Anesthesiologists' biggest threats

From provider shortages to declining reimbursements, two anesthesiologists joined Becker's to discuss the threats facing anesthesiologists currently. 

Question: What are the biggest threats to anesthesiologists right now?

Editor's note: These responses were edited lightly for clarity and length. 

John Bramhall, MD, PhD. Professor of Clinical Anesthesiology at the University of Washington (Seattle): Paradoxically, I see staff shortages as being the greatest current threat to anesthesiologists. There are close to 2,000 current job postings (i.e. vacancies) for anesthesiologists in the U.S. One might think this would be a positive sign — interest in hiring anesthesiologists — but the reality is that these positions are open because of a dire shortage of physicians trained in anesthesiology (leading to disruption of surgical schedules in many parts of the country, and also increased stress on existing practitioners). The temptation, for hospitals and surgical centers, is to resort to hiring nurse anesthetists — and there are approximately 2,400 current postings for CRNAs — as a way to maintain patients’ access to needed procedures and surgeries. These numbers lead many people to support a dramatic increase in residency training positions in anesthesiology (and also, of course, by a similar logic, an increase in CRNA training slots). Currently there are about 2,000 residency training positions for physicians graduating from medical school, and this number has been increasing steadily over the past several years. These positions are completely filled (almost 100% match) and there is no shortage of physicians who would like to train to be anesthesiologists. The problem is that this training takes at least 4 years, and so a rapid increase in anesthesiologist manpower is elusive. The relatively much shorter training period required for converting a registered nurse into a nurse anesthetist means that that workforce seems, superficially, to be a more attractive way to get a rapid increase in clinical practitioners. This is also the logic behind the recent interest in anesthesiology assistants (or anesthesia-trained PAs). I worry that the short term staffing problems will lead to a medium term reliance on less well-trained anesthesia providers.

Mark Destache, MD. Anesthesiologists in St. Paul, Minn.: There are a lot of threats to anesthesiologists right now. More so than any of the 37 years I have been doing this. Not sure what the biggest threat is but they include declining reimbursement (from Medicare and the No Surprise Act), aging workforce leading to short staffing and title misappropriations.

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