Breaking down the anesthesia workforce imbalance, strategies to address crisis

Editor's Note

Increased demand for anesthesia services, especially in non-operating room (non-OR) sites, has outpaced the growth of anesthesia clinicians, a June 2024 special article published by the journal Anesthesiology reports. The imbalance in the anesthesia workforce supply and demand, the article argues, was exacerbated by the COVID-19 pandemic and has led to compromised healthcare facilities, increased costs, clinician burnout, disrupted schedules, and challenges in academic missions.

According to the authors, between 2018 and 2023, the anesthesia workforce grew by approximately 18%, whereas surgical specialists increased by only 3%, and specialists associated with non-OR procedures grew by 26%. By 2023, the percentage of facilities reporting an anesthesia staffing shortage had more than doubled to 78% from 35% before the pandemic. As of December 2023, there were an estimated 138,000 anesthesia providers in the US, including about 43,500 anesthesiologists, 50,000 nurse anesthetists, and 3,200 anesthesiologist assistants. In 2023, approximately 5,200 new anesthesia professionals entered the workforce, while nearly 4,800 left, resulting in a net increase. Despite this, the increasing demand for procedures and the medical complexity of patients continue to strain resources.

Several factors contribute to the workforce imbalance and heighten the demand for anesthesia services:

• Aging population: there were more than 58 million Americans aged 65 or older in 2023 demanding more surgeries and procedures
• Outpatient trends: the shift of procedures from hospitals to outpatient settings and physician’s offices, along with the rise of minimally and non-invasive procedures
• Generational changes: newer generations in the workforce, such as Generation Y and Z, prioritize work-life balance, reducing the total clinical capacity as they work fewer hours compared to their predecessors.

The labor shortage in anesthesia has led to several adverse outcomes, notes the article, including:

• Increased job postings and compensation to attract clinicians
• Higher work hours and increased burnout among existing staff
• Greater reliance on contract and temporary workers, leading to inconsistencies in care
• Disruptions in surgical and procedural schedules, impacting patient care and hospital operations.

Addressing the anesthesia workforce imbalance requires a multifaceted approach, pose the authors. Proposed short-term solutions include:

• Increase staffing ratios: optimize supervision ratios and improve scheduling efficiency.
• Moderate sedation programs: utilize trained sedation teams for non-anesthesia required procedures.
• Leverage technology: automate low-value tasks and use clinical decision support systems to enhance supervision and efficiency.

Long-term solutions include:

• Increase training positions: expand residency programs and create new academic partnerships.
• Retention policies: address workplace environment issues like burnout and provide flexible scheduling.
• Innovative practice models: develop risk-based models for physician supervision and integrate technology effectively.
• Financial reforms: adjust Medicare payments and develop new payment mechanisms for sedation services.

The anesthesia workforce imbalance is a significant healthcare crisis with wide-reaching implications, concludes the article. Collaboration between anesthesiologists, administrators, and policymakers is essential to create sustainable solutions and ensure the continued delivery of high-quality anesthesia care.