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April
2002
Volume 66 |
Number
4
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| Already
a Busy Year for Committee on Physician Resources |
Gregory
K. Unruh, M.D., Chair
Committee on Physician Resources
The Committee
on Physician Resources carries bylaws charges as follows:
- To explore
matters related to anesthesia personnel and service patterns
of such personnel.
- To study
and make recommendations pertaining to physician anesthesia
needs in the future.
- To work
with other entities (e.g., government, quasigovernment) concerning
anesthesia resources.
- To report
to the Annual Meeting of the House of Delegates membership data
of the Society, including active member changes, anesthesiology
resident numbers and the status of members vis-a-vis certification
by the American Board of Anesthesiology and/or the American
College of Anesthesiologists.
- To solicit
and provide information to those anesthesiologists, groups of
anesthesiologists or departments of anesthesiology that currently
are seeking additional professional personnel.
- Make available
to members of this Society a list of such reported vacancies.
Our committee
would like to discuss with you how we attempt to accomplish these
charges.
ASA staff
assists us in our endeavors by providing membership information
on an annual basis. This information is summarized in our committee
report to the House of Delegates each October (Report 425-1.2).
We report on all the categories of ASA members, including detailed
information on anesthesiology residents currently in training.
We would like to develop even more extensive demographic information
about our ASA members, and we have been working with the Committee
on Information Management in the development of a Web-based member
survey. This would replace the annual member survey that our committee
had been sending to each of you every year on your birthday. A
Web-based survey will be easier for members to complete, allow
more flexibility in data collection and save ASA considerable
costs in printing and mailing.
Our committee
uses information from many different sources to look at physician
supply and demand. We have continual and ongoing debate about
the Abt Associates study published by ASA in 1994 titled "Estimation
of Physician Work Force Requirements in Anesthesiology."
Within the committee, we have varying and sometimes conflicting
opinions about the information in that study and its impact on
our specialty.
We recently
reviewed the article by Armin Schubert, M.D., et al., "Evidence
of a Current and Lasting National Anesthesia Personnel Shortfall:
Scope and Implications," which was published in Mayo Clinic
Proceedings. 2001; 76:995-1010. Dr. Schubert states: "Our
model suggests that there is currently a 3.6-percent to 10.9-percent
shortage of anesthesiologists nationwide, depending on the assumption
of a 2-percent or 3-percent increase in annual demand since 1994
and a constant pattern of work distribution by anesthesia providers.
This amounts to approximately 1,200 to 3,800 anesthesiologists.
If projected demand continues to increase at the rate of 1.5 percent
to 2 percent annually, this shortfall will amount to 2.6 percent
to 12 percent of the labor supply by 2005, representing a deficit
of 1,000 to 4,500 anesthesiologists. Compared with the expected
graduating class of 1,100 anesthesiology residents in 2001, our
model calls for nearly 1,600 graduates by 2005 and 2,000 by 2010."
We also reviewed
the article by Kevin K. Tremper, M.D., Ph.D., et al., "Surviving
the Perfect Storm: The Financial Environment of Academic Anesthesia"
. This report was presented at the annual meeting
of the Society of Academic Anesthesiology Chairs (SAAC) and the
Association of Anesthesiology Program Directors (AAPD) in October
2000. This article discusses a variety of issues including workforce,
Medicare reimbursement, the SAAC/AAPD financial survey results
and ³Strategies for Improving Financial Well-Being" for academic
departments. It states there were 490 open faculty positions in
our teaching programs as of August 2000.
We use external
sources of information such as the National Residency Matching
Program and the American Board of Anesthesiology to look at current
numbers of residents. Alan W. Grogono, M.D., provides a picture
of the residency match and its results every year in the NEWSLETTER.
His articles can be referenced on his Web site . We are indebted to Dr. Grogono for compiling this information
in such terrific fashion.
In addition
to tracking ASA members and residents, we have been looking at
the impact of other anesthesia providers and attempting to trend
their numbers. We follow three groups: nurse anesthetists, anesthesiologist
assistants (AAs) and osteopathic physicians.
Nurse anesthetists:
The American Association of Nurse Anesthetists (AANA) information
is as follows: 24,516 active members and 1,617 inactive members.
The five states with the largest total number of nurse anesthetists
are Pennsylvania (1,906), Texas (1,612), Florida (1,545), North
Carolina (1,370) and Michigan (1,349). The five states or regions
with the smallest total number of nurse anesthetists are Wyoming
(29), District of Columbia (42), Alaska (40), Nevada (51) and
Vermont (52). There are 84 accredited nurse anesthesia programs.
There are 2,971 student members of AANA.
Anesthesiologist
assistants: Committee member Michael P. Herndon, M.D., provided
us with information about AAs. There are two schools, Emory University,
Atlanta, Georgia, and Case Western Reserve University, Cleveland,
Ohio. Since 1971, Emory has graduated 507 AAs, and Case Western
Reserve has graduated 210 AAs since 1973, for a grand total of
717. Currently, 525 AAs practice in Georgia and 84 practice in
Ohio. No other state has more than eight assistants in practice,
and most states have none. Dr. Herndon states that 8 percent of
Emory's graduates went on to medical school. These numbers were
higher in the early years of the program. Almost 35 percent of
Case Western's graduates went on to medical school when the AA
degree was a bachelor of science/pre-medical degree. Since 1988
when the degree became a master's in medical science, fewer AAs
have gone on to medical school after graduation.
Osteopathic
physicians: Our committee became interested in examining numbers
of osteopathic physicians practicing anesthesiology. Lydia A.
Conlay, M.D., Ph.D., and Michael S. O'Connor, M.D., provided us
with information about this topic. Currently, ASA membership includes
973 D.O.s (4 percent of current members) who trained in accredited
residency programs. An informal survey of SAAC/AAPD members (87
percent response reporting on 80 percent of current residents)
revealed that 163 residents (5.2 percent) currently in allopathic
training programs are D.O.s. In the 2001 residency match statistics,
107 D.O.s matched into allopathic residency programs, representing
11 percent of incoming residents.
In addition
to D.O.s entering the field of anesthesiology from allopathic
residency programs, there also are 11 osteopathic programs in
anesthesiology. The Committee on Postdoctoral Training of the
American Osteopathic Association (AOA) accredits these programs.
At present, they have 49 available training spots of which 17
are filled. There are approximately 11,000 students in the 19
osteopathic medical schools in the United States. The board certification
process for these D.O.s is offered through the American Osteopathic
Board of Anesthesiology. Its organizational and political association
(similar to ASA) is the American Osteopathic College of Anesthesiologists,
which currently lists 700 active members.
ASA offers
a placement service to assist members in recruiting physicians
and in securing positions at (while on the homepage,
click the "Placement" button). A recent look revealed
that approximately 90 jobs were advertised as available. The ASA
Web site also maintains links to GasJobs and GasWork. A quick
look at GasJobs revealed 73 anesthesiologists seeking jobs and
108 permanent positions advertised as available. For nurse anesthetists,
there were 34 individuals seeking jobs and 193 permanent positions
available. As you can see, we attempt to take information from
many sources and condense it to usable form. If I can provide
any further information about any of these topics, please do not
hesitate to contact me at : gunruh@kumc.edu
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Gregory
K. Unruh, M.D., is Associate Professor and Director, Anesthesiology
Resident Education, Kansas University Medical Center, Kansas
City, Kansas. |
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