nesthesiologists in the United States have been accustomed to having to recruit residents; making our specialty attractive has been a tradition. In the late 1980s, concern about recruitment was exacerbated by the decision to lengthen the residency training program from two years to three. In fact what followed was our most successful period of recruitment ever: 1990 to 1993.

Nevertheless concern about recruitment resulted in regular presentations from anesthesiology chairs about recruitment via the National Resident Matching Program at the Annual Meetings, beginning in 1990. These presentations were followed by annual articles in the ASA NEWSLETTER, beginning in 1993. The tenor of the first article reflected our traditional concern of attracting both excellent medical students and excellent graduates. In the chairs’ meetings, however, the potential impact of managed care and the possibility of changes in surgical practice were causing increasing concerns about the threat of an oversupply. In August 1993, ASA leaders exemplified their own concern by commissioning Abt Associates, Inc. to compile a report on “Estimation of Physician Work Force Requirements in Anesthesiology.”

The final Abt report appeared in September 1994 and projected possible workforce requirements under several hypothetical scenarios. To meet these requirements, Abt also calculated the associated “Training Needs,” assuming varying retirement ages, physician/nurse anesthetist mixes and hours worked per year. The startling conclusion was that, even using the most optimistic projections, Abt said we were training about 30 percent too many residents. The most pessimistic projections implied that we should train no anesthesiologist for the subsequent 16 years.

Influenced by this report and by the contemporaneous mood of the specialty, the 1994 Match article concluded, “The current decline in both applicants and positions may prove to be both necessary and desirable.” This was a remarkably quick reversal from the year before!

If, in 2004, we find it surprising that Abt reached the conclusions that it did, it is completely incomprehensible that the specialty took it so seriously — but we did! In operating rooms, meetings and publications, we openly expressed concern about declining employment opportunities. Practice groups and academic departments delayed recruitment, reasoning that “with so many applicants, let’s wait until we need them and they are even cheaper.” This made a significant contribution to an apparent shortage of employment opportunities.

Listening to the cacophony were three other groups. Our residents left the residency programs at unprecedented levels; the cohort that started its CA-1 year in 1994 lost more than 20 percent of its members by the start of the CA-3 year. Students were further back in the “pipeline” and were no doubt influenced by the third group, the deans. Their impact was delayed but, ultimately, far more influential. In 1992 we had 1,904 CA-1 residents, of whom 1,609 were graduates of American medical schools. In the years 1996-99, the numbers of American CA-1 graduates fell to only 641, 493, 496 and 617, respectively.

Despite the subsequent decline in recruitment, we have, in the last 10 years, actually trained an average of 1,360 residents per year. Surprisingly this is higher than the maximum level Abt Associates contemplated in their scenarios. Despite that, we are still experiencing a significant shortage of anesthesiologists. Of concern now is that we only graduated 1,333 in 2003; still fewer are expected to graduate this year, and there is little prospect of a significant increase in the foreseeable future.

What would have happened without the Abt report? A significant decline in recruitment would have occurred anyway. Even before its publication, concern about oversupply was growing and had already reduced the supply of U.S. graduates. The Abt report, however, amplified our concerns. The anxiety, the delayed recruitment and the associated apparent oversupply inhibited recruitment for years. Without the report, however, our traditional efforts to attract U.S. graduates might have been better maintained, which, in 2004, would appear to have been preferable.

Dr. Grogono’s articles appeared in the ASA NEWSLETTER in August 1993, May 1994, June 1995 and then in each May from 1996 to 2004.

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