Is there a world wide shortage of anesthesiologists?

[Agast]

I’m getting so many texts and cold calls from recruiters now for anesthesiology. Is this a problem limited to the US? Are there anesthesiology shortages in Canada and other places?

If we don’t expand the number of residencies are there any projections over how long this will be a problem?

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[Cornfed101]

To be blunt: It will be a problem until all the baby boomers are dead. Many boomers retired during covid and many more will retire over the next 10-20 years. That is a large population that will need surgeries

 

[makemoney2024]

To be blunt: It will be a problem until all the baby boomers are dead. Many boomers retired during covid and many more will retire over the next 10-20 years. That is a large population that will need surgeries

And the next generation? Will they have enough of us?

 

[nimbus]

They’ll not only have a shortage of doctors but also a shortage of all workers.

South Korea: Doctors on strike face arrest if they do not return to work

Junior doctors have gone on strike over the past week, causing disruption and delays to surgeries.

www.bbc.com

 

[nimbus]

To be blunt: It will be a problem until all the baby boomers are dead. Many boomers retired during covid and many more will retire over the next 10-20 years. That is a large population that will need surgeries

Anesthesiology's workforce: 5 stats to know

Here are four more stats on the anesthesiologist workforce to know.

www.beckersasc.com

“Of all active anesthesiologists, 56.9 percent are 55 or older, according to the Association of American Medical College's "2022 Physician Specialty Data Report."

The report is based on data from the American Medical Association, the Census Bureau and a national resident database and tracking system. Overall, it covers about 950,000 physicians and physicians-in-training among 48 of the largest specialties in 2021, according to a Jan. 12 AAMC news release.

Here are four more stats on the anesthesiologist workforce to know:

1. A total of 31,188 anesthesiologists (73.9 percent) are men and 11,032 (26.1 percent) are women.

2. There are 7,727 people per active anesthesiologist.

3. There are 42,220 active anesthesiologists in the country, 18,227 (43.1 percent) of which are younger than 55 and 24,029 (56.9 percent) are 55 or older.

4. The majority of anesthesiologists (39,195) practice patient care, whereas the remainder focus on teaching, research or other areas. “

 

[Agast]

They’ll not only have a shortage of doctors but also a shortage of all workers.

South Korea: Doctors on strike face arrest if they do not return to work

Junior doctors have gone on strike over the past week, causing disruption and delays to surgeries.

www.bbc.com

I was listening to the NPR segment and they interviewed a S Korean emergency medicine resident. He said he was going back to being a farmer since he had the skills to make jam and wine.

 

[NightyNight]

We will move toward an ACT model everywhere and some things will not involve us like conscious sedation for GI. It will be all about availability and new lesser standards than we are use to.

 

[nimbus]

We will move toward an ACT model everywhere and some things will not involve us like conscious sedation for GI. It will be all about availability and new lesser standards than we are use to.

In our area, we never did much GI work. >90% of cases are without anesthesia. With the exception of ERCPs I didn’t do a single GI case during residency and during my first 3 jobs. Also cataracts could easily be done by sedation nurses. There’s no reason a patient needs an anesthesiologist for cataract surgery while they can have a cardiac Cath or an IR procedure with a sedation nurse.

 

[Silo004]

In our area, we never did much GI work. >90% of cases are without anesthesia. With the exception of ERCPs I didn’t do a single GI case during residency and during my first 3 jobs. Also cataracts could easily be done by sedation nurses. There’s no reason a patient needs an anesthesiologist for cataract surgery while they can have a cardiac Cath or an IR procedure with a sedation nurse.

You didn't listen to the retrievals podcast, did you?

 

[nimbus]

You didn't listen to the retrievals podcast, did you?

No. Is that about diversion at the Yale fertility center?

Anybody can divert regardless of training background. AFAIK sedation nurses are no more likely to divert than anesthesiologists and CRNAs. Plenty of anesthesiologists and CRNAs have diverted. I personally knew an anesthesiologist who overdosed at work. He was found dead in a call room while supervising a resident in a liver transplant.

This is a more recent case.

https://www2.mbc.ca.gov/BreezePDL/document.aspx?path=%5CDIDOCS%5C20180409%5CDMRAAAGL1%5C&did=AAAGL180409203452403.DID

Drug Diversion in the Anesthesia Profession: How Can the Anesthesia Patient Safety Foundation Help Everyone Be Safe?

Reprinted with permission from the International Anesthesia Research Society. Meeting Report. DOI: 10.1213/ANE.0000000000003878. Anesthesia &

www.apsf.org

 

[pgg]

We will move toward an ACT model everywhere and some things will not involve us like conscious sedation for GI. It will be all about availability and new lesser standards than we are use to.

I've always thought GI to be one of the more dangerous places we provide sedation (actually general anesthesia).

Bunch of sick cirrhotic people with GI bleeds getting wheeled down from the ICU to get EGDs, obese pre-bariatric-workup OSA'ers on GLP1s getting their EGDs, and scopes being driven by gastroenterologists who are even further away from thinking like doctors than orthopods.

