Eight states have no anesthesiology residency programs, and the states where residents are trained are not always where they end up practicing, a gap that is widening as rural ASCs and hospitals compete for a shrinking pipeline.
States with no anesthesiology programs in the 2026 Match include Alaska, Delaware, Hawaii, Idaho, Montana, North Dakota, South Dakota and Wyoming, according to 2026 NRMP Match results. That means for ASCs operating in those states, every anesthesiologist on staff was trained elsewhere and recruited in, a structural dependency that becomes more expensive as the national shortage deepens.
The shortage itself is adding to this issue. The projected shortage of anesthesiologists by 2036 will hit 6,300, according to a 2025 Medicus Healthcare Solutions white paper, driven by rising surgical demand alongside a training bottleneck, with residency positions failing to expand enough to meet workforce needs. Currently, 56.9% of practicing anesthesiologists are 55 or older, with more than 17% nearing retirement.
The match data underscore how competitive the pipeline has become. The 2026 NRMP Main Residency Match recorded a 100% fill rate across all 1,865 PGY-1 anesthesiology positions offered. But a full match does not mean supply is meeting demand; it means applicants are competing intensely for a fixed number of slots. More than 3,000 students applied to anesthesiology residency training programs in the 2025 Match, resulting in 40% of applicants going unmatched.
The states with programs are not evenly distributed by population or surgical need. A 2026 study published in Proceedings of Baylor University Medical Center found that CMS has capped Medicare-funded GME positions since 1997, with minimal growth in anesthesiology residency positions despite major demographic shifts, and that expansion often follows institutional resources rather than community need, leaving some high-growth, low-income regions without adequate training pipelines.
The geographic mismatch shows up most acutely in rural markets. More than 80% of rural counties lack physician anesthesiologists, and more than 50% lack any type of anesthesia provider, according to a 2026 study published in Anesthesiology and hosted at the National Library of Medicine. States with the fewest anesthesiologists per capita include Idaho, South Dakota, Mississippi and North Carolina, according to Medicus data as of May 2025.
The retention problem compounds the training gap. Anesthesiologists have the highest desire to leave their roles of all physician specialists, with 40.6% expressing an interest in leaving their current jobs within two years, according to a June 2025 AMA report. Around 50% of anesthesiologists report feeling burned out and depressed, according to the Medicus white paper, while 61% would take less pay for a better work-life balance.
For states without training programs, every anesthesiologist they recruit was trained in a state that invested in GME infrastructure, and every one they lose to burnout or retirement cannot be replaced locally.
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