Short- and Long-Term Solutions for the Anesthesiologist Shortage

Around the world, the increasing shortage of anesthesiologists poses a threat to the medical industry and the global patient population. In the United States in the early 2000s, the deficit of anesthesiologists was growing by 2-3% per year until recent acceleration (1). In early 2020, anesthesiology staffing shortages affected approximately 35% of US hospitals, but the increased surgical demand and large patient influx during the COVID-19 pandemic pushed the shortage prevalence to 78% in late 2022 (2). Factors motivating the shortage include the aging of the anesthesiologist population, the increase in early departures from the field due to employment dissatisfaction and burnout, and the lack of training opportunities (1). The consequences of this shortage – including longer surgery wait times, increased costs, stressful work environments, and high workloads – impact providers and patients alike, signaling a critical need for short- and long-term solutions (2, 3). To continue providing high quality care to patients and to improve the sustainability of the anesthesia field, stakeholders must examine both short- and long-term solutions to the anesthesiologist shortage.

Short-term solutions to the anesthesiologist shortage can tackle the immediate needs of the anesthesiology workforce by targeting administrative and clinical practices. First, administrative efforts to reduce the excessive workload of anesthesiologists  and to help minimize burnout and augment workforce satisfaction can result in decreased turnover (4). For example, many hospitals have implemented hiring and retention strategies, such as increased recruitment, flexible scheduling, part-time transitioning instead of immediate retirement, and burnout prevention programs (4, 5). Second, clinical strategies to increase efficiency can assist providers in scheduling and delivering anesthesia care. Expanding the utilization of supervised nurse anesthetists (CRNAs), implementing automated scheduling tools, and, if warranted, using moderate sedation instead of anesthesia all help optimize the workforce in the face of anesthesiologist shortages (2, 6-8). During the implementation of these solutions, the immediate gap of providers may be addressed by partnering with contract providers or staffing agencies if available (8). Critically, although these short-term strategies strengthen responses to the anesthesiologist shortage via acute solutions, they cannot repair the shortage itself (2, 6-8).

On the other hand, long-term solutions can address the problems at the root of the anesthesiologist shortage, including the size of the labor pool and the imbalance of the labor market. First, with at least 45% of anesthesiologists over the age of 55, a significant portion of the workforce could retire within the next 10 years, signaling an impending plummet in the labor pool that fuels demand for the next generation of anesthesiologists (1). However, residency opportunities remain limited – for example, in 2023, there were approximately 35,000 anesthesiologists over 55, compared to 1,609 first-year residency positions (2, 9). Although medical school class sizes and anesthesiology residency seats have grown steadily in recent years, anesthesiology organizations have called for further expansion of training programs by lobbying government funding agencies, developing anesthesia clerkship programs, and strengthening anesthesia education in medical school curricula (1-3, 10). Second, financial constraints – such as the trend of Medicare payment cuts over the last 5 years – have pressured many anesthesiologists to leave hospitals or retire early (3). As the industry continues to lobby against further cuts, experts recommend that medical facilities subsidize anesthesiologists’ loss of Medicare income (1, 11). Currently, more than 80% of hospitals financially assist their anesthesiologist groups, but this amount will likely have to increase. Although facilities may resist, maintaining a strong anesthesia team will ensure financial security in the long run, considering that surgical departments typically account for the majority of facility revenue and cannot subsist without anesthesiologists (12).

Overall, the multifaceted causes behind the anesthesiologist shortage necessitate a combination of short-term and long-term solutions. Currently, experts predict the deficit to increase to at least 12,500 anesthesiologists by 2033, unless the problem is addressed (13). Long-term solutions to educational and financial problems must be implemented, but in the meantime, short-term measures such as clinical strategies, workforce optimization, and burnout prevention can help protect the industry and its patients.

References

1: Menezes, J. and Zahalka, C. 2024. Anesthesiologist shortage in the United States: A call for action. Journal of Medicine, Surgery, and Public Health, 2. DOI: 10.1016/j.glmedi.2024.100048

2: Abouleish, A., Pomerantz, P., Peterson, M., Cannesson, M., Akeju, O., Miller, T., Rathmell, J. and Cole, D. 2024. Closing the chasm: understanding and addressing the anesthesia workforce supply and demand imbalance. Anesthesiology, 141(2). DOI: 10.1097/ALN.0000000000005052

3: Afonso, A., Cadwell, J., Staffa, S., Sinskey, J. and Vinson, A. 2024. U.S. attending anesthesiologist burnout in the postpandemic era. Anesthesiology, 140(1). DOI: 10.1097/ALN.0000000000004784.

4: Mousavi, S., Asayesh, H., Sharififard, F. and Qorbani, M. 2019. Job satisfaction and turnover intention among anesthesiologists: an Iranian study. Anesthesiology and Pain Medicine, 9(3). DOI: 10.5812/aapm.83846

5: Cherian, M., Choo, S., Wilson, I., Noel, L., Sheikh, M., Dayrit, M. and Groth, S. 2010. Building and retaining the neglected anaesthesia health workforce: is it crucial for health systems strengthening through primary health care? Bulletin of the World Health Organization, 88(8). DOI: 10.2471/BLT.09.072371

6: Howard, F., Gao, C. and Sankey, C. 2020. Implementation of an automated scheduling tool improves schedule quality and resident satisfaction. PLoS One, 15(8). DOI: 10.1371/journal.pone.0236952

7: Peters, J. and Young, D. 2022. The physician leader’s role in navigating the anesthesia provider shortage. Physician Leadership Journal, 9(6). DOI: 10.55834/plj.9178639149

8: Moura, T. 2024. Breaking down the anesthesia workforce imbalance, strategies to address crisis. OR Manager. URL: https://www.ormanager.com/briefs/breaking-down-the-anesthesia-workforce-imbalance-strategies-to-address-crisis/

9: National Resident Matching Program. 2023. Advance data tables: 2023 main residency match. National Resident Matching Program. URL: https://www.nrmp.org/wp-content/uploads/2023/03/2023-Advance-Data-Tables-FINAL.pdf.

10: Sawka, D., Yadav, A., Kendall, M., Diorio, M. and Asher, S. 2023. The impact of a new anesthesiology residency program on the number of medical students matching into anesthesiology at a single institution: a retrospective longitudinal study. Cureus, 15(12). DOI: 10.7759/cureus.50677

11: Belli, B. 2024. The anesthesia staffing crisis: How we got here, what hospitals can do. OR Manager. URL: https://www.ormanager.com/the-anesthesia-staffing-crisis-how-we-got-here-what-hospitals-can-do/

12: Mira, T. 2022. Anesthesia subsidies: from the hospital perspective. Anesthesia Business Consultants. URL: https://www.anesthesiallc.com/publications/anesthesia-provider-news-ealerts/1521-anesthesia-subsidies-from-the-hospital-perspective

13: Wallace, C. 2024. Anesthesia provider outlook: 13 things to know. Becker’s Spine Review. URL: https://www.beckersspine.com/orthopedic/anesthesia-provider-outlook-13-things-to-know/