Sunday, March 30, 2014

Is Anesthesiology Losing Its Cachet?

Another Match Day has come and gone. We are finally getting some details on the results of Match Day of 2014. The NRMP crowed about the increasing number of U.S. medical school graduates matching into primary care. They highlighted in their press release that more than 3,000 seniors had decided to go into Internal Medicine. Never mind that most of these folks will probably move on to a more lucrative subspecialty once their residency is completed.

Despite this laudatory statistic, less than half, 48.5% to be specific, of all Internal Medicine spots were filled by U.S. graduates, the rest presumably taken mostly by foreign medical graduates. The same dismal numbers are found in Family Medicine (45%), Psychiatry (51.8%), and Prelim General Surgery (38.1%). If the match rate is an indication of the popularity of a field, then subspecialties like Dermatology, Neurology, Orthopedic Surgery, and Neurosurgery are still the most desired by U.S. medical students, each with nearly 100% fill rate. Overall, 61.5% of all PGY 1 spots were filled by U.S. graduates.

How did anesthesiology do? At least we can say we did better than average. For 2014, 71.9% PGY 1 spots were filled by U.S. seniors. It was the ninth most popular field ranked by the students, falling just behind OB/GYN. But if you look at the trend over the last few years, the numbers are starting to look troubling.

The 71.9% is the smallest percentage filled since at least 2010, the last year published in the NRMP press release. This follows a drop last year to 74.8% from 78.9% in 2012. In 2011, 79.8% of all PGY 1 spots were taken by U.S. seniors. Is it because we are now reaching a saturation point in the number of anesthesia residencies being offered? This year 1,049 positions were offered, with 754 successfully filled with American students. In 2010, just 797 spots were available which were taken by 626 lucky seniors. So the number of positions has expanded dramatically while the take rate has grown to a lesser degree.

Other fields that are highly sought after have kept the number of residency positions level or even decreased despite the clamoring for spots. Dermatology went from 31 in 2010 to just 20 this year, making it even more desirable like a rare commodity. Neurosurgery went from 191 five years ago to 206 today, a barely perceptible increase of 7.9%. Orthopedics stayed fairly stable from 656 to 695, or 5.9%. What did anesthesiology department heads do? They increased the number of positions available by 31.6% in five years. That rate of growth is clearly not sustainable and will take time to absorb.

Perhaps all the talk about the encroachment of CRNA's into the profession is scaring away potential anesthesia candidates? That sounds like a pretty defeatist attitude for the next generation of anesthesiologists. But a quick glance through the Student Doctor Network will quickly demonstrate the anxiety facing medical students who are thinking about going into anesthesiology.

I get emails routinely from nervous medical students asking me for my prognosis on the future of anesthesiology. All I can tell them is that statistically there is still a shortage of anesthesiologists in this country, particularly away from large cities and the coasts. Will CRNA's overrun our field with their cheap labor? Not if we're smart and organized like them and contribute to PAC's like the ASAPAC to help get our voices heard in the halls of Congress. What is our leadership at the ASA doing to prevent an exodus of bright medical graduates from going into something else? I don't know but they better get their heads out of their butts and start doing something more constructive besides building a new headquarters for their bloated bureaucracy.

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