Friday, March 18, 2016

Is Anesthesiology At The End Of The ROAD?

For nearly two decades, anesthesiology was considered one of the elite fields that medical students aspire to. Along with the other ROAD specialties (radiology, ophthalmology, and dermatology), anesthesiology was associated with intellectual stimulation, good income, and a humane lifestyle. But the specialty may be peaking, or even already peaked and heading back down to the ignominy of the 1990's.

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Match Day 2016 results were released today to thousands of innocent and hopeful medical students this morning. For nearly everybody, there was news worth cheering. However the results for the anesthesiology match was less than sensational. Sure the anesthesia residency programs can tout that over 95% of their spots were filled this year. But as the NRMP chart shows,  that leaves the highest number of vacancies unfilled in the past five years.

Worse, the number of PGY1 positions being offered are increasing even though the number of U.S. seniors applying to anesthesiology has not, staying roughly in the mid 700's. This year, there were 1,127 PGY1 spots offered. Back in 2012, there were only 919, a 22.6% increase. Consequently the percentage of positions being filled by U.S. seniors has dropped to only 68.7%. This compares to a fill rate by U.S. educated seniors of 78.9% in 2012.

How bad is 68%? That's a number that feels more at home with the primary care fields which offer thousands more residency jobs than anesthesiology. Pediatrics has 2,689 positions and 68% filled by U.S. seniors. Internal Medicine has 7,024 jobs and 46.9% acceptances. Family Medicine has 3,238 and 45.3%. Meanwhile more desirable fields like Emergency Medicine managed to fill 78.4% of their spots with U.S. seniors. Orthopedic Surgery, 90.7%. Even General Surgery (categorical), supposedly a field nobody wants to enter because of the terrible lifestyle, filled 76.4% of their positions.

What about the other ROAD specialties? As usual, Dermatology was able to offer 100% of their jobs to U.S. seniors. Ophthalmology, though not in the official NRMP match, usually matches around 90%. Unfortunately for Radiology, it is also suffering the same kind of loss of prestige, with 61.6% of its PGY1 jobs going to U.S. students.

Is there any hope for anesthesiology? First we have to stop increasing the number of residency positions offered. We want the best and brightest medical students to go into the field, not try to fill residency positions out of a sense of desperation. Besides, many people already feel the anesthesia market is saturated and all the graduates have to do an extra year of fellowship just to find a job. Next, the ASA needs to find a future direction for the field besides the Perioperative Surgical Home. Yes the leadership feels that is the most compelling vision for the specialty. But frankly I didn't sign up for this gig to become an internist and compete with the hospitalists for a job. Finally, we need to make anesthesiology exciting again. This field has made some of the greatest contributions to the advancement of medicine. Why does anesthesiology feel like it's stuck in a rut? Why aren't there any smart companies developing exciting new technology to improve patient safety and monitoring? Why is the most talked about anesthesia tech in the past five years related to how to remove anesthesiologists from the procedure room? Why does the anesthesiology match every year feel more and more like a sinking ship and nobody wants to be stuck as the last one out?


  1. Disappointing to hear this as someone who has committed to anesthesia.... I love your blog though. Please keep it up!

  2. Your numbers are off. You are only looking at PGY-1 Spots.

    Derm PGY-2 spots (the vast majority of them) had 85.5% of those go to US Seniors, not the 100% you saw with PGY-1 spots.

    Also Rads had 67% of PGY2 spots go to US Seniors up from approx 50% the year before.

    These numbers are pointless without tallying the TOTAL of PGY-1 spots AND PGY2 spots for each specialty. For rads I know that the spots typically offering PGY1 spots (Beaumont, UNM, Kaiser, etc) are less competitive on average than those offering PGY2 spots.

  3. I finished residency in anesthesiology nearly 25 years ago. I am boarded in anesthesiology and pain management. I still work full time in interventional pain management, but have not provided a general anesthetic in over 15 years. I can say with absolute clarity that outside of a career in academics, a career as a physician anesthetist is a gross underutilization of the full potential of a medical school education. In my mind, it is an illogical and unsound investment in your future as a physician.