center Proceedings 0, 1–6 (2026), https://doi.org/10.1080/08998280.2025.2611216
5. Menezes, J. & Zahalka, C. Anesthesiologist shortage in the United States: A call for action. Journal of Medicine, Surgery, and Public Health 2, 100048 (2024), https://doi.org/10.1016/j.glmedi.2024.100048
6. Jones, J. H. & Fleming, N. Geographical Distribution of Newly Accredited Anesthesiology Training Programs in Relation to Health Professional Shortage Areas and Medically Underserved Populations. J Educ Perioper Med 26, E731 (2024), DOI: 10.46374/VolXXVI_Issue4_HarveyJones