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Health Care Industry

It's Official: There's a Shortage Of Anesthesiologists for 10+ Years

Physician Compensation Report, Dec, 2001

There's a nationwide shortage of 1,300 to 3,800 anesthesiologists, or from 3.5% to 10.5% of the current supply of active anesthesiologists. The shortage will last at least until 2010, and, depending on future conditions, may persist well beyond 2015. And this in turn suggests that annual pay for anesthesiologists will keep soaring.

So says an article in the October 2001 Mayo Clinic Proceedings. While some may argue with specific parts of the methodology, the four authors -- all Ohio anesthesiologists led by Armin Schubert, M.D., of the Cleveland Clinic Foundation -- used many data sources and rigorous statistical projection techniques.

More Articles of Interest: Are you prepared for a shortage of anesthesia providers? It may be time to...; Shortage of anesthesiologists blamed on reimbursement rates.(St. Vincent...; Bonus or Cut-Rate Reimbursement? Anesthesiologists, Hospitals Joust; Good 5-Year Outlook for Most Specialties: Demand Rises as MD Supply Marks Time; MGMA: Starting Salary Jumps Point to Specialty Shortages

The real significance of the article is not that the shortage exists. PCR quoted an anesthesiology practice manager back in April 2000 that there was already a well-established shortage (PCR 4/12/00, p. 3). For people in the market for anesthesiologists, the study merely verifies the supply-and-demand reason for the big jumps in pay for new and experienced physicians over the last several years. Market participants observing pay hikes include:

* The authors of the study report from their own experience that starting salaries for anesthesiologists in Ohio have risen about 30% in the past two years, and that recruiting demands much more time than it did several years ago.

* Mark Meisel, COO of 64-physician Anesthesia Associates of Kansas City (Mo.) and immediate past president of MGMA's Anesthesia Administration Assembly, says that "to retain and attract providers, we're having to pay more....[Recruits] can almost write their own ticket [on pay] -- within reason." Salaries for new anesthesiologists have risen 10% to 15% over the past year.

* Larry Stewart, president of Salt Lake City-based CompHealth Physician Search Group, an outside recruiting firm, predicts a further increase of 5% to 7% in pay for anesthesiologist recruits over the next year based on the current shortage and continuing strong demand.

* For MGMA data on anesthesiology and other specialties, see article and chart, pp. 8 and 9.

Instead, the real significance of the article is that the medical establishment is recognizing in a peer-reviewed research journal that there is a shortage in one important specialty. It may not be long before such recognition reaches other specialties that market participants consider to be in shortage, such as cardiology, radiology and urology. Policymakers in Washington and elsewhere will have to take into account shortages of -- and inflation in pay for -- non-primary specialists for years to come. The mid-1990s concept that there were too many specialists is no longer viable. (Primary care may not be so far behind; see PCR 8/9/00, p. 1, and 9/01, p. 9.)

From the patient's point of view, shortages of anesthesiologists are resulting in delays of non-emergency surgery. Judging from local press articles, the delays are substantial in the Boston area but moderate in Denver.

Perhaps the only comparable study was a 1997 article in Urology concluding that the then-prevalent view that specialists were in excess did not apply to urology (PCR 12/13/00, p. 1). That study did not say there was an outright shortage in urology at that time, but suggested an increase nationally of 200 urologists per year through 2020 would keep the field in equilibrium. Since then, urology is growing, if at all, less rapidly than that. Urology practice managers report tight recruiting conditions.

Putting the Abt Study to Rest

Touching off much of the problem was a 1994 manpower study commissioned by the American Society of Anesthesiologists (ASA) and conducted by Abt Associates in Cambridge, Mass. The "predictions of the Abt study could not have been more incorrect," according to two leading anesthesiologists, Ronald Miller, M.D., and William Lanier, M.D., in a Mayo journal editorial accompanying the new study.

The Abt study was written under the strong influence of then-current assumptions, consistent with the ascendancy of managed care, that vast numbers of medical procedures were unneeded and that certified registered nurse anesthetists (CRNAs) could and would take over most of the anesthesia workload. The "most likely scenario" in the Abt study was that essentially no anesthesiologists were needed to be trained through 2010 for U.S. clinical needs.

Unlike many "ivory tower" white papers, the Abt study drew an immediate and dramatic response in the marketplace. The number of American medical school graduates (AMGs) choosing to start anesthesiology residency plummeted in 1994 and continued falling through 1997. The number of AMG residency graduates fell about 75% from 1,547 in 1995 to 392 in 2000. About 25 of 125 residency programs closed.

International medical graduates (IMGs), whose number in U.S. anesthesiology residency programs rose by 50%, made up some of the shortfall. IMGs now comprise the majority of anesthesia residency graduates.

The Mayo study's estimates of the loss of anesthesiology residents in the aftermath of the Abt study are roughly equivalent to its higher-range estimates of the shortage of anesthesiologists. Thus, the shortage in this specialty appears to have started in reaction to the Abt study. This differs from shortages in other specialties, which did not start in response to discrete events. Miller and Lanier warn, however, that training in many specialties suffered from the mid-1990s shift toward primary care and away from non-primary specialties. In fields such as cardiology, shortages appear to reflect steadily widening gaps between supply and demand.

Health Care Industry

It's Official: There's a Shortage Of Anesthesiologists for 10+ Years

Physician Compensation Report, Dec, 2001

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