Update on the state of the anatomy educator shortage.

Abstract

Anatomy education is a cornerstone of health professions education. With the expansive growth of graduate and health professions programs, increased student enrollments, and the advancement of new medical techniques and technologies, the demand for anatomy education is robust. At the time of this editorial, within the United States (U.S.) and Puerto Rico there were 330 masters level nursing programs ((AACN) AAoCoN, n.d.), 329 speech-language pathology programs (CAA, n.d.), 300 physician assistant programs (ARC-PA, n.d.), 300 physical therapy programs (CAPTE, n.d.), 248 occupational therapy programs (ACOTE, n.d.), 198 osteopathic and allopathic medicine programs (LCME, n.d.; Association AO, n.d.), 70 dental medicine programs (CODA, n.d.), and 32 veterinary medicine programs (Association AVM, n.d.). Anatomy curricula, in some form, are common among these most popular health professions programs. However, with a limited supply of anatomy educators entering the workforce (Wilson et al., 2020, 2021; Edwards et al., 2022), hiring well-qualified individuals to teach the anatomical sciences is presently a challenge. The identified supply and demand mismatch has brought anatomy job market trends into the limelight and raises the question, “Are we, as a profession, equipped to meet the current and future needs of the health education market?” The anatomy educator shortage was first reported in 1961 when Eldred and Eldred observed an imbalance in teaching faculty as the number of medical schools expanded (Eldred & Eldred, 1961). In 2002, 41 years later, a national survey found that more than 80% of chairpersons anticipated difficulty in recruiting and hiring qualified anatomy educators (Holden, 2003). More recent reports, as of 2020, have explored the anatomy educator shortage from a variety of viewpoints including chairperson perspectives (Wilson et al., 2020), American Association for Anatomy (AAA) annual job posting outcomes (Wilson et al., 2020), National Science Foundation (NSF) outcomes from the Survey of Earned Doctorates (Wilson et al., 2021), and AAA membership retirement intentions (Edwards et al., 2022). Collectively, this information points to a continued and widening shortage of anatomy educators. Over the past seven years, from 2016 to 2022, AAA job postings for anatomy educators have increased by 60% at an average rate of six additional postings per year (Figure 1; R2 = 0.56). In 2022, the AAA job board hosted 128 openings for anatomy educator positions across US and Canadian medical, health professions, and undergraduate institutions (Figure 1). These 128 postings for anatomy educator positions were collated from a larger list of 184 AAA job postings. Duplicate postings were defined as postings for the same position, at the same institution, that were posted over multiple sequential time periods throughout the course of the year. Duplicate postings and positions for postdoctoral trainees, chairpersons, administrators, basic science researchers, clinical positions, or adjunct/part-time faculty were excluded from the analysis. Fewer job postings in 2020 were likely a direct consequence of the COVID-19 pandemic (Edwards et al., 2022). The proportion of schools that have posted job openings consecutively from one year to the next has remained relatively constant over time and has not exceeded 25% of the total number of postings (Figure 2). As such, most job postings each year represented new/unique openings. The job advertisements posted across consecutive years predominately represented postings that first opened late in the calendar year (e.g., November) and lingered as unfilled positions into the next calendar year. Limited information in the AAA dataset prevented clear delineation between new versus lingering unfilled positions across consecutive years. Changes to the AAA job posting intake form are needed to yield a richer and more precise dataset. Additionally, a separate future analysis is needed to discern why certain schools take longer to fill their open positions than others, a possible byproduct of geographic characteristics, institutional factors, and the selectivity of searching anatomists (i.e., it is currently an employee's market). Based on job postings alone, the current market suggests a positive outlook for the future of the anatomy education job market. Previously, Wilson et al. reported a 5-year forecast, through 2025, regarding the number of PhD graduates expected to enter the workforce based on NSF data and the number of graduates that would be needed for the profession to reestablish a state of homeostasis (i.e., an equilibrium in the supply versus demand) (Wilson et al., 2021). Since this report, the number of PhD graduates reported by 62% (13 of 21) of active anatomy PhD programs has closely mirrored the projected estimate of 22 graduates per year (Figure 3). While 2023 is anticipated to yield at least 30 PhD anatomy graduates, these numbers (from 2020 to 2023; Figure 3) still fall short of the forecasted need of 40 to 51 graduates per year, through 2025. These forecasts did not account for faculty retirements, which now are estimated at approximately 40 per year, through at least 2026 (Edwards et al., 2022). Although job posting increases suggest a positive outlook for the profession, the trickling pipeline of anatomy PhD graduates entering the workforce is barely able to keep pace with faculty retirements, let alone fill the needs of new and expanding programs (Edwards et al., 2022). According to the NSF's Survey of Earned Doctorates dataset, over a three-year period, from 2019 to 2021, 20 different schools graduated at least one individual with a PhD in anatomy. The additional need to staff new programs, and existing programs with increased enrollments, will inevitably place further strain on the anatomy educator shortage. These outcomes suggest that within the foreseeable future, unless deliberate actions are taken and sustainable streams of financial support are identified, the supply of PhD-trained anatomists will continue to trail behind the growing health professions' demand for anatomy education. Without an adequate supply of anatomy educators, departments may come to rely more heavily on retirees, masters-trained individuals, and/or faculty from other related disciplines, which has the potential to increase demands for additional professional development (Wilson et al., 2018). While similar supply and demand misalignments may be occurring internationally, this dataset cannot be generalized to health education markets in other countries. The outcomes reported herein relied solely on the AAA job board. These numbers may be underestimates of the job market demand as they may not fully capture open positions posted through other sources. Future investigations that include data from additional job boards (e.g., American Association of Clinical Anatomists (AACA), Human Anatomy and Physiology Society (HAPS)) are needed to ensure a more comprehensive assessment of the anatomy education job market. Continued annual monitoring of the anatomy educator job market is necessary for identifying gaps and recognizing areas for improvement. However, simply tracking numbers without strategically developing and implementing a solution to reverse the shortage is not enough. To use an analogy, we must not allow a “threatened” species to become “endangered” without considering a need for intervention. To make a concerted effort to reverse the anatomy educator shortage will require input, cooperation, and coordination between anatomy PhD programs, departments, and professional associations. Instead of merely pontificating about the anatomy educator shortage, we must actively work to devise practical solutions to help turn the tide. Remaining idle at this critical juncture and failing to capitalize on our profession's unique growth opportunity will only result in stagnation within our community and perhaps a further loss of identity among anatomists. The authors would like to thank Liz Phares for providing the American Association for Anatomy Job Board data used in this manuscript.