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April 2000
Volume 64 |
Number 4
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Anesthesiology's Workforce:
The Good, the Bad and the Ugly -- A Resident's Perspective
We have recently seen an increase in medical student
interest in our specialty, but even this trend will be in
jeopardy if we cannot fix the current problems in academics.
Anesthesiology's Workforce: The Good, the Bad and the
Ugly --
A Resident's Perspective
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Michael H. Ryan, M.D.
Resident Delegate to Missouri Society of Anesthesiologists
It seems that one of the most frequent comments I receive from
attendings is, "it sure is a great time to be getting out of training."
This sort of remark comes more frequently from young attendings
who remember their own experience upon graduating from residency
training. They often lament how difficult it was to find a practice
setting with which they were comfortable at the time they graduated.
Now these same attendings are taking leave of academia in record
numbers to pursue the private practice opportunities they might
otherwise have taken upon their own graduation from training.
Many assume that a resident's primary concern should be the jobs
available to him or her upon graduation. It is true: residents
are indeed concerned with jobs available after training is complete.
Many residents interested in private practice want to be able
to join the kind of practice they desire in a suitable location
and be fairly compensated for their work. Due to the record small
number of students entering training three or four years ago,
there is a relative dearth of graduating residents today.1
Furthermore, despite some dire predictions regarding managed
care, the number of surgeries and the number of anesthetizing
locations has continued to grow over the past several years. It
all adds up to a pretty good job market for the newly graduated
or graduating resident. In most people's eyes, this would be considered
the "good."
What could possibly be bad or even ugly about this sort of job
market? If this were a Clint Eastwood spaghetti western, you would
expect an unshaven gunslinger with a bad attitude. Unfortunately,
it is not quite that obvious, but the "bad" could include some
of the following.
It was only recently that perioperative medicine, pain management
and the other subspecialties of anesthesiology were all the rage;
and fewer residents are now interested in pursuing fellowship
training with these sorts of opportunities available in the job
market. The hard-won success of anesthesiology in the United States
to expand its scope of practice seems in danger again if only
for lack of residents entering the appropriate fellowship training.
This of course does not even include the fact that operating room
staff will have little time to pursue interests for a private
practice group short on anesthesiologists. At a time when anesthesiologists
are arguing in favor of the need to supervise nurse anesthetists,
there are fewer anesthesiologists available. This potential problem
will be felt most acutely at small rural hospitals where there
may be few or no anesthesiologists available. In training programs
throughout the country, some of the attendings with which residents
most identify are the ones leaving for greener pastures. These
young, energetic attendings who are in demand in private practice
are leaving academic practice in droves and leaving residents
with fewer role models.
Owing to the isolated nature of our practice, anesthesiology
training has in some regard been one of those specialties that
is "self taught." In recent years, the moves to improve residencies
by increasing didactic training, simulator instruction and closer
clinical supervision are in jeopardy due to the loss of these
physicians from the academic setting. When there is increasing
financial pressure on academic programs, this lack of incoming
residents is all the more critical. Professors who once dedicated
themselves to research find themselves devoted to the operating
room out of staffing necessity. Finally, while it is nice to be
in a resident's job market position, the moment one signs a contract,
the role is reversed. Now the physician working harder, searching
for anesthesiologists to fill positions in a growing practice,
is you. The physician staying late and doing more call
in order to cover for that vacant position is, again, you.
Finally, there is the "ugly." Returning to the Clint Eastwood
analogy, that same unshaven gunslinger with a bad attitude would
now be frightening innocent women and children while he robbed
the town bank. Thankfully, anesthesiology and academia do not
include these habits. Residents and young attendings, however,
might be telling another story in the near future. The increasing
workload in academic anesthesia will fall on the shoulders of
the young energetic attendings who will leave academia in search
of better opportunities. The residents will be in the operating
rooms for longer periods of time with less actual bedside teaching
since their attending may also be watching three other rooms.
Academic surgeons, watching this saga from the other side of the
ether screen, may lose respect for our specialty. These same surgeons
might then voice their displeasure to other specialties, residents
and students. Medical students may be subsequently influenced,
and fewer will choose to enter our specialty at a time when opportunities
for them abound.
We have recently seen an increase in medical student interest
in our specialty, but even this trend will be in jeopardy if we
cannot fix the current problems in academics. Anesthesiology residents
feel short-changed in that hard work is rewarded with less actual
training. They have less time to read prior to taking the boards,
and they have greater difficulty dealing with the rare but deadly
operating room emergency because they are tired and poorly trained.
Thankfully, not all of these consequences have come to pass. Speaking
with residents from other programs and from around the country,
however, I have found that even the best training programs are
beginning to have problems. The less well-known programs are already
in some dire straits. I do not pretend to know the answers to
these problems, but they can be disheartening to residents who
truly love their specialty and want it to do well.
Reference:
1. Grogono AW. Update on residency composition,
1960-1999. ASA NEWSLETTER. 1999; 63(5):21.
Michael H. Ryan, M.D., is Chief Resident
in anesthesiology, Washington University School of Medicine, St.
Louis, Missouri.
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