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November 2001
Volume 65 |
Number 11
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| Residency Composition
and Numbers Graduating from Residencies and Nurse Anesthesia
Schools |
Alan W. Grogono, M.D..
Anesthesiologists and nurse anesthetists have been interested
in and concerned about workforce issues since the threat of a
relative surplus emerged in the early 1990s. This threat appears
to have affected both groups and caused a reduction in the numbers
entering the workforce. This article provides updated information
provided by the American Board of Anesthesiology about the number
of residents in training and graduating from anesthesiology residency
programs. In addition, for the first time this year, data have
been provided by the American Association of Nurse Anesthetists
(AANA) about the number of nurse anesthetists graduating each
year.
Number of Anesthesiologists Graduating
The lowest number recruited into the CA-1 year (1,073) occurred
in 1996. This decline passed through the residency training programs,
reducing the size of the graduating class to 919 in 2000. This
year, the number of residents recorded as graduating has risen
to 1,078, a 17-percent increase [Table
1 and
Figure 1]. This is still 49 percent less than the peak of
1,796 graduating only six years ago in 1995. The numbers in training
(CA-1=1,466; CA-2=1,374; CA-3=1,253) indicate that the number
graduating should continue to increase, at least for the next
three years. However, even if no attrition occurs from the residencies,
these numbers indicate that the maximum number graduating will
still be at least 20 percent lower than the peak.
Number of Nurse Anesthetists Graduating and Being Certified
During the last 12 years, the number of nurse anesthetists graduating
has varied from a low of 592 in 1989 to a high of 1,079 in 1996
[Table 2]. The number being certified
has varied from a low of 574 in 1989 to a high of 1,082 in 1995
[Table 2]. However, the graphs of this
data [Figure
2] show a marked rise during the first six years (13 percent
graduating and 15 percent certifying). The decline in the number
being certified in 1996 is not accompanied by a reduction in numbers
graduating. This contrasts with the remainder of the graphs, which
otherwise track each other reasonably closely.
Number of Residents in Training
The size of the CA-1 year remains the best indicator of trends
in recruitment into anesthesiology. This year, a total of 1,466
residents were recruited into the CA-1 year, a less than 1-percent
increase from 2000 [Table 1]. This
is approximately the same as the number recruited in 1986 and
well below the peak of 1,904 recruited in 1992. The number entering
the PG-1 year, however, increased from 446 last year to 543 this
year. This reverses the apparent trend of the last five years.
With the exception of the unusual 580 recruited in 1996, this
is the largest PG-1 group recruited in the last 19 years.
Residency Composition [Figures 1
and 3]
The numbers of international medical graduates (IMGs) in anesthesiology
residencies has declined to 1,907 from a peak of 2,285 in 1999
[Table 3]. In addition, compared with
the total in training (4,636), the percentage also fell from the
peak of 58 percent to 41 percent this year. The trend is more
marked in the critical CA-1 year [Table 1], where the numbers
of IMGs declined this year to 486 out of 1,466 (33 percent) from
a peak of 770 out of 1,387 (56 percent) in 1999. The PG-1 year
also shows a decline in the number of IMGs to 173 out of 543 (32
percent) from a peak of 397 out of 507 (78 percent) in 1997.
Attrition
For the residents entering the CA-1 year from 1986 to 1993, attrition
from anesthesiology residencies was approximately 4 percent during
the whole three-year clinical residency. The same attrition rate
affected American medical graduates (AMGs) and IMGs. In the following
years [Figure
4], the attrition rate for the three-year period rose to average
17 percent (AMGs 15 percent and IMGs 20 percent). This attrition
may be declining again; the loss between CA-1 and CA-2 years has
been about 4 percent for the last three years compared to 12 percent
for the four years prior to that. The trends in attrition are
more easily understood by averaging several years. For the five
cohorts recruited into the CA-1 year from 1994 to 1998, there
is actually an average attrition of 17 percent, nearly fivefold
higher than the 3.8 percent average for the previous eight cohorts.
Figure
5
Correction of an Anomaly
Last year’s article discussed an apparent aberration in 1996:
the size of the 1996 CA-1 cohort apparently increased by 26 percent
as it progressed to the CA-2 year. The article stimulated a careful
review and update of the original American Board of Anesthesiology
(ABA) data. The revised data eliminated this variation. The size
of the 1996 cohort actually fell by about 10 percent, which approximates
the fall for the 1995 and 1997 cohorts.
Discussion
The numbers graduating from anesthesiology residencies and nurse
anesthetist schools have both fluctuated. The decline from the
maximum for residents graduating, which occurred over five years,
was from 1,796 in 1995 to 919 in 2000 (49 percent). The maximum
of nurse anesthetists graduating declined from a high of 1,079
in 1996 to 934 in 1997 (13 percent). However, the number of nurse
anesthetists being certified is probably a more accurate reflection
of the numbers entering the workforce. Here, the greatest decline
was from 1,082 in 1995 to 703 in 1996 (35 percent). This decline
in the numbers of nurse anesthetists being certified actually
preceded the decline in the numbers graduating. For the next two
years, however, the number being certified rose sharply and actually
exceeded the number graduating. This may be explained by graduates
opting to delay certification at a time when confidence and employment
opportunities were diminished.
This year, the number entering the PG-1 year has risen by 22
percent. The number of AMGs in this group has risen by 58 percent.
This is remarkable and suggests a contribution by factors outside
the specialty of anesthesiology. The decline in the number entering
the PG-1 year in the early 1990s was partly explained by the growth
of interest in primary care and the reduction in the number of
positions being made available to anesthesiology program directors.
The growth in numbers now may be explained by the reverse process,
a declining interest in primary care creating an increased availability
of primary care internship positions for anesthesiology residents.
By contrast, the number entering the anesthesiology CA-1 year
has only risen slightly, but it too is associated with a further
growth in the recruitment of AMGs. If these trends are followed
by a reduction in the attrition rate to one more characteristic
of the specialty prior to 1993, then the number of graduates should
continue to rise significantly for the next three years —
for example, from 919 this year to perhaps 1,100, 1,250 and 1,350
in the next three years.
The marketplace and the way we all react to it will continue
to govern recruitment for both anesthesiologists and nurse anesthetists.
Acknowledgments
This year I particularly wish to thank Francis P. Hughes, Ph.D.,
his staff and the members of the American Board of Anesthesiology.
Their personal support and additional effort this year provided
the updated cumulated data about resident numbers and numbers
graduating. It also is a pleasure to thank Steven Horton of the
Bookstore and Resource Center of the American Association of Nurse
Anesthetists for providing details of the numbers of nurse anesthetists
graduating and being certified.
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 former Chair and Meryl and Sam Israel Professor,
Department of Anesthesiology, Tulane University School of
Medicine, New Orleans, Louisiana. |
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