Alan W. Grogono, M.D.

Earlier this year,¹ the report on the results of the Match showed some increase in the number of recruits entering our specialty via the National Residency Matching Program (NRMP). This rise was almost entirely explained by an increase in the number of American medical graduates (AMG), which comprised 60 percent of those matching. Subsequent to the Match, residencies recruit graduates from other sources, principally international medical graduates (IMGs).

In recent years, there has been an appreciable number of positions not filled via the Match and the final composition of the residencies rarely corresponds with the Match results. This year, all of the data currently available from the American Board of Anesthesiology (ABA) between 1960 to 1998 are presented. In addition to providing the update for this year, the retrospective data include 12 years not available for presentation in the summary last fall.²

The ABA has compiled data annually since 1960 regarding the number of residents in training [Table 1], and since 1983 regarding the size and composition of all four years in residency training [Table 2]. In the early 1960s, approximately 1,200 residents were in training, mostly in the two required years. Since then, the number in training increased and, in 1994, peaked at 5,868 - nearly five times higher. However, these figures include the PGY-1 year as well as the CA-3 year introduced in 1988. This year, even with the decline of recent years, there are still 3,618 graduates in training. A better comparison with the 1960s would be that there are 1,886 graduates in the two senior years (CA-2 and CA-3), which is still a significant increase over 1,200.

The number of American and international medical graduates in anesthesiology residency programs 1960 - 1998

The data this year show the size of the PGY-1 year unchanged at 507, but the AMG component has increased from 110 to 140. By contrast, in the CA-1 year, the increase from 1,132 to 1,225 is due to an increase in the number of IMGs. This year's figures again show some attrition as graduates are promoted each year. The 1,132 CA-1 residents in 1997 lost 131 members as they became 1,001 CA-2 residents this year. Similarly, 939 CA-2 residents in 1997 lost 54 members to become 885 CA-3 residents this year. The attrition at the CA-1/CA-2 transition affected AMGs and IMGs equally. By contrast, at the CA-2/CA-3 level, the attrition only affected the IMG group.

Historical Composition of Anesthesiology Residencies

Graph showing the percentage of international medical graduates in anesthesiolgy residencies 1960-1998.

The data available from 1960 to the present time show that the percentage of IMGs in anesthesiology residencies fluctuated widely from a high of 58 percent in 1972 to a low of 9 percent in 1988 [Figure 1]. The rapid growth in recruitment of AMGs that occurred in the 1980s was associated with a decline in recruitment of IMGs [Figure 2]. Recently, the decline in recruitment of AMGs in the last four years has been associated with increasing recruitment of IMGs, although this increase appears to have commenced about five years earlier, in 1988. The detailed composition of all four years is available from 1983 onward [Figure 3].

Figure 2 Graph showing the numbers of American, international and total medical graduate in anethesiology residencies 1960-1998.

Figure 3 Graphs showing the composition in all four years of anesthesiology residencies 1983-1998.

The total of 1,225 residents now entering the CA-1 year will, mostly, be available to enter the job market in the summer of 2001. The relatively few residents graduating to enter employment this year, and for the next two years, appear to be barely adequate to meet the demand. It is hoped that the number we are now recruiting will prove appropriate to meet future needs.

The decline in the number of AMGs entering anesthesiology appears to have been interrupted if not actually reversed. However, several program directors report a current resurgence of interest among medical students, which should result in increased recruitment of AMGs in the near future. This will be confirmed or denied by the next two years' results.

Once again, it is a pleasure to thank Francis P. Hughes, Ph.D., Executive Director, American Board of Anesthesiology, who made available the accumulated data about resident numbers.

References:

1. Grogono AW. National Residency Matching Program (NRMP) 1998. ASA NEWSLETTER. 1998; 62(5):21-24.
2. Grogono AW. Update on residents and their prospects in 1997. ASA NEWSLETTER. 1997; 61(12):17-20.

Alan W. Grogono, M.D., recently retired, is the former Chair and Merryl and Sam Israel Professor, Department of Anesthesiology, Tulane University School of Medicine, New Orleans, Louisiana.

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