Can a Community-Based Residency Program Address Needs in Anesthesia?
Summary
Discussion continues on how to address the labor needs in the specialty of anesthesia, which is projected to worsen as the US population (and anesthesia physician population) ages. Community-based residency programs—common in internal medicine, family practice, pediatrics and OB-GYN—may help the specialty of anesthesiology address these needs.
The specialty of anesthesia has seen two significant responses to a perceived labor shortage. First, competition has arrived in the form of increased pressure from non-physician providers to expand their independent practice. In addition to expanding the types of providers, increased demand for physicians has yielded increasing compensation, and there has been growth in anesthesia specialization amongst medical students. Mary Dale Peterson, MD, MSHCA, FACHE, FASA, 2020 president of the American Society of Anesthesiologists (ASA), has stated, "The good news is that we've seen a 20 percent increase in graduates and graduate medical education positions since 2015, so we have over 1,800 anesthesiologists coming out on a yearly basis."
On March 15, 2021, tens of thousands of medical students, including those hoping to become anesthesiologists, learned whether they had won a spot in a residency training program. The selection of this residency program often influences where an anesthesiologist will practice for the rest of her or his career. While the majority of residency programs in anesthesia are at established academic programs, community-based programs are an alternative.
Existing anesthesia residency programs are widely distributed geographically and amongst institutions. The American Medical Association (AMA) maintains a searchable database of residency programs, called FREIDA™. The programs are divided into university based, community based and combined classifications. Community-based residencies are a far less common option for anesthesiologists in training, though the model has been embraced by specialties more closely aligned with primary care. FREIDA™ shows 160 residency programs for anesthesia as of March 2021. While 87 percent of the residencies listed in the database for family practice are either community-based or combined programs, only 34 percent of anesthesia programs are described as such.
Program Descriptions
The curriculum at a university residency program includes training in the educational and research elements of practicing medicine in addition to clinical practice. University hospitals also tend to be tertiary care centers where residents see a diverse patient population, often with complex pathology, leading to unique experiences in off-services. Purely academic programs have more resources at their disposal which allows them to practice medicine that takes advantage of the most recent techniques and research.
The community-based model exposes residents to a different environment during training. The programs seek a smaller cohort of residents, and may emphasize clinical activity with little exposure to research, and even less to the principles of teaching. Residents can expect to be more hands on with patients, with a wider exposure to common cases that more closely mirror the practice setting that graduates will go into after residency. Community programs may have fewer subspecialty and other academic options. Anesthesiology residents looking to supplement training may not be presented with options for rotations in other more specialized areas.
Many programs blur the line between these two types of institutions. University programs have community rotations, and some community programs are affiliated with university centers. All can be accredited by the Accreditation Council for Graduate Medical Education (ACGME) and produce Board Eligible anesthesiologists.
Financial Impact
There may also be financial incentives to structuring a practice to include a community-based residency program. Salaries for anesthesia residents are typically far less than half of those for CRNAs. Recent eAlerts have addressed the billing and reimbursement opportunities related to teaching anesthesia providers. In short, CMS rules were updated in 2010 to allow full reimbursement to a physician supervising a maximum two concurrent resident cases. Academic programs in general are less productive than those that do not carry the burden of instruction. Further modeling specific to the clinical capabilities of residents and practice would be necessary to explore the financial impact of the program.
In addition, federal dollars are paid to sponsoring institutions to support academic programming and instruction inherent in graduate medical education programs. In addition to compensation for academic duties, the practice may further secure their hospital relationship by partnering in a residency program.
Summary
Community-based residencies are not common in the specialty of anesthesia. They may provide an opportunity to address current and future needs in anesthesiology. The programs aim to produce clinicians more closely aligned with the communities served. Residents emerge from the program with more experience with hands-on care, and with less emphasis on research and teaching. The program may provide a financial incentive in return for the effort and commitment involved in advancing graduate medical education. Finally, the training in the context of community-based services may draw anesthesia providers into practice in settings where such services are in great demand. If you'd like more information on this, please reach out to us at info@anesthesiallc.com.