his is the 13th report in a series started in 1995 following an abrupt decline of resident recruitment into anesthesiology training programs. Data for the 2007 entering class and 2007 graduates are consistent with several trends apparent during the last three years:

1. Slow but steady growth in the total number of residents in the PGY-1, CA-1, CA-2 and CA-3 years to 5,472, the largest number since the 1992-94 peaks. The slight growth is taking place in the CA-2 and CA-3 years, as the CA-1 entering class sizes have remained stable near 1,570 in 2005, 2006 and 2007.

2. A steeper increase in PGY-1 recruitment, to 729 in 2007, a new high point over a 20-year period.

3. Sustained steady increase in the proportion of females entering the CA-1 class — this year to 38 percent, from 28 percent in 2000.

Anesthesiology Residents Entering Training [Table 1 and Figure 1]: We have reframed our time period for this annual overview to the 20-year period since 1988, which includes the increase in overall resident numbers after the introduction of the mandatory CA-3 year in 1987. This period also reflects the resident recruitment crisis of 1994 and the subsequent recovery of trainee numbers after 1999. It is noteworthy that, while the size of the PGY-1 class has risen steadily, recovery of the CA-1, CA-2 and CA-3 class sizes during the last three years is leveling off at about 86 percent of the high mark achieved during the years 1992-94.

In 2007 there were 1,566 residents who started their CA-1 year, a decrease of 10 from 2006, but representing a three-year plateau since 2005, at an average of 1,571. There was an impressive increase of the PGY-1 class to 729, up 85 (13 percent) from the previous year and an increase of 298 (69 percent) since 2004.

Graduates of Anesthesiology Residency Programs [Table 2]: In January 2007, the American Board of Anesthesiology (ABA) changed its reporting grace period for graduation to September 30. As a result, residents who graduated between September 1, 2006, and September 30, 2007 (a one-time-only graduation class consisting of 13 months) are assigned to the 2007 graduation class. Effective with the 2008 graduation class, residents who completed the training requirement for admission to the ABA examination system between October 1 and September 30 will be included in the current year’s graduation class. Therefore, the number of 2007 graduates, 1,530, is spuriously high when compared to prior classes because it represents a 13-month instead of a 12-month reporting period. As noted in last year’s report, the number of graduates remained steady near 1,393 during the years 2004-06. Because of the change in the definition of the graduation period, we omit a graphical representation of graduate numbers.

Gender Balance of Anesthesiology Residents [Table 3 and Figure 2]: Eight years of data are now available for gender trends among anesthesiology residents. The fastest increase in the recruitment of females is occurring in the PGY-1 year, rising from 105 to 266 over eight years (by 153 percent). During the same period, the proportion of females entering the CA-1 class has increased by 10 absolute percentage points from 28 percent to 38 percent and from 27 percent to 35 percent for all PGY-1, CA-1, CA-2 and CA-3 years combined. Because total class sizes are not increasing substantively (see above), the corollary of this trend has been a 5-percent decline in male resident CA-1 class sizes from about 1,074 during the years 2000-04 to 1,016 during the last four years.

Trends in Class Size, CA-1 through CA-3 [Table 4 and Figure 3]: Although CA-1 class size has been stable since 2005 at about 1,570, the CA-2 and CA-3 classes have increased in the same period by 74 and 33, respectively. It is difficult to account for the changes in reported class sizes. They represent the net result of attrition and re-entry into individual training years. Factors determining this likely include illness, pregnancy, relocation, leave of absence and additional training requirement as well as true attrition. We examined graphically the class sizes through their three-year training course from the class of 2000 through the (projected) class of 2009.

Most readily apparent is the continued stability in class size since about 2003 compared with higher class cohort size losses in the years before. However, whether this trend truly reflects less attrition (i.e., loss of anesthesiology residents from the specialty) — perhaps as reflected in the shape of the line for each class cohort — cannot be deduced with certainty from these data. Of interest is that CA-2 classes appear to be consistently larger than CA-1 classes in recent years, perhaps reflecting off-cycle training periods occasioned by leaves of absence, including maternity leave. Whether this reflects the greater proportion of women in anesthesiology residency training or generational priorities is a matter of conjecture.

Non-Match Recruitment [Table 5]: Knowledge of total residency class sizes and match recruitment, for example as reported in this year’s May NEWSLETTER, allows some assessment of the magnitude of out-of-Match recruitment into anesthesiology residency training programs. For example, the 2006 National Resident Match Program (NRMP) resulted in recruitment of 748 potential CA-1 residents. After completing its PGY-1 year this June, this same class is reported to number a total of 1,566, suggesting non-Match recruitment of approximately 800 CA-1 residents.

Non-NRMP recruitment into anesthesiology residency programs remains popular, accounting for slightly more than 50 percent of all anesthesiology residency recruitment. While non-NRMP recruitment may exhibit a slightly increasing trend in recent years, it is still well below the historical highs of 71-81 percent during the years 1997-2000. Interestingly, non-NRMP recruitment into the PGY-1 year is only 23 percent of total recruitment and as such is much lower than non-Match recruitment into the CA-1 class.

Discussion: Residency class size and graduation data can provide the basis for certain inferences about the anesthesiology physician trainee population, including production of practitioners, non-NRMP recruitment, class cohort attrition and demographic trends.

The 2007 data show graduating class size to be stable at approximately 1,400-1,500. There may be a modest increase this year, but no clear conclusion can be reached because of a change in ABA reporting procedures.

The PGY-1 class continued to grow healthily this year, consistent with a trend initiated four years ago; residents in PGY-1 anesthesiology program positions now account for approximately one-third of the total class size. The PGY-1 class is also characterized by substantially lower non-Match recruitment and higher growth of female resident entry compared to the CA-1 class. The proportion of female residents rose by two percentage points to 35 percent across all four years of the training continuum. Attrition between the CA-1 and CA-3 years continues to be low, although the data supporting this statement should be viewed with caution. Finally, out-of-Match recruitment remains near historical lows.

Taken together, these data suggest that recruitment and retention of anesthesiology residents is stable and healthy. Consistent with the gender composition of medical student classes, the gender balance of anesthesiology residents is accelerating toward a greater proportion of females.

Acknowledgements: This report is a work product of ASA’s Committee on Physician Resources (Michael W. Champeau, M.D., Daniel J. Cole, M.D., Gifford V. Eckhout, M.D., Kenneth J. Freese, M.D., Susan L. Goelzer, M.D., Sarah B. Hull, M.D., Alan D. Kaye, M.D., Ph.D., Joseph J. Kryc, M.D., Nagy A. Mekhail, M.D., Ph.D., David A. Nakata, M.D., Mary Dale Peterson, M.D., and Julia E. Pollock, M.D.). We appreciate the assistance of Steven C. Hall, M.D., of the ABA, in providing the 2007 residency data. We also gratefully acknowledge the guidance that previous work from Alan W. Grogono, M.D., has provided. Finally, we wish to express our appreciation to Eric Christiansen, M.B.A., F.A.C.H.E., who assisted materially in the collation and presentation of the data received.

Armin Schubert, M.D., M.B.A., is Professor and Chair, Department of General Anesthesiology, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio. He is ASA Representative, Workforce Studies Group of the Association of American Medical Colleges.