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November 2000
Volume 64 |
Number 11
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| Update
on Residency Composition, 1960-2000 |
Alan W. Grogono, M.D.
This article is one of a series in the
ASA NEWSLETTER that tracks the size and composition of the
anesthesiology residency programs each fall. The American Board
of Anesthesiology (ABA) provides data about four groups: graduates
of American medical schools (AMGs), international graduates, Canadian
graduates and "unknown" graduates. The latter two groups
are small and, in this report, are combined with international
medical graduates to form a single group (IMGs); they make up
about 5 percent or less of this combined group. ABA also provided
data this year about the number of residents reported as having
completed their training during the previous 12 months, September
1 to August 31. (Note: a few residents who complete their training
late, e.g., in August, are therefore counted both in the CA-3
year in July and in the graduating group.)
Previous articles charted the precipitous
decline in recruitment of AMGs in the mid-1990s followed by the
return of interest in the specialty, particularly in the IMG group.
In addition to reporting the numbers recruited this year, this
article also provides information about the numbers graduating
from the residencies during the last 15 years and summarizes the
level of attrition during this period.
Numbers Graduating
The number of residents graduating represents the pool potentially able to seek employment. This year, 919 residents completed their training, the second year running that the number fell below 1,000 and well below the peak of 1,796 graduating in 1995 [Table1]. The numbers currently in training (CA-1=1,453; CA-2=1,339; CA-3=1,105) indicate that the number graduating should rise again and be well over 1,000 for the next few years.
Recruitment
The first clinical anesthesia year (CA-1)
incorporates recruits: a) from the previous first postgraduate
anesthesiology year (PG-1); b) who obtained their primary medical
experience in another specialty; and c) who are obtaining clinical
anesthesia experience before their primary medical experience.
The CA-1 year is the best indicator of trends in recruitment.
This year, a total of 1,453 residents were recruited into the
CA-1 year [Table1]. This
is approximately the same as the number recruited in 1986, which
was the first year that the residents were required to undergo
three years of clinical anesthesia training. The total is still
well below the peak of 1,904 recruited in 1992.
A relatively smaller number enter the specialty
in the PG-1 year. The number peaked at 580 in 1996 when there
was a shortage of recruits. Since then, this number has declined,
and this year, the size of the PG-1 year for July 2000 continued
the recent trend and fell to 446.
Composition Figure 1 and Figure 2
The number of IMGs in anesthesiology residencies has declined to 2,195 from a peak of 2,285 last year [Table 2]; In addition, compared with the total in training (4,343), the percentage also fell from 58 percent to 51 percent. The trend is even more evident in the critical CA-1 year [Table1], where the number of IMGs declined to 642 (44 percent) from a peak of 770 (56 percent) last year. The PG-1 year also shows a decline in the number of IMGs to 212 (48 percent) from a peak of 397 (78 percent) in 1997.
Attrition
The last "Residency Composition"
article (November 1999 ASA NEWSLETTER) mentioned that attrition
appeared to have been more evident in anesthesiology residencies
in recent years. The addition this year of data about the numbers
graduating shows that, on average, for the 12 years for which
complete data are available, there is no evidence of significant
attrition in the CA-3 year. The average change for these 12 cohorts
actually shows a slight increase (0.57 percent). This could be
explained by the residents whose training has been prolonged by
a few weeks, due to illness for example; they would then be counted
with the residents commencing their third year and cause an apparent
increase in that cohort's size.
Some loss of residents during training is to be expected. The size of each annual cohort would, therefore, be expected to shrink as it is followed from year to year. The data Figure 3 confirm this observation, but there is considerable annual variability Figure 3. For example, in the 1996 CA-1 cohort, there is an apparent increase in numbers after the first year: CA-1 = 745; CA-2 = 939. One possible explanation is that many residents commencing their residency in 1995 may have started with clinical anesthesia training. They would then have left for a year in 1996 to obtain their basic medical experience. In 1997, they would have joined the 1996 CA-1 cohort to swell their numbers at the CA-2 level. This would explain the remarkable rise in the size of the 1996 PG-1 group as well as the very low number recruited to the CA-1 year in 1996. Residents who would normally have completed their PG-1 year in 1995 had been in clinical anesthesia instead and, now in their PG-1 year, were not available. However, because such fluctuations cannot be reliably explained from numerical data alone, ABA intends to investigate these changes further.
Because of the variability, recent trends
in attrition may be better understood by averaging several years.
For the four cohorts recruited into the CA-1 year from 1994 to
1997, despite the apparent rise affecting the one cohort described
above, there is actually an average attrition of 12.8 percent,
four-fold higher than the 3.2 percent average for the previous
eight cohorts.
Comments
The growth in recruitment that was predicted
last year appears to be continuing. The ready availability of
employment for both anesthesiologists and nurse anesthetists provides
an explanation as well as some reassurance that, for the foreseeable
future, such recruitment is appropriate. The data about the number
of residents graduating provide confirmation that few residents
are lost to the specialty during the final clinical year, but
data do show that attrition from anesthesiology residencies has
risen in recent years.
This annual analysis of the numbers of
residents in training and graduating provides an overview of trends
in recruitment to the residencies and, this year, in the numbers
available to seek employment. The analysis depends, however, only
on totals obtained for each cohort. Detailed inspection of the
data emphasizes that the approach used here is imperfect; residents
whose training sequence is atypical, or whose training is prolonged,
distort the data for that group and cause some of the fluctuations
observable in the size of each cohort as it progresses through
training.
The composition of the group being recruited
shows a rising percentage of AMGs. This is reassuring as it confirms
that the specialty is once again viewed favorably by our own medical
students. The changes observed in the last few years provide strong
evidence that our own concerns, attitudes and behavior have a
most powerful effect on the students we meet and, therefore, on
recruitment.
Acknowledgment
As usual, it is a pleasure to thank Francis
P. Hughes, Ph.D., American Board of Anesthesiology, 4101 Lake
Boone Trail, Raleigh, North Carolina, who made available the cumulated
data about resident numbers as well as the additional data about
numbers graduating this year.
Web Site
To see previous articles, additional data
about manpower and the results of the residency matching program,
readers are invited to visit: www.grogono.com/nrmp
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Alan
W. Grogono, M.D., is the former Chair and Meryl and Sam Israel
Professor, Department of Anesthesiology, Tulane University
School of Medicine, New Orleans, Louisiana. He is now retired |
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