 

[kidthor]

Bunch of sick cirrhotic people with GI bleeds getting wheeled down from the ICU to get EGDs, obese pre-bariatric-workup OSA'ers on GLP1s getting their EGDs, and scopes being driven by gastroenterologists who are even further away from thinking like doctors than orthopods.

That, and then they argue with you about intubating the patients who clearly need it - and some of the GI docs know absolutely nothing about the patients aside from the fact that someone somewhere recommended a procedure.

 

[abolt18]

That, and then they argue with you about intubating the patients who clearly need it - and some of the GI docs know absolutely nothing about the patients aside from the fact that someone somewhere recommended a procedure.

GI docs I work with never push back when I decide to intubate (thankfully).

 

[gassyclimber]

“Of all active anesthesiologists, 56.9 percent are 55 or older, according to the Association of American Medical College's "2022 Physician Specialty Data Report."

The other factor we often ignore is how many Anesthesiologists under 55 have different priorities than the older generation. Work life balance is more important across all generations of physicians. FIRE and all its forms is more prevalent. Not only will there be more retirements straining the workforce, but quiet quitting and hour reductions are just as significant.

 

[Dr. Rude]

The other factor we often ignore is how many Anesthesiologists under 55 have different priorities than the older generation. Work life balance is more important across all generations of physicians. FIRE and all its forms is more prevalent. Not only will there be more retirements straining the workforce, but quiet quitting and hour reductions are just as significant.

Not so sure. We have lots of opportunities to pick up extra shifts for premium pay. Lots of the younger guys are all over this. People will work just as hard as before...if the dollars are there.

 

[makemoney2024]

In our area, we never did much GI work. >90% of cases are without anesthesia. With the exception of ERCPs I didn’t do a single GI case during residency and during my first 3 jobs. Also cataracts could easily be done by sedation nurses. There’s no reason a patient needs an anesthesiologist for cataract surgery while they can have a cardiac Cath or an IR procedure with a sedation nurse.

Totally agree. We are overused for money on this country and we are part of the $$ problem. Only thing I can say is these greedy GI docs need to have good healthy non morbidly obese patients at their outpatient surgery centers and not push propofol. I cant trust their or their nurses ventilation skills but the other drugs can be reversed. And do the sicker/larger patients in the hospitals.

 

[makemoney2024]

You didn't listen to the retrievals podcast, did you?

That was about diversion. Although I can’t figure out why it took five months to figure out the Fentanyl was tampered with. Maybe since it was discovered by one of us, we are more anal about the Fentanyl?
Of course I have pushed thousands of sticks handed to me by a CRNA so…. Really

 

[makemoney2024]

I've always thought GI to be one of the more dangerous places we provide sedation (actually general anesthesia).

Bunch of sick cirrhotic people with GI bleeds getting wheeled down from the ICU to get EGDs, obese pre-bariatric-workup OSA'ers on GLP1s getting their EGDs, and scopes being driven by gastroenterologists who are even further away from thinking like doctors than orthopods.

Why are they wheeling ICU GI bleeders to the GI suite instead of the suite coming to them? And you are right, it can be dangerous due to the tunnel vision and greed of the GI docs. If they cared more and picked the right patient population and didn’t push propofol things would be safer for patients for sure and we wouldn’t be needed.

 

[gassyclimber]

Not so sure. We have lots of opportunities to pick up extra shifts for premium pay. Lots of the younger guys are all over this. People will work just as hard as before...if the dollars are there.

If the dollars are there is the key. Once people get out from their mountains of student loan debt by paying it off or loan forgiveness, priorities change. I’m in my early-40s, there are more important things than making a buck. 75% of my department is burned out and trying to give up work and the secondary market is not rushing in. There’s not enough young hungry partners to go around. They’re already overworked as it is.

 

[pgg]

Why are they wheeling ICU GI bleeders to the GI suite instead of the suite coming to them? And you are right, it can be dangerous due to the tunnel vision and greed of the GI docs. If they cared more and picked the right patient population and didn’t push propofol things would be safer for patients for sure and we wouldn’t be needed.

Sometimes we do the cases in the ICU, if the patients are especially sick. For the most part, if the patient isn't unstable or on a ventilator, I do prefer they come to us in the GI suite. It's a little better (ergonomically) to do cases there, you don't have to haul a travel cart around, the GI docs are in their comfort zone.


If they cared more. Yeah.

Our GI group is such a moneygrubbing bunch of scope drivers that
1) They don't even see clinic any more - it's all NPs and PAs - so they can do 4+ days/week doing scopes.
2) They collectively quit doing ERCPs because they're inconvenient and unprofitable. Hospital had to go employ an outside GI doc to do them.

On Friday the GI doc I was with wanted me to go to the ICU to sedate this patient for an EGD: Admitted after massive hematemesis in the field, coded on the way to the hospital, intubated, on ventilator, possibly seizing, had received 12 mg of midazolam in the last hour, on 15 mcg/min of norepi. Admission Hb was 3.0 and had received 6 units of RBCs that morning, now Hb above 8. Completely unresponsive. Mass of electrodes on scalp for neurology evaluation.


