In the United States healthcare space, there is often dialogue presented regarding the projected shortage of physicians throughout the country in the coming years. Although medical school admissions remain as competitive as ever, with over 50,000 applicants to the American Medical College Application Service this past year, students filter into a relatively tiny number of medical schools and are dispersed unequally across the states for residency training, and eventually permanent medical practice1. It is often cited that primary care physicians, such as internal medicine, family medicine, and pediatric medicine clinicians, are in a reported shortage in underserved areas of the U.S., such as rural areas. However, recent analyses have suggested that highly specialized physicians are similarly in shortage in rural areas, with an emphasis on anesthesiologists.
As strongholds in the perioperative care cycle, anesthesiologists are necessary and indispensable for a majority of surgical and medical procedures. In 2010, the prestigious non-profit organization RAND Corporation published a study that predicted a shortage of between 4,500 and 12,000 anesthesiologists nationwide by 20202. Given that highly specialized physicians tend to match and practice in urban areas, this creates a significant concern for rural clinics and hospitals, which also must provide surgical care for large populations. In line with these predictions, the American Association of Medical Colleges (AAMC) recently concluded a multi-sector, macroanalysis of physician supply and demand from 2017 to 20323. Anesthesiologists were included among others as specialists that will see a significant demand, combined with a shortage of licensed providers, in the coming years.
In considering this large question of ensuring that all forms of complex healthcare are delivered to all populations, there are several solutions at-hand. To commence, anesthesiologists and anesthesiologists-in-training must be encouraged to apply widely when it comes to residency and consider multiple options for permanent practice. Programs such as the National Health Service Corps provide such a program4. Moreover, general anesthesiologists that are working in rural hospitals with little access to sub-specialty anesthesiologists may consider pursuing mechanisms to meet population health needs in the interim. For example, a recent study focused on anesthesiologists at a rural community hospital in North Carolina concluded that general trained anesthesiologists were effective in acquiring skills regarding regional anesthetic blocks for specific orthopedic procedures, including ultrasound and peripheral nerve stimulation5. Formal and informal programs in rural hospitals have thus met the need so far, while larger structural changes can initiate an increase, and even distribution, of specialists across the U.S.
The United States remains a leader in the field of healthcare, particularly in perioperative and surgical care more broadly. It is essential that all regions of the country can access the care they need, and rural shortages of physicians are a priority for thought leaders and policy makers in healthcare. Tailored research, combined with in-depth interventions and advocacy, will together build an approach to ensure that high-quality surgical and anesthesia care may be accessed by all.
1. AMCAS. “Applicants and Matriculants Data – FACTS: Applicants, Matriculants, Enrollment, Graduates, MD/PhD, and Residency Applicants Data – Data and Analysis – AAMC.” Association of American Medical Colleges, 2019, www.aamc.org/data/facts/applicantmatriculant/.
2. Daugherty, et al. “United States Faces a Shortage of Anesthesia Providers.” RAND Corporation, 7 July 2010, www.rand.org/pubs/research_briefs/RB9541.html.
3. AMCAS. “The 2019 Update: The Complexities of Physician Supply and Demand: Projections from 2017 to 2032.” Association of American Medical Colleges, Data and Reports – Workforce – Data and Analysis – AAMC, 2019, www.aamc.org/data/workforce/reports.
4. “National Health Service Corps.” HRSA Bureau of Health Workforce, 23 May 2019, bhw.hrsa.gov/loans scholarships/nhsc.
5. Bryan, Yvon F. “The Successful Use of Different Regional Anesthetic Blocks for Total Knee Arthroplasty by General Anesthesiologists in A Rural Community Hospital.” Abstract A1142, American Society of Anesthesiologists, 13 Oct. 2018, www.asaabstracts.com/strands/asaabstracts/abstract.htm?year=2018&index=18&absnum=4418.