November 1996
Volume 60 |
Number 11
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Resources Revisited,
Part 1:
Recruitment and Residency Size Changes for Anesthesiology,
1996 |
Alan W. Grogono, M.D., President
Association of Anesthesiology Program Directors
The National Residency Matching Program (NRMP) results for 1996
confirmed the expected marked reduction in recruitment into anesthesiology
via the match (May 1996 NEWSLETTER).
At the first-year postgraduate (PG-1) level, only 43 U.S. seniors
(out of 113 total) matched into the specialty, and at the first-year
clinical anesthesia (CA-1) level, 126 U.S. seniors (out of 212
total) matched. At the same time, the number of international
medical graduates (IMGs) recruited via the match rose from 114
in 1995 to 175 in 1996.
Based on these figures, concern about over-recruiting was replaced,
understandably, by anxiety about under-recruitment, in particular
about the small number of American medical graduates (AMGs) entering
the specialty. Because the numbers were so small, the recruitment
subsequent to the match was predicted to significantly affect
the final composition for the year. This data is now available
and reveals some unexpected trends.
Marked Increase in the PG-1 Group
In 1990, there were 479 residents in the PG-1 group (Table
1). The following five years showed significant falls in recruitment
to 207 in 1995 (Figure 1).
This year, it was widely assumed that there would be a further
marked reduction. Instead, the size of the PG-1 class has trebled
to almost 580. This size has been exceeded only once before, when
there were 614 PG-1 residents in 1981.
Marked Decrease in the CA-1 Group
In 1994, there were 1,873 members in the CA-1 group (Table
1). In 1995, the size of the group fell to 1,436. This year,
the CA-1 group has fallen by almost 50 percent to only 745 residents.
This is the smallest CA-1 group in the last 25 years.
Decreases in CA-2 and CA-3 Years
This year again, there was significant attrition as the groups
progressed from CA-1 to CA-2 (a loss of 177) and from CA-2 to
CA-3 (a loss of 153).
International Medical Graduates
The figures reported in Table 1 and graphed in Figure
2 provide evidence of some increase in the recruitment of
IMGs. This is supported by the percent of IMGs per residency year
in 1996: CA-3, 24 percent; CA-2, 30 percent; CA-1, 45 percent;
and PG-1, 58 percent. The final number of IMGs recruited for the
CA-1 year in 1997-98 will not be known for another year but will
almost certainly be higher than the CA-1 group in 1996.
Implications and Trends
For some years, there inevitably will be a significant reduction
in the number of residents graduating from anesthesiology residency
programs. If this year's CA-1 group is subject to the attrition
that currently affects anesthesiology residencies, then the group
graduating in 1999 could fall to about 600. Such a reduction in
the production of residents was regarded as desirable in the wake
of the report "Estimation of Physician Work Force Requirements
in Anesthesiology" by Abt Associates Inc. It is of interest
that this has occurred so rapidly and has been achieved by market
forces and publicity more than by policy and direction.
The size of this year's PG-1 group suggests that recruitment
could now increase. This can only be finally judged next year,
when any additional recruits will have been accepted to complete
the 1997 CA-1 year. The growth in the number of IMGs appears to
have slowed.
The small size of the CA-1 group will reassure those who believe
a decline in the production of anesthesiologists is required.
It affords time to continue our assessment of trends and future
needs. The growth in size of the CA-1 group suggests that there
are still physicians wishing to be anesthesiologists and available
to meet future needs. Next year's CA-1 group could well show some
increase rather than a further decline.
Acknowledgment:
It is a pleasure to thank Francis P. Hughes, Ph.D., of the American
Board of Anesthesiology, who once again provided the cumulated
data about residents and international medical graduates.
Editor's Note: "Resources Revisited, Part 2: Employment
Obtained by Graduates of Anesthesiology Residencies, 1996"
will appear in the December 1996 issue of the ASA NEWSLETTER.
Alan W. Grogono, M.D., is Chair and Merryl
and Sam Israel Professor, Department of Anesthesiology, Tulane
University School of Medicine, New Orleans, Louisiana.
E-mail the author.
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