There is considerable flexibility in decisions made by healthcare facilities concerning anesthesia services, specifically with respect to the employment of physician anesthesiologists and the use of non-physician anesthesia providers. While there are a variety of providers involved with the delivery of anesthesia care, as well as diversity among anesthesia delivery models, anesthesiologists and certified registered nurse anesthetists (CRNAs) are the primary anesthesia provider types. Non-physician providers are increasingly being utilized in today’s anesthesia workforce, and there is a growing influx of women and younger providers into the workforce. Concerns about a provider shortage are also escalating, and regional differences exist throughout the workforce. Understanding these recent trends necessitates examining changes in demography and today’s healthcare sector, specifically in the aging population, the rise of value-based care, and new provider models.
Current demographic changes are influencing the anesthesia workforce and causing shifts in demand, as the growing number of baby boomers retiring as well as an aging U.S. population are causing an increase in the demand for healthcare services, including anesthesia and perioperative care. Additionally, many older, predominantly male anesthesiologists are retiring. There is an influx of younger anesthesiologists, including an increasing number of women, into the field. This trend is expected to continue as older providers retire [1]. The overall number of anesthesia providers continues to shrink, however. These demographic trends, including the retiring physician population, may increase the shortage of anesthesia providers. Studies on the anesthesia labor market in the U.S. have predicted that the shortage will continue to grow through at least 2025 [2]. This trend is not unique to the U.S., however, as there is currently a global shortage in the surgical and anesthesia workforce leaving five billion people around the world without access to safe, affordable anesthesia and surgical care, according to a WFSA global workforce survey [3].
As concerns about the cost of health care and the physician shortage persist, restructuring the anesthesia workforce to reduce the total personnel costs for anesthesia care is another continuing trend. Restructuring the anesthesia workforce in favor of utilizing more CRNAs has been found to be cost efficient. Increasing the number of anesthetics delivered by CRNAs or the proportion of cases performed under a care team model are two potential cost saving strategies [4]. The use of non-physician anesthesia providers is growing, as are team-based anesthesia delivery models. This shift towards collaborative anesthesia models is in part the result of the current trend in today’s healthcare system of bundled and value-based care. As the team-based approach and CRNA-only services continue to expand, and as more women and younger providers enter the workforce, it is important to understand these recent trends and their potential impact on future workforce dynamics.
SOURCES
[1] http://anesthesiology.pubs.asahq.org/article.aspx?articleid=2442988 [2] https://www.rand.org/content/dam/rand/pubs/research_reports/RR600/RR650/RAND_RR650.pdf [3] https://www.ncbi.nlm.nih.gov/pubmed/28753173 [4] http://www.lewin.com/content/dam/Lewin/Resources/AANA-CEA-May2016.pdf [5] https://www.aana.com/docs/default-source/aana-journal-web-documents-1/anesthesia-medicare-trend-analysis-shows-increased-utilization-of-crna-services-october-2017.pdf?sfvrsn=ab2d45b1_4