Anesthesia practitioners include anesthesiologists, certified registered nurse anesthetists, and anesthesia assistants. These providers often work together in teams to deliver perioperative care. Healthcare practices and facilities have flexibility in determining how they want to deploy anesthesia services including the structure of care team models. Most anesthesia providers are either physician anesthesiologists or CRNAs. Approximately 48.3% of all anesthesia providers are anesthesiologists, while 49.6% are CRNAs. The anesthesia workforce currently faces regional variation, growing concerns about provider shortages, a greater influx of women into the workforce, and an increasing utilization of non-physician providers. When examining these recent workforce trends, influential factors to consider include an aging population, cost containment efforts in health care, and changes in structure to the healthcare system.
As physician shortages continue, the number of anesthesiologists continues to dwindle. There is currently a global shortage in the surgical and anesthesia workforce, according to a WFSA global workforce survey, and multiple studies on the anesthesia labor market in the U.S. have made predictions that the trend of shortages in the workforce will continue. Specifically, a report by RAND projected a persistent shortage from 2017 through at least 2025 [4]. Today, the workforce is influenced by substantial shifts in demand resulting from an aging U.S. population and the growing number of retiring baby boomers. Both factors increase the demand for healthcare services, including anesthesiology and perioperative care. These demographic changes also have the potential to increase the shortage of anesthesia providers. The impending retirement of the aging anesthesia provider population is an additional aggravator, as many older, predominantly male anesthesiologists are retiring [1]. A study evaluating anesthesia workforce trends with a focus on regional and gender variations documented a rapid movement of women into the workforce, which is expected to continue as these older providers retire. This research additionally illustrated a recent shift to younger anesthesiologists in the U.S. workforce [1].
Because of regional differences, not all trends are uniform nationwide. Anesthesiologists in the western half of the country are less likely to work with CRNAs in a care team model. However, the utilization of CRNA services is increasing in this part of the country [2]. Restructuring the anesthesia workforce to reduce total personnel costs for anesthesia care is a continuing trend, and two cost saving strategies include either increasing procedures performed by CRNAs or increasing the proportion of procedures under a care team model [5]. Since altering the anesthesia workforce in favor of using CRNAs has been found to be incredibly cost efficient, the number of non-physician anesthesia providers is growing [1]. Team-based anesthesia delivery models are also becoming increasingly common. The rising trend of bundled payments and value-based care in today’s healthcare system necessitates an increase in team-based anesthesia delivery, and these models increase collaboration among anesthesia providers. The workforce today is now not only experiencing an expansion of collaborative anesthesia models but also CRNA-only services, as research continues to support their safety record and ability to provide cost-effective, quality anesthesia care. Understanding these trends in today’s anesthesia workforce will require looking at the drivers that affect it, specifically changes in demography and the healthcare sector.
SOURCES
[1] http://anesthesiology.pubs.asahq.org/article.aspx?articleid=2442988
[2] 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
[3] https://www.ncbi.nlm.nih.gov/pubmed/28753173
[4] https://www.rand.org/content/dam/rand/pubs/research_reports/RR600/RR650/RAND_RR650.pdf
[5] http://www.lewin.com/content/dam/Lewin/Resources/AANA-CEA-May2016.pdf