By Kevin K. Tremper, Ph.D., M.D.
The past year there has been a dramatic change in the number of U.S. medical students applying for training in Anesthesiology. On a national basis there were in the range of 1,500 applicants two years ago and there may be as few as 250 for the February 1996 match. This dramatic shift has been due to the perception that there are no positions available in our field resulting from an overproduction of trainees and a speculated reduction in the number of procedures due to the rapid expansion of managed care. In Michigan we had 25 senior students match in anesthesiology two years ago and are probably going to have 2 this year. It is clear that medical students are extremely vulnerable to concerns about employment. They are graduating with debts as large as many of us had as home mortgages. Although I do agree there are too many specialists in general being trained and most likely too many physicians altogether, I do not really agree that anesthesiology can survive as a specialty with only 200-250 graduates per year. Personally I feel that there will be a great deal of work to do over the next 20 years because the post-war baby boom generation will be entering the medicare generation (I being one of those) who will require and demand health care. I therefore feel there will be a gradual increase in the number of procedures over the next 20 years even with the pressures of managed care. I think it would be unfortunate if we as a specialty were unable to fulfill the needs with well-trained physicians.
The Chairs of the training programs meet every fall to discuss issues and this fall “Managing the Change” was the major topic. All residency programs are reducing their classes and many programs are going out of existence altogether. The American Board of Anesthesiologists has worked through the ACGME to tighten the minimum standards for our residency training program. These new regulations go into effect in 1996 and will put more pressure on reducing class sizes. Our program is no exception for we are currently phasing in a 25% reduction in class size and may anticipate further reductions over the next few years. Ironically with the reduction in resident trainees, academic programs will require more faculty to provide service. This will in itself improve the job market for the next two years by creating at least 500 positions. Our concern is the reverse problem. As the “pendulum” swings back we may find ourselves in a few years with an inadequate supply of trained anesthesiologists similar to the 1970s.
In spite of this real and perceived jobs problem, Michigan graduates were extremely fortunate last year and are doing well this year with respect to job opportunities. As I stated in a previous Airway issue many of these opportunities were provided by our alumni. We only hope to be able to continue to train sufficient numbers of top quality practitioners to meet the needs of our patients. Medical students should choose a specialty on the basis of their interests and talents primarily. It would be very unfortunate to spend most of one’s healthy years training for a specialty that one does not enjoy practicing. Anesthesiology in the future, as in the past, is an extremely exciting, enjoyable, and rewarding field.