The Shortage of Anesthesiologists—and Other Medical Specialists

Abstract

To the Editor: The article on the shortfall in anesthesia care providers raised many unanswered questions for other specialists, including internists and surgeons, most importantly how to implement an effective national system that addresses the number of specialists required to provide optimal health care.1Schubert A Eckhout G Cooperider T Kuhel A Evidence of a current and lasting national anesthesia personnel shortfall: scope and implications.Mayo Clin Proc. 2001; 76: 995-1010Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar In contrast to the oversimplified approach highlighted by Schubert et al,1Schubert A Eckhout G Cooperider T Kuhel A Evidence of a current and lasting national anesthesia personnel shortfall: scope and implications.Mayo Clin Proc. 2001; 76: 995-1010Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar which was based on a single snapshot analysis of data driven by incomplete economic analysis, we propose the establishment of a series of standing interdisciplinary committees to reevaluate specialty training needs on an ongoing basis. Specifically, we recommend a core group of statisticians, health economists, legislators, regulators, and insurers be established and funded to serve as a permanent oversight committee. This committee would convene on a regular basis with academic and community physician representatives from individual specialties (eg, internal medicine, anesthesiology, or surgery) and subspecialty groups (eg, gastroenterology, critical care, or urology). Together, they would be charged with identifying supply/demand economic factors that have an impact on specialty personnel needs such as reimbursement, cost of training, and insurer and governmental expenditures. The group would establish criteria to address manpower requirements from a broader, more rational, and more realistic perspective. These experts would meet to reevaluate and redefine their recommendations based on the rapid and continuous changes taking place in our health systems environment. Demand for physician services is ever increasing with our growing and aging population. The need is not specialty specific. With ever-expanding pharmaceutical and technologic innovation and expenses, the delivery of care by a specific specialty becomes a dynamic process, such as the shift in demand for a specific specialty created by interventional cardiology vs cardiac surgery. The supply side of physician manpower availability necessitates a preemptive and ongoing perspective to allow compensation for the time required to train additional specialists to meet a specific patient demand.2Pingleton SK Committee on Manpower of Pulmonary and Critical Care Societies: a report to membership.Chest. 2001; 120: 327-328Crossref PubMed Scopus (6) Google Scholar, 3The Leapfrog Group Available at: www.leapfroggroup.org/purchase1.htmGoogle Scholar In addition, if reimbursement issues are not addressed, specific care providers will not be available. Various specialties, most recently critical care medicine, have been directly affected by the absence of comprehensive reimbursement despite a demonstrated need and benefit. Meanwhile, the fear of inadequate reimbursement by Medicare for physician services has altered generalist and specialist physician training and may continue to impact this dramatically in the future. We need to look no further than the current Medicare reimbursement proposals that call for an overall 5.4% cut in physician payments to see hard evidence of factors that will directly affect physician numbers, specialization, and training.4Grassroots Action Center Congress fails to fix Medicare physician cut.Available at: capwiz.com/ama/issues/alert/?alertid=26171&type=COGoogle Scholar If we fail to address physician manpower needs, do not provide appropriate and attractive training and practice opportunities, and allow reimbursement to be inequitable or inadequate, future quality American practitioners may follow more appealing paths into nonmedical fields. Such a scenario presents a lose-lose situation for clinicians, patients, and society. The Shortage of Anesthesiologists—and Other Medical Specialists: In ResponseMayo Clinic ProceedingsVol. 77Issue 2PreviewWe appreciate the thoughtful letter by Drs Coursin and Vender regarding our article. We agree that personnel fluctuations need to be minimized. The issue is how to accomplish such a complex and never-ending objective. A comprehensive approach across all medical specialties may be too cumbersome to establish and fund de novo. As Coursin and Vender point out, changes in the health care sector occur rapidly. In addition, personnel supply considerations differ across specialties. For example, surgical specialties control training positions more tightly than does anesthesiology. Full-Text PDF The Shortage of Anesthesiologists—and Other Medical SpecialistsMayo Clinic ProceedingsVol. 77Issue 2PreviewIn reply: The recommendations to form an interdisciplinary group to provide advice and/or oversight regarding physician manpower requirements and availability are logical at first glance. The concept that physician availability is not just a “medical profession” problem but clearly a major societal issue is obviously appropriate. Therefore, a committee to represent the intellectual and pragmatic framework of physician availability is an excellent recommendation. Full-Text PDF