Every year since 2015, the Association of American Medical Colleges (AAMC) releases an updated report on a prospective shortage of U.S. physicians expected in the coming years. The estimates have varied through the years, most recently predicting a shortfall of up to 139,000 physicians by 2033, but the core message is always the same: The health care industry won’t be able to keep up with the growing demand.
“The gap between the country’s increasing health care demands and the supply of doctors to adequately respond has become more evident as we continue to combat the COVID-19 pandemic,” said David J. Skorton, MD, the president and CEO of the AAMC. “The challenge of having enough doctors to serve our communities will get even worse as the nation’s population continues to grow and age.”
While the AAMC report predicts a potential shortage of up to 139,000 physicians across all of health care, the projection for anesthesiology, among several other specialties, is between 17,000 and 42,000 physicians. The analysis does not provide details on how much of a shortage could be anticipated in anesthesiology specifically, leaving doubt among some experts about whether anesthesiology will experience a shortage at all.
“I think a lot of that press is conflating anesthesiologists and nurse anesthetist. There may be more need for people to give anesthesia, but that doesn’t necessarily translate into a shortage of anesthesiologists,” said Karen Sibert, MD, FASA, an associate professor and the director of communications for the Department of Anesthesiology and Perioperative Medicine at UCLA Medical Center, in Los Angeles.
As Dr. Sibert highlighted, a specialty like anesthesiology could adapt to address any pending physician shortage in the coming years. So although a shortage may affect the specialty, it won’t necessarily be through the inability to meet overwhelming demand.
The report from AAMC shows that major change is likely to occur across all health care industries, but it doesn’t get to the heart of that change for anesthesiology, according to Dr. Sibert, who was interviewed as part of the new season of The Etherist podcast.
Dr. Sibert, along with other experts in the specialty, sees a range of issues looming on the horizon for the anesthesiology field. The overall message is that physician anesthesiologists will be faced with major changes in the coming decade as issues ranging from changing practice and compensation models, to evolving business trends, to the fallout from the COVID-19 pandemic affect the industry.
“Everybody is like frogs in a pot of water,” Dr. Sibert said. “The temperature is increasing slightly over time, and they’re not going to realize that the pot is boiling until they’re right in the middle of it.”
—Michael DePeau-Wilson
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CRNAs ARE THE ANSWER!
There is no mention of the predominant independent practice of highly qualified Doctorate-prepared CRNAs.
We are the best kept secret in healthcare in that we provide excellent, high quality anesthesia for less than half the price of our counterpart MDAs. The most effective and efficient practice model is COLLABORATIVE healthcare in which EACH anesthesia provider actually performs their own anesthetic.
The anesthesia profession is faced with a future where stagnant reimbursement, a focus on safety/quality, and the demand for evidence will drive policy and practice. At the same time, the growing number of Baby Boomers who are retiring will increase the demand for healthcare services, including anesthesia services. The current anesthesia care team model, where there is one anesthesiologist for every four CRNAs, is a healthcare-system albatross which is not tenable to maintain in the future. It is fiscally irresponsible to pay a non-revenue generating anesthesiologist two to three times the salary of a CRNA when the evidence has shown such a provider does not improve quality, outcomes, morbidity or mortality. The future will see an expansion of collaborative anesthesia models where CRNAs and anesthesiologists are doing their own cases and they will be judged on performance and quality metrics, not initials. There will be an expansion of CRNA-only anesthesia services across the country in light of CRNAs near six sigma safety record and ability to provide high-quality, cost-effective anesthesia care. Facilities are not going to continue to pay millions a year in subsidies for providers who do not add concrete value to the process—they simply cannot afford to.