Trends in Anesthesia providers

[DoctorDude]

Some interesting statistics and facts about the number of anesthesiologists, the population, and other anesthesia providers....

• In 2012, there were 45,357 anesthesiologists. This represented 5.8% of all physicians in patient care activity in 2012. This is up from 39,032 anesthesiologists in the workforce in 2003.
• Between 2003 and 2012, the physician anesthesiologist workforce increased 16.2% over this 10 year period compared to a 13.4% increase in the overall physician workforce.
• Using Medicare 5 percent beneficiary sample claims data, the number of physician anesthesiologists and nurse anesthetists with Medicare claims between 2009 and 2012 was examined. Over this time period, the number of nurse anesthetists increased almost 3x faster (14.7%) than the number of anesthesiologists (4.4%).
• Between 2001 and 2011, the number of graduating nurse anesthetists more than doubled (from 1,159 to 2,447).
• The ratio of the number of anesthesiologists to population between 2003 and 2012 grew 7.4%.
• Changes in the number of gastroenterologists and in the number of surgeons within a state had a relatively large and significant effect on the number of anesthesiologists. This accounts for 95% of the variation of change in the number of anesthesiologists across states.
• Finally, there is no significant correlation between CRNA-supervision opt-out states and the change in anesthesiologists per population ratio for states. (That is to say, there are some opt-out states which had a decrease in this ratio, and others which had 10-20% increases).
• An update to the RAND Corporation report in 2010 will be forthcoming later this year (anesthesiology workforce survey and analysis report).

These facts are from the April, 2014 ASA newsletter. A lot of this is already known. But I find it interesting that some of the CRNA opt-out states have not seen drastic decreases in the number of practicing anesthesiologists. The CRNA position is not a new one; it's been around for quite sometime. Can we draw the conclusion that the number of CRNAs in the workforce will not have as drastic an impact on anesthesiologist positions as we might assume given current trends in healthcare?

Also, given that there are around 45,000 practicing anesthesiologists and about 1,600 new anesthesiology resident graduates per year, what does this say about future numbers? If the average career lifespan of an anesthesiologist is 35 years (estimate), this means we only need around 1,300 anesthesiologists per year to preserve the current workforce. Is the aging population and population growth enough to offset the ~300 increase in the anesthesiologist workforce per year?

---

Members don't see this ad.

 

[anbuitachi]

wasn't there data somewhere that showed a large # of practicing anesthesiologists are over 55 or something. I don't remember the exact #s. but if something like that is true. maybe soon a lot of them will retire, opening up many positions for new anesthesiologists

 

[BLADEMDA]

wasn't there data somewhere that showed a large # of practicing anesthesiologists are over 55 or something. I don't remember the exact #s. but if something like that is true. maybe soon a lot of them will retire, opening up many positions for new anesthesiologists

Yes, there is a significant number of us who would like to retire or semi retire. Another large number would like to work less. Still, 1600 Graduates per year may be 300 too many considering the trend towards AMCs and 4:1 supervision.

There is a GLUT of CRNAs on the market and most employers can hire one easily. The good ones aren't as easy to find but a warm body from a CRNA mill is no problem.
Wages for all anesthesia providers are on the decline.

 

[BLADEMDA]

 

[BLADEMDA]

 

[DoctorDude]

If this survey is an accurate representation of the overall anesthesiologist workforce, then we would expect a very large percentage of the workforce (almost 50%) to retire within the next 10-15 years. Somehow I do not believe the survey demographics are indeed representative and are likely skewed toward a higher response rate from older anesthesiologists. Because if it is not skewed, then there should be a very large number of jobs opening up as physicians retire/transition to part time work. The reason I don't believe this is right is because the number of residency spots has increased over the last 20-30 years, so there should be a relatively higher proportion of younger anesthesiologists vs older ones. This graph clearly shows the opposite.

 

[Wiscoblue]

We have a couple guys who are in their mid fifties and are looking to slow down and we could hire. But the unpredictability of what is coming down with Obamacare in the near future is keeping us from hiring right now. We are just going to suck it up and see what happens in the next 2-3 years. There's got to be more groups who are in a similar bind.

 

[deleted126335]

There are massive pressures and lots of variables.
-Economic pressures to shave wherever possible will continue for as far as the eye can see. However, administrators just don't have enough cover yet to adopt widespread independent CRNA practice outside of endo centers, cataract factories and physician offices.
-Hospitals will close and consolidate. Taking OB out of a hospital cuts the need for 24/7 in house anesthesia and the number of FTE anesthesiologists.
-Anecdotally the amount of non medically directed CRNA practice is going up. It is both a Billing issue to avoid compliance problems (meeting all the steps for medical direction) as well as true non anesthesiologist supervised practice.
-Anecdotally MD only practices are transitioning to an ACT model.
-Supervisory ratios are ratcheting up towards 1:4. If the rules for reimbursement change that number will go to 1:>4. How much greater? Who the F#ck knows?
-Traditionally docs cut back at age 50 something and retire at 60 ish. Financial and real estate markets and bounce back kids have delayed this practice. Continued Decreasing job satisfaction will accelerate this. If salaries drop through the floor or markets recover, it will accelerate this.
-Anecdotally, the quality of CRNA grads in recent years has been dropping. Poor quality practitioners will slow the AANA agenda and the adoption of independent CRNA practice.
-Large scale federal tort reform will be a boon to independent CRNA Practice. In the absence of tort reform, dramatic highly publicized bad outcomes in cases where anesthesiologist supervision was removed in non tort reform areas will slow or reverse independent CRNA practice.
-The glut of CRNAs will cause a lot of CRNAs to mind their ps and qs- locally at least, in doc controlled groups.
-There has to be an incentive for a CRNA in an ACT practice to want the anesthesiologists to go away. Right now the smart ones have figured out that if the anesthesiologists go away, they will likely not get a pay raise (the financial benefits will all flow to the hospital). They will have less help and more responsibility and liability.

For those that put a lot of stock in the upcoming "Rand update". I suggest that you review the original in 2010. See how relevant it is today. I also suggest that you review the Abt Associates report about projected manpower needs published around 1995 which was commissioned by the ASA. Generously, they were both less than accurate.

 

[BuzzPhreed]

-Anecdotally, the quality of CRNA grads in recent years has been dropping. Poor quality practitioners will slow the AANA agenda and the adoption of independent CRNA practice.

Yet the irony is that most of them come out of school brainwashed into believing that they don't really need to be supervised because they do the exact same job in the OR. And they all think they should be doing regional anesthesia.

-There has to be an incentive for a CRNA in an ACT practice to want the anesthesiologists to go away. Right now the smart ones have figured out that if the anesthesiologists go away, they will likely not get a pay raise (the financial benefits will all flow to the hospital). They will have less help and more responsibility and liability.

Only if they work for the hospital. If they can contract and independently bill then there is a lot more money in it for them especially provided the hospital is subsidizing offsite coverage, L&D, etc. But you are right about the liability and getting in over their heads aspect. Right now they don't need you... until they need you.