Friday, April 4, 2014

Too Many Anesthesiologists? Let's Take A Look At The Numbers.

The latest issue of the ASA Newsletter has some very interesting statistics about the trend in the supply of anesthesiologists over the last decade. The figures were compiled from physician workforce data compiled by the trusty AMA. Not counting research and academically oriented anesthesiologists, the study showed that as of 2012 there were 45,357 practicing anesthesiologists in this country. They constitute 5.8% of all doctors for that year.

This number has been steadily climbing in the last ten years. Taking 2003 as a baseline, the U.S. population has increased 8.21% in that period. By contrast, the number of anesthesiologists have increased by 16.2%, or nearly double the rate of population growth. The anesthesiologist growth rate also eclipsed the growth rate of physicians in general, which rose 13.4%. Growth in a few specific medical fields include primary care (6.6%), gastroenterologists (20.2%), and surgeons (4.7%).

Where are all these anesthesiologists congregating? During that time, the District of Columbia, Vermont, and Connecticut have shown a >20% increase in anesthesiologists per population ratio (ApPR). Most of the states fall between 0-20% ApPR increase. Where are the anesthesiologists hanging up their shingles? Delaware, Nevada, New Mexico, Alaska, Iowa, Montana, West Virginia, and Idaho all registered lower ApPR. The study does not try to understand why D.C, VT, and CT showed such large increases. Maybe they started from a low baseline of anesthesiologists. Though with D.C. and CT, I find that to be hard to believe. We also don't know why those eight states showed a decrease in per capita anesthesiologists. Bad economies? Poor reimbursements? Who knows?

How many CRNA's are out there competing for anesthesia jobs? The study authors used Medicare claims data to deduce how many CRNA's filed claims compared to doctors. From 2009 to 2012, Medicare showed that the number of CRNA's had increased by 14.7% compared to only 4.4% for physicians. From 2001 to 2011, the number of graduating CRNA's each year increased from 1,159 to 2,447. They estimate that between 2003 to 2012, the number of nurse anesthetists practicing in the country increased by 50-75%, or at least triple the rate of growth of anesthesiologists.

How are all these anesthesia providers going to find work? We better hope there are a lot more GI docs and surgeons in the future. The authors note that the number of cases performed by these two specialties significantly determined the number of anesthesiologists working in a given state. Surprisingly, the change in a state's population had no significant impact on the number of practicing anesthesiologists. They are unable to answer questions such as how work hour changes and inroads made by nurse anesthetists and anesthesia assistants will affect the need for future anesthesiologists. They also couldn't predict whether we are currently at an equilibrium with the supply of anesthesiologists and the work available.

There you go. This is the most current data for the demographics of anesthesiologists. It gives us some numbers but it really can't tell what we really want to know. Do we already have too many anesthesiologists or are we still working off a shortage from the doldrums two decades ago? Regardless, we better hope the gastroenterologists and surgeons stay busy for awhile.

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