It's funny. We give ortho good-natured crap for asking IM to manage their joint patients' mild chronic hypertension, but if there's a specialty that collectively has no interest in being medical doctors any more, it's GI.


I am going to disagree a little and say that the great majority of GI case should get propofol. It's a vastly superior patient experience to the old way of RN-administered midazolam and fentanyl. It just needs to be an anesthesiologist doing it.

 

[makemoney2024]

Sometimes we do the cases in the ICU, if the patients are especially sick. For the most part, if the patient isn't unstable or on a ventilator, I do prefer they come to us in the GI suite. It's a little better (ergonomically) to do cases there, you don't have to haul a travel cart around, the GI docs are in their comfort zone.


If they cared more. Yeah.

Our GI group is such a moneygrubbing bunch of scope drivers that
1) They don't even see clinic any more - it's all NPs and PAs - so they can do 4+ days/week doing scopes.
2) They collectively quit doing ERCPs because they're inconvenient and unprofitable. Hospital had to go employ an outside GI doc to do them.

On Friday the GI doc I was with wanted me to go to the ICU to sedate this patient for an EGD: Admitted after massive hematemesis in the field, coded on the way to the hospital, intubated, on ventilator, possibly seizing, had received 12 mg of midazolam in the last hour, on 15 mcg/min of norepi. Admission Hb was 3.0 and had received 6 units of RBCs that morning, now Hb above 8. Completely unresponsive. Mass of electrodes on scalp for neurology evaluation.


It's funny. We give ortho good-natured crap for asking IM to manage their joint patients' mild chronic hypertension, but if there's a specialty that collectively has no interest in being medical doctors any more, it's GI.


I am going to disagree a little and say that the great majority of GI case should get propofol. It's a vastly superior patient experience to the old way of RN-administered midazolam and fentanyl. It just needs to be an anesthesiologist doing it.

While I agree that propofol given by us is superior, there are just not enough of us and we are already stretched too thin. And the rest of the developed world does not do it the way we do it. I do have to admit that our patient population is quite wimpy though.

 

[woopedazz]

Sometimes we do the cases in the ICU, if the patients are especially sick. For the most part, if the patient isn't unstable or on a ventilator, I do prefer they come to us in the GI suite. It's a little better (ergonomically) to do cases there, you don't have to haul a travel cart around, the GI docs are in their comfort zone.


If they cared more. Yeah.

Our GI group is such a moneygrubbing bunch of scope drivers that
1) They don't even see clinic any more - it's all NPs and PAs - so they can do 4+ days/week doing scopes.
2) They collectively quit doing ERCPs because they're inconvenient and unprofitable. Hospital had to go employ an outside GI doc to do them.

On Friday the GI doc I was with wanted me to go to the ICU to sedate this patient for an EGD: Admitted after massive hematemesis in the field, coded on the way to the hospital, intubated, on ventilator, possibly seizing, had received 12 mg of midazolam in the last hour, on 15 mcg/min of norepi. Admission Hb was 3.0 and had received 6 units of RBCs that morning, now Hb above 8. Completely unresponsive. Mass of electrodes on scalp for neurology evaluation.


It's funny. We give ortho good-natured crap for asking IM to manage their joint patients' mild chronic hypertension, but if there's a specialty that collectively has no interest in being medical doctors any more, it's GI.


I am going to disagree a little and say that the great majority of GI case should get propofol. It's a vastly superior patient experience to the old way of RN-administered midazolam and fentanyl. It just needs to be an anesthesiologist doing it.

Couldn't agree more re: GI being the worst of the worst. It's like explaining medicine to a layman off the street. The 3/4 dead patient occasionally has more common sense.

 

[nimbus]

On Friday the GI doc I was with wanted me to go to the ICU to sedate this patient for an EGD: Admitted after massive hematemesis in the field, coded on the way to the hospital, intubated, on ventilator, possibly seizing, had received 12 mg of midazolam in the last hour, on 15 mcg/min of norepi. Admission Hb was 3.0 and had received 6 units of RBCs that morning, now Hb above 8. Completely unresponsive. Mass of electrodes on scalp for neurology evaluation.

If they had 12 of midaz in an hour, are already on a vent, and need an EEG to tell if they are alive or dead, why did they need you? Corpses don’t need sedation even though this one already had a lot of sedation.

 

[psychbender]

If they had 12 of midaz in an hour, are already on a vent, and need an EEG to tell if they are alive or dead, why did they need you? Corpses don’t need sedation even though this one already had a lot of sedation.

I have been really surprised with the amount of midaz some of these chronic alcoholics in withdrawal can get, and still be awake and talking, with the ICU MINDS protocol. I've had numerous getting repeat 5-10mg boluses, then started on infusions titrated up to 20mg/hr, and they're still twitchy and telling me to **** off. For this particular patient, I think the EEG was to look for evidence of seizure, not to see if they were dead.

Regardless, I completely agree that we are not necessary for a sedated, intubated patient in the unit, and yet some of our GIs request us, because they don't feel that the unit nurses respond to changes in clinical status rapidly enough. We still, as a department, tell them no, however, when it comes to such patients.