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Summary
Two new studies point to an increased demand for medical specialists, including anesthesiologists, in the coming years and decades.  We review reports from the American Association of Medical Colleges and recruitment firm Merritt Hawkins, and offer thoughts on the implications of these findings for anesthesia groups and practitioners.

July 2, 2018

Is there an impending shortage of anesthesiologists, as various reports have suggested over the past several years?  A definitive answer to a question this multi-factorial is hard to find.  This eAlert shares some new data in an effort to at least begin to tease out some answers and their potential implications for groups and individual clinicians.

A 2010 study by the RAND Corporation, commissioned by the ASA, projected a shortage of nearly 4,500 anesthesiologists by 2020, assuming an annual growth in demand of 1.6 percent, or a shortage as high as 12,500, assuming three percent annual growth to account for an aging population.

"The projected shortage of anesthesiologists suggests that this country will soon face a gap in anesthesiology services that is just as important to Americans' health as the projected physician gap for primary care services," said Mark A. Warner, MD, ASA president-elect at the time of the study’s release.  

Although the ASA has not reported on whether those predictions are coming to fruition, a recent study by recruitment firm Merritt Hawkins offers new evidence for this trend.  While demand for primary care physicians remains high, healthcare organizations are increasingly looking for specialists, according to the report.

“It is a mistake to believe that physician shortages are confined to primary care.  Specialists also are in short supply,” said the company’s senior vice president, Travis Singleton.  Anesthesiologists were on the report’s list of the top 20 most requested recruitment searches.

In addition, a report published this past April by the American Association of Medical Colleges (AAMC) points to a potential shortfall of 33,800 to 72,700 physicians across the specialties by 2030, with anesthesiologists certainly falling into that group.

Changing demographics are driving the increased demand.  In just over a decade, the number of Americans in the 65-and-older age bracket will have mushroomed by 50 percent, compared with only three percent for those under the age of 18, the study observes.  It further asserts that the rapid aging of the population is likely to impact physician supply as well, because one-third of all currently practicing physicians will be older than 65 within the next 10 years. 

Physicians nearing retirement age represent a significant proportion of working physicians, with those aged 65 years and older accounting for 13.5 percent of the workforce and those between 55 and 64 years representing 27.2 percent, the study reports.

Among the other key findings:

The explosion in the number of older Americans relative to younger age groups will fuel demand for medical services used by seniors.  In our view, it’s not a stretch to see that this is likely to include a growing demand for surgical, and, by extension, anesthesia services. 

Population health efforts may increase the long-term demand for physicians.  Health improvements achieved through population health management, including weight reduction; better blood pressure, cholesterol and blood glucose management; and smoking cessation could slightly decrease the demand for physicians.  But the increased life span associated with these health improvements could also lead to growth in the need for medical services by 2030.  AAMC’s study predicts a need for 17,300 physician full-time equivalents (FTEs) related to these population health goals.

(In addition, a Milken Institute report published in May estimates that 83 million people in the United States will suffer from three or more chronic diseases in 2030 compared to 30 million in 2015.) 

Increased access to healthcare would increase the demand for physicians.  Modeling of the impact of effectively removing current barriers to care (through increased healthcare coverage as a result of the Affordable Care Act) reveals that demand for physicians could rise substantially. 

The trend among physicians to work fewer hours weekly is contributing to the FTE physician shortage.  A decline in the number of weekly work hours among physicians in all age groups between 2002 and 2016 could lead to 32,500 fewer FTE physicians by 2030, assuming the downward trend continues.

In a Medscape interview, Ezekiel Emanuel, MD, PhD, chair of the department of medical ethics and health policy at the University of Pennsylvania, challenged the AAMC study, asserting that the physician supply issue is due less to a genuine shortage than to, among other things, a physician distribution problem.  Certain geographic areas, notably rural areas, have had, and always will have, a harder time attracting physicians.

“There may not be enough pediatric cardiologists or pediatric rheumatologists, but they are never going to be in North Dakota.  That is a problem you are only going to solve by changing the amount that we reimburse them and linking them when patients need their services in rural areas by telemedicine or MD-MD consults via the Web.  Serving the rural patient population is a hard nut to crack, but it's not going to be solved by training more docs.”

Implications for Providers and Groups

What does all of this mean for your anesthesia group and for you as an individual practitioner?  In our view, depending on your perspective, where you are in your career and other factors, the glass can be half full or half empty.

There are things we know and things about which we can only make educated guesses.  One thing we know is that people are living longer, and that the aging baby boom population will create a wave of patients that will require services for the foreseeable future.  Regardless of which model is used, these demographic realities will significantly impact the healthcare landscape, including the delivery of anesthesia care.

But we also know that, in general, people with higher levels of education are beginning to work longer and delay retirement beyond the traditional age of 65 or 66.  Models that use the traditional retirement age to forecast a physician shortage may not be accounting for those who will choose to stay in practice.  This “new normal” could reduce the physician shortage.

In general, forecasting models are only as good as the assumptions upon which they are based.  They’re to be understood and considered, but used cautiously in planning at the individual or group level.  Think critically and examine the assumptions before jumping to conclusions for yourself and your practice.  It’s also up to you, the individual practitioner and anesthesia group member, to decide whether the predictions of shortages and increased demand are an opportunity for job security, a cause for concern, or some mixture of the two.

If you’re further on in your career or you’re thinking of retiring, you will need to consider how your retirement will impact your group as it plans to meet the growing demand for anesthesia services.  If you’re a new provider just starting out, the current predictions bode well for your future professional outlook, but they also suggest the importance of taking steps to ensure that you do not become overworked and burned out if your facilities do not have enough qualified anesthesiologists to provide adequate coverage.

With best wishes,

Tony Mira
President and CEO