Research Brief
Key Findings
- The United States is experiencing a shortage of anesthesiology providers, including both Anesthesiologists (ANs) and Certified Registered Nurse Anesthetists (CRNAs).
- Projections of current trends suggest that, by 2020, the shortage of ANs will persist, but under a reasonable set of assumptions there will be a surplus of CRNAs.
- Labor markets for anesthesia specialists showed substantial variation across regions and across states within a region, suggesting that state-level approaches to addressing shortages may be the most promising options.
Anesthesia is an important medical specialty provided by highly skilled professionals: Anesthesiologists (ANs) and Certified Registered Nurse Anesthetists (CRNAs). ANs are physicians trained to deliver anesthesia and certified by professional boards to manage complicated medical and surgical situations. CRNAs are licensed professionals who have master's degrees and training to participate in anesthesia delivery. There are approximately 40,000 ANs and 39,000 CRNAs and student CRNAs practicing in the United States. In most states, CRNAs must work under a physician's supervision, although 15 states now have opted out of this requirement. In general, these two professional groups provide complementary services, though there is continuing debate over the appropriate division of labor between them.
However, overshadowing this debate has been growing concern over whether the United States is facing a shortage of anesthesia providers. Anecdotal evidence suggests that such a shortage exists. If true, this could limit access to high-quality care, especially in light of growing demand for surgical and interventional procedures for an aging population. Understanding current and future demand and supply for anesthesia services is therefore critical for policymakers, regulators, and professional bodies, because markets for highly specialized medical services are difficult to balance. Limits on the number of training positions, regulation of permission to practice, and a limited capacity for wages to respond to market conditions can all lead to national or local surpluses or shortages in the absence of proper workforce planning.
NOTE: The positive percentage for CRNAs in the West indicates a surplus; the other, negative percentages indicate shortages
To inform such planning decisions, a team from RAND Health examined anesthesia labor markets in the United States. The study addressed two main questions:
- Is there a shortage or surplus of anesthesia specialists?
- What are the demographic patterns, employment arrangements, usages of time across different types of procedures, and working patterns present in the AN and CRNA labor markets?
To address these questions, the team first conducted a national survey of ANs, CRNAs, and hospital anesthesiology directors to gather data on work practices, wages, time usage, and procedure volumes for the year 2007. Next, the team used an econometric model that drew data from these surveys and incorporated state-level variables (such as the percentage of the population over age 65, health maintenance organization [HMO] penetration, and capacity of medical facilities) to estimate the supply of and demand for AN and CRNA services. This approach can be used to calculate both national- and state-level shortages or surpluses. The results from this approach are presented in the next section.
NOTE: The positive percentage for CRNAs in the West indicates a surplus; the other, negative percentages indicate shortages
Results
There are Shortages of ANs and CRNAs Nationwide
The researchers estimated that, as of 2007, there was a nationwide shortage of 3,800 ANs and 1,282 CRNAs, or 9.6 percent and 3.8 percent of the total anesthesiology-provider workforce, respectively.
- Shortages of ANs were spread evenly across all regions of the United States. Shortages of CRNAs were particularly acute in the Northeast, while some states in the West showed surpluses (see Figure 1).
- There was considerable variation across states. Just over half (54 percent) of states were experiencing shortages of ANs, and about 60 percent of states a shortage of CRNAs (see Figure 2).
- While labor-market patterns varied when examined by region, variation by state was even more pronounced. For example, Delaware had a surplus of ANs, while New York, in the same region, had a 28-percent shortage of CRNAs. Nevada had a 53-percent surplus of CRNAs, while Idaho, in the same region, had a 46-percent shortage of ANs.
| Indicator | ANs | CRNAs |
|---|---|---|
| Average age | 49 years | 49 years |
| Average experience | 16 years | 17 years |
| Urban location | 95% | 44% |
| Average annual income | $337,551 | $151,380 |
| Average clinical workweek | 49 hours | 37 hours |
| Time in MAC | 16% | 25% |
Shortages Will Persist Until 2020 in Some Scenarios
The team also estimated future trends in anesthesiology labor markets, using different scenarios for changes in supply and demand. These scenarios assumed that current trends would continue; the analysis did not consider possible sudden changes in the demand for or supply of anesthesia providers. Baseline scenarios (which assumed balanced labor markets initially, a 1.6-percent annual increase in demand for both groups, a 0.67-percent net annual increase in the supply of ANs, and a 3-percent net annual increase in the supply of CRNAs) showed a projected shortage of 4,479 ANs by 2020 and a surplus of 7,970 CRNAs. However, under some other scenarios, the situations were reversed for each group. For instance, an entry rate into the AN profession exceeding 2.76 percent will cause a surplus, and an annual growth in demand exceeding 3 percent will cause a shortage of CRNAs.
Patterns of Work For Each Profession Differed Markedly
ANs worked more hours per week and made about twice as much annually as CRNAs (see table). ANs spent a greater percentage of their time on general anesthesia, while CRNAs spent more time than ANs on monitored anesthesia care (MAC, in which a patient is sedated but remains responsive). ANs were much more likely than CRNAs to work in urban locations (95 percent versus 44 percent, respectively).
Implications for Policy
The study's key finding is that the United States is currently experiencing a shortage of both ANs and CRNAs, although this varies across regions and states. Under most scenarios, there will be a shortage of ANs but a surplus of CRNAs by 2020. These results have important implications for workforce planning. Residency positions for ANs and certifications for CRNAs that are controlled by professional decisionmaking bodies could be increased in the case of shortages (such as the ones found nationally). Moreover, since labor markets are heterogeneous, planning issues would have to be addressed at the state level.
Related Content
Report
An Analysis of the Labor Markets for Anesthesiology
Mar 9, 2010
This report is part of the RAND research brief series. RAND research briefs present policy-oriented summaries of individual published, peer-reviewed documents or of a body of published work.
This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited; linking directly to this product page is encouraged. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial purposes. For information on reprint and reuse permissions, please visit www.rand.org/pubs/permissions.
RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.
