Anesthesiology Residents Entering Training [Table 1]:
This year there were 1,576 residents in the critical CA-1 year, almost unchanged from 1,572 in 2005. By contrast the number of residents in the PGY-1 year increased to 644, a significant increase from 514 in 2005 and 431 in 2004. It exceeds the average for the last 15 years by 130. It is also the largest PGY-1 group since 1972, the year before the introduction of the mandatory PGY-1 year, when there were 893.

The Number of Anesthesiology Residents Graduating [Table 1 and Figure 1]
This year the data have been updated to represent more accurately the number graduating. Previous reports utilized the total up to the end of August, a value that omitted any additional people who recorded their graduation later in the year. For this report, with the inevitable exception of this year, the values have been updated to reflect the true total of those graduating each year.

Table 1: The number of residents in each year and graduating from 1959 to 2006. Until the introduction of a mandatory CA-3 year in 1987, the CA-3 year was optional. When graduation rates were first recorded, they initially bore no relationship to the size of the previous CA-3 year. From 1988 onward, these two values are closely related.

Figure 1: Numbers of residents in each year and graduating from 1968 to 2006.

Last year’s report indicated that graduation rates for 2004 and 2005 were 1,393 and 1,390. This year’s update changes these values to 1,398 and 1,525. This indicates that last year a significant number of graduates submitted their paperwork after August. Therefore little value can be placed on the value obtained each August for the current year.

The number of residents who have so far reported graduating this year (1,395) is in line with the number collected at the same time last year. As there were 1,513 in the CA-3 group one year ago, however, the final number of graduates is likely to be considerably higher.

The Number of Anesthesiology Residents in Each Year [Table 1 and Figure 1]
This year’s CA-3 group (1,502) contains 45 fewer residents than the CA-2 group one year earlier; but this year’s CA-2 group (1,602) contains 43 more residents than the CA-1 group one year earlier. The likely explanation is that about 45 residents were held back by factors such as illness, pregnancy or a requirement for additional training. Whatever may have been the cause, the effect is that the CA-2 group is the largest for any year since 1994.

Attrition from Residencies [Tables 2 and 3 and Figures 2 and 3]
The size of the CA-1 group each year is compared to the size of the same cohort at graduation. This comparison provides a rough guide to attrition. For a given year (e.g., 2000), one column shows the size of the CA-1 group for that year, and another beside it shows the size of that cohort graduating (e.g., in 2003).

Table 2: The number of residents in the CA-1 year compared to the number graduating three years later – a rough measure of attrition.

Figure 2: Graph showing the size of a CA-1 group compared to the size of the same group three years later.

In the early years, the number graduating three years later was close to the number in the CA-1 group. The striking attrition of the mid-1990s has been followed by a gradual recovery. There is considerable variability in the last year or two, e.g., more people apparently graduated from the 2002 cohort than entered it. When the totals are averaged over the last few years, however, the overall attrition rate appears to be very small with no significant difference between the rates of attrition for men and women [Figure 3].

Gender [Table 3 and Figures 3 and 4]
The American Board of Anesthesiology (ABA) now has seven years’ data about gender distribution in anesthesiology residencies. The increase in the number of women observed in the last two reports is continuing: the PGY-1 year is now 38 percent women, and the CA-1 year is 34 percent women. Despite these increases, the number of women still does not approach the proportion found in the medical school population.

Table 3: Male and female residents in each year and graduating from 2000-06.

Figure 3: Graphs showing the relative changes in the size of the male and female groups in the CA-1 year compared to the same groups three years later.

Figure 4: Graphs showing the relative change in the number of male and female residents in the CA-1 year from 2000-06.

Anesthesiology’s Recruitment History
Figure 1 neatly illustrates several aspects of anesthesiology’s history. In general the size of a cohort continues almost unchanged from year to year. Thus the 1989 CA-1 group (1,592) became the 1990 CA-2 group (1,593), the 1991 CA-3 group (1,565) and the 1992 graduates (1,552). Exceptions are usually associated with major events.

The huge drop in the size of the PGY-1 group in 1973 occurred when anesthesiology introduced two clinical anesthesiology years preceded by a PGY-1 year. Surprisingly, when this occurred, the number seeking additional training hardly changed: the size of the optional CA-2 (PGY-3) year in 1972 is almost exactly the same size as the optional CA-3 (PGY-4) year in 1973. Indeed one appears to be a continuation of the other. Although the number seeking CA-3 training subsequently fell slightly, it began to rise rapidly with the approach of the mandatory CA-3 year. The total graduating is only recorded back to 1985, but the remarkable dip in 1998 marks this introduction of the CA-3 year and the associated delay in graduating for one cohort.

The decline in the mid-1990s is striking. The attrition during this period is, too. It is clearly visible as the nadirs for the CA-1, CA-2 and CA-3 years are progressively lower. The attrition continued in the late 1990s and the early 2000s and is visible as the wide separation of the lines for the CA-1, CA-2 and CA-3 groups.

Discussion
This year the number of residency positions filled in March via the National Resident Matching Program (Match) rose to 1,287, the largest number ever recorded. Only 24 positions were unfilled, which is the smallest number ever recorded.

There was actually a decrease in recruitment via the Match for the 2007 CA-1 group (down 61 to 759), but it was accompanied by an even greater increase in the number recruited for the 2006 PGY-1 group (up 89 to 552).  Thus, although recruitment via the Match for the CA-1 group was reduced, overall recruitment has actually improved, and the enlarged PGY-1 group should enter the CA-1 group one year later.

During the months after this year’s Match in March, for the PGY-1 year, an additional 105 residents (16 percent) were recruited for a total of 644.  For the 2006 CA-1 year, a total of 1,230 students matched in 2005, 791 for the 2006 CA-1 year and 439 via the 2005 PGY-1 year.  An additional 346 residents (22 percent) were recruited to make this year’s CA-1 total 1,576.  These figures for post-Match recruitment are almost certainly an underestimate, however, because losses due to attrition necessitate additional recruitment.  This means that about a quarter of the recruitment into the CA-1 year occurs after the Match.

Attrition is a rough measure of satisfaction — with career prospects, with quality of the training process and with suitability of the recruits themselves. Lower rates of attrition imply higher levels of satisfaction. In the mid-1990s, dissatisfaction was common and attrition was high. In recent years, attrition appears to have returned to levels approaching those experienced in the late 1980s. In any one cohort, however, the actual numerical values must be viewed with caution because the size of any one graduating group is affected by various factors, e.g., delayed completion of paperwork, ill health, childbirth, relocation and being held back for additional training.

Conclusion
There is continuing growth in recruitment into the PGY-1 year both via the Match and by further recruitment after the Match. More women are joining the specialty, and attrition is close to the historically low values experienced in the late 1980s.

Acknowledgment
As usual it is a pleasure to thank Francis P. Hughes, Ph.D., and Rhonda Oletti of ABA. Their efficient help makes it possible to produce this report promptly.

Web Site
To see previous articles, additional data about the workforce and the results of the Match, readers are invited to visit <www. grogono.com/nrmp>.

The editor would like to thank Dr. Grogono for his dedicated service in providing articles on anesthesia recruitment and residency training. His decade-long service has been a credit to us all.

— D.R.B.

